[Vaccine rejection and vaccination management: the grey areasRecusa vacinal e gestão da imunização: nuances e contrastes].

Vaccinating children has been an unquestioned tradition for many years. However, there is now great concern over the growing rejection of childhood vaccination, as well as other less evident obstacles that affect vaccination coverage.Multiple factors are involved in the rejection of a specific vaccine or vaccination in general, including actions by anti-vaccination groups, as well as disinformation or the dissemination of erroneous information. In some countries, delays in completing the immunization schedule may be due to poor program management. These factors compromise effective vaccination coverage, constituting a serious threat to public health.Susceptible populations constantly change, due to epidemiological shifts determined by phenomena such as globalization and various conflicts that interfere in the operation of health services. In recent years there have been outbreaks of previously controlled diseases such as diphtheria, whooping cough, and measles, resulting both from imported cases and from deficiencies in national immunization programs.This paper explores different aspects of the increasing frequency of vaccine rejection. There is a need for a review of its causes and for the design of innovative strategies and approaches to regain acceptance of vaccination and its place as the most cost-effective tool in public health.