Integrating Scientific Concerns on Antibody-Dependent Enhancement and Cross-Reactive Immunity with Cultural Contexts: A “Better Safe than Sorry” Model for Public Acceptance of Vaccination

The COVID-19 pandemic has underscored the crucial importance of vaccination; however, public acceptance in Malaysia is influenced not only by access and trust but also by cultural, religious, and scientific considerations. In the Klang Valley, a highly urbanised and demographically diverse region, vaccine uptake has been relatively high. Nonetheless, scepticism remains, particularly regarding complex immunological issues such as antibody-dependent enhancement (ADE) and cross-reactive immunity. This study seeks to inform the development of a comprehensive public acceptance model for immunisation by integrating expert insights into these scientific concerns, along with socio-cultural and religious contexts. A focus group discussion (FGD) was conducted involving nine experts in public health, immunology, and vaccine policy. The transcribed data were analyzed using Reflexive Thematic Analysis, leading to the emergence of four key themes: (1) Disentangling religious, cultural, and traditional constructs; (2) Distinguishing awareness from knowledge of scientific risks; (3) Practical applicability for public health communication and policy; and (4) Model adaptability, including potential applications for other vaccines such as HPV and dengue. This study uniquely combines the Arham Model with the Health Belief Model (HBM) to create a culturally grounded framework that acknowledges both the behavioural and immunological dimensions of vaccine acceptance. By emphasising the significance of science communication, sociocultural sensitivity, and theoretical integration, this work contributes a novel, adaptable model for guiding immunisation strategies in Malaysia, offering insights that are relevant to broader global contexts.