Social inequalities in COVID-19 vaccine acceptance and uptake for children and adolescents in Montreal, Canada

COVID-19 vaccine acceptance and uptake among caregivers of children aged 5-11 years in Ontario, Canada: A cross-sectional survey

INTRODUCTION

Although COVID-19 vaccine safety in 5-11-year-old children has been documented, half of Ontarian children this age remain unvaccinated. This study aimed to assess caregivers' vaccine acceptance for 5-11-year-old children and identify factors associated with vaccine non-acceptance.

METHODS

A multi-language self-administered survey was sent to caregivers of 5-11-year-old children through schools and community health centers within the Greater Toronto Area from April-July 2022. Sociodemographic characteristics and immunization behaviours were collected for caregivers, their 5-11-year-old children, and any older siblings. The primary outcome, COVID-19 vaccine acceptance, was previous uptake of COVID-19 vaccine or caregiver intent to vaccinate for their 5-11-year-old child. Data were analyzed using descriptive statistics and multivariable logistic regression.

RESULTS

In total, 807 caregivers were included in analysis. Although 93 % of caregivers had received two doses of COVID-19 vaccine, 77 % had a 5-11-year-old child who received at least one dose of vaccine. Caregivers age was associated with vaccine acceptance (vs. < 40 years; adjusted odds ratio [aOR] 2.1, 95 % confidence interval [CI] 1.4-3.1 for ages 40-49; aOR 2.8, 95 % CI 1.1-7.1 for ages ≥50 years). Immunization factors associated with vaccine acceptance included caregiver COVID-19 vaccination (aOR 38.1 vs. unvaccinated caregivers; 95 % CI 15.8-92.3), older siblings COVID-19 vaccination (aOR 49.2 vs. unvaccinated siblings; 95 % CI 18.3-132.3), and recent influenza vaccination for the child (aOR 6.9 vs. no influenza vaccine; 95 % CI 4.6-10.5). Among 189 caregivers with unvaccinated 5-11-year-old children, the most common reasons for non-acceptance were concerns about long-term side effects (59 %), lack of experience vaccinating children (41 %), and concerns that vaccines were developed too quickly (39 %).

CONCLUSION

Acceptance of COVID-19 vaccination for 5-11-year-old children were associated with caregiver vaccine behaviors and sociodemographic factors. These findings highlight groups of caregivers that can be targeted for educational interventions and concerns that may be addressed to increase vaccine confidence.

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

The COVID-19 pandemic prompted governments worldwide to implement a range of containment measures, including mass gathering restrictions, social distancing, and school closures. Despite these efforts, vaccines continue to be the safest and most effective means of combating such viruses. Yet, vaccine hesitancy persists, posing a significant public health concern, particularly with the emergence of new COVID-19 variants. To effectively address this issue, timely data is crucial for understanding the various factors contributing to vaccine hesitancy. While previous research has largely relied on traditional surveys for this information, recent sources of data, such as social media, have gained attention. However, the potential of social media data as a reliable proxy for information on population hesitancy, especially when compared with survey data, remains underexplored. This paper aims to bridge this gap. Our approach uses social, demographic, and economic data to predict vaccine hesitancy levels in the ten most populous US metropolitan areas. We employ machine learning algorithms to compare a set of baseline models that contain only these variables with models that incorporate survey data and social media data separately. Our results show that XGBoost algorithm consistently outperforms Random Forest and Linear Regression, with marginal differences between Random Forest and XGBoost. This was especially the case with models that incorporate survey or social media data, thus highlighting the promise of the latter data as a complementary information source. Results also reveal variations in influential variables across the five hesitancy classes, such as age, ethnicity, occupation, and political inclination. Further, the application of models to different MSAs yields mixed results, emphasizing the uniqueness of communities and the need for complementary data approaches. In summary, this study underscores social media data's potential for understanding vaccine hesitancy, emphasizes the importance of tailoring interventions to specific communities, and suggests the value of combining different data sources.

Factors associated with childhood non-vaccination against COVID-19 in Canada: A national survey analysis

Background

COVID-19 vaccination efforts are critical in mitigating the impact of the virus, but despite proven safety and efficacy, vaccination rates among children in Canada are lower than in adults, prompting a need to explore determinants of childhood COVID-19 non-vaccination to improve uptake.

Method

This study analyzed data from the Canadian COVID-19 Immunization Coverage Survey 2022. Using multivariable logistic regression, it examined the association between COVID-19 non-vaccination among children aged 5-17 and factors such as parental sociodemographic characteristics, vaccine knowledge, attitudes, and beliefs (KAB), and vaccination history.

Results

The analysis revealed that negative KAB towards vaccines, reflected in higher KAB composite scores, significantly increased the likelihood of non-vaccination. Additionally, factors such as lower household incomes, rural residence, employment in sectors not at risk for vaccine-preventable diseases, and younger parental age were associated with higher non-vaccination. The study also highlighted ethnic disparities in vaccination odds and found that children with incomplete routine vaccinations or inconsistent flu vaccination histories were more likely to be unvaccinated against COVID-19. Surprisingly, children of parents who consistently received flu vaccinations were more likely to be unvaccinated against COVID-19. Furthermore, parental education levels showed a complex relationship with children's COVID-19 vaccination status, indicating nuanced influences on vaccination decisions.

Conclusion

The findings offer vital insights into the factors influencing COVID-19 vaccination uptake among children in Canada, suggesting avenues for targeted strategies to improve vaccine coverage.

How did we protect children against COVID-19 in Iran? Prevalence of COVID-19 and vaccination in the socio-economic context of COVID-19 epidemic

INTRODUCTION

The COVID-19 pandemic posed significant risks to children worldwide. This study aimed to assess the COVID-19 protection status of children and explored the relationship between household socio-economic status and COVID-19 morbidity and preventive measures, including vaccination and mask-wearing, in two cities in Iran.

METHOD

A population-based cross-sectional study was conducted from July to October 2022 among 7 to 18-year-old children and their families in Tehran and Karaj. A total of 3,022 samples were selected using stratified multistage cluster sampling. Data were collected through interviews with children and adults, using questionnaires and was analyzed with Stata software version 14.

RESULTS

The analysis focused on 2,878 children with a median age of 12. Over half (54%) reported that the pandemic negatively affected their family's financial status, with 45% describing its impact on children's needs as negative or very negative. Just under 50% of respondents consistently wore masks during the study period, and around 54% had received at least one dose of the COVID-19 vaccine. Reasons for not getting vaccinated included concerns about side effects, ineligibility for the target age group, and overcrowding at vaccination sites. The odds of not getting vaccinated were significantly lower for children aged 15-18, with boys more likely to refuse vaccination than girls.

CONCLUSION

The financial impact of the pandemic in Iran affected families' ability to meet their children's needs. Moreover, low vaccination acceptance rates increased children's vulnerability to health problems and contributed to COVID-19 infections. Efforts should be made to increase vaccination acceptance, particularly among immigrant populations.

Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria

BACKGROUND

There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.

OBJECTIVES

This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.

METHODS

This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.

RESULTS

A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1-0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1-6-6.8).

CONCLUSION

Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.

Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria

Background

There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.

Objectives

This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.

Methods

This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.

Results

A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1–0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1–6–6.8).

Conclusion

Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.

Socio-demographic determinants of COVID-19 vaccine uptake in Ontario: Exploring differences across the Health Region model

The COVID-19 pandemic continues to be a worldwide public health concern. Although vaccines against this disease were rapidly developed, vaccination uptake has not been equal across all the segments of the population, particularly in the case of underrepresented groups. However, there are also differences in vaccination across geographical areas, which might be important to consider in the development of future public health vaccination policies. In this study, we examined the relationship between vaccination status (having received the first dose of a COVID-19 vaccine), socio-economic strata, and the Health Regions for individuals in Ontario, Canada. Our results show that between October of 2021 and January of 2022, individuals from underrepresented communities were three times less likely to be vaccinated than White/Caucasian individuals across the province of Ontario, and that in some cases, within these groups, individuals in low-income brackets had significantly higher odds of vaccination when compared to their peers in high income brackets. Finally, we identified significantly lower odds of vaccination in the Central, East and West Health Regions of Ontario within certain underrepresented groups. This study shows that there is an ongoing need to better understand and address differences in vaccination uptake across diverse segments of the population of Ontario that the pandemic has largely impacted.

Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people: meta-analysis of UK prospective cohorts

SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5-17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5-11 year-olds were less likely to receive their first vaccine compared to 16-17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29).

Systematic review of socioeconomic factors and COVID-19 in children and adolescents

AIM

To systematically review the evidence on Covid-19 infection risk, severity and vaccination uptake among children and adolescents by socioeconomic status.

METHODS

We conducted a systematic literature review, using the PubMed database. We searched for articles published from January 2020 to January 2022 using "MeSH" words and titles. The key terms were "COVID", "social status", "socioeconomic factor" and "children". We also searched secondary sources such as published reports and other databases.

RESULTS

The search identified 15 relevant articles and reports. This review shows that children of lower socioeconomic status have a higher risk of COVID-19 infection and a higher risk of being hospitalised. Mortality in a global setting was also higher in children with low socioeconomic status, though not observed in high-resourced countries. These children are also less likely to be vaccinated against the SARS-CoV-2 virus.

CONCLUSIONS

The higher risk of COVID-19 infection and hospitalisation and lower vaccination coverage in children and adolescents from lower socioeconomic backgrounds demonstrate health disparities also in young age. These disparities should inform health authorities in planning for future pandemics.

'It's quite a balancing act': A qualitative study of parents' experiences and information needs related to the COVID-19 pandemic

INTRODUCTION

Throughout the coronavirus disease 2019 (COVID-19) pandemic, parents and children faced significant challenges as a result of prevention measures implemented to control the spread of the disease. Ensuring that families have access to essential health information is critical for improving health outcomes and adherence to public health recommendations. Understanding parents' experiences and information needs related to the pandemic and associated health measures (e.g., vaccination, mask wearing, social distancing, etc.) will inform the development and dissemination of resources tailored to parents' needs to support informed decision making.

METHODS

We conducted a qualitative descriptive study. Between September and November 2021, parents across Canada were recruited online via social media and community organisation newsletters and listservs to participate in focus groups via Zoom. Focus groups were audio-recorded and transcribed verbatim. Data were coded and analysed using thematic analysis. Participants completed a demographic questionnaire before the focus groups (via SimpleSurveys).

RESULTS

Sixty-seven parents participated in 12 focus groups between October and November 2021. In relation to experiences, parents felt they were (1) constantly trying to balance everything, and (2) trying to do their best with the information they had at the time when making decisions. Regarding information needs, parents reflected on (1) how difficult it was navigating copious amounts of changing information and finding credible sources to rely on, (2) the need for resources that were easily accessible, credible and in plain language and (3) the need for resources that were tailored to their needs to support them and their children make informed decisions.

CONCLUSIONS

Trying to mitigate the risk of COVID-19 infection and adhere to public health recommendations, while balancing various factors (work, online learning, and social interactions) and navigating changing information, was overwhelming for many parents. Reflecting on their needs, parents suggested tailored resources that provided concise, credible information in plain language to help them make informed decisions and navigate conflicting information. These findings reveal important knowledge gaps and highlight areas that need to be addressed to support parents during the pandemic period and beyond.

PATIENT OR PUBLIC CONTRIBUTION

Members of our established Paediatric Parent Advisory Group (P-PAG) were involved as collaborators throughout the planning (grant proposal), development and execution of the study. P-PAG members gave input on the design of the questionnaire, interview guide, recruitment strategy and interpretation of findings.

"I shall not poison my child with your human experiment": Investigating predictors of parents' hesitancy about vaccinating younger children (<12) in Canada

BACKGROUND

Since the approval of SARS-CoV-2 vaccines for younger children (those under the age of 12), uptake has been low. Despite widespread vaccination among older children and adults, these trends may undermine public health efforts to manage future waves of SARS-CoV-2 or spill over into other childhood vaccines. The objectives of this study were to understand parents' intentions to vaccinate their children (under age 12) against SARS-CoV-2, and to explore reasons for and against SARS-CoV-2 vaccination.

METHODS

A representative sample of parents of school-aged children (ages 3-11 years) from Canada's four largest provinces were invited in June 2021 to complete a survey on the impact of COVID-19 on schooling. The survey included specific questions on parents' intentions to vaccinate their child(ren) against SARS-CoV-2. Multinomial regression models were run to estimate associations between demographic factors, political affiliation and voting, concerns about individual / family health and vaccination intention.

RESULTS

A total of 74.0 % of parents (n = 288) intended to vaccinate their children with the SARS-CoV-2 vaccine, 18.3 % (n = 71) did not intend to vaccinate and 7.7 % (n = 30) were unsure. The strongest predictor of parental hesitancy was whether a parent had themselves been vaccinated. Other factors including past voting behaviour, dissatisfaction with the government's response to the pandemic, and relatively less concern about contracting SARS-CoV-2 were also correlated with hesitancy. Parents of older children were more likely to indicate plans to vaccinate their child(ren). Analysis of the reasons for hesitancy showed parents are concerned about the safety and side effects of the vaccine, as well as with processes of testing and approval.

INTERPRETATION

A considerable proportion of Canadian parents of younger school-aged children (ages 3-11) were unsure and/or hesitant about vaccinating their children against SARS-CoV-2. As well, a much larger proportion who are not necessarily hesitant have also not had their children vaccinated. Given the evolving nature of SARS-CoV-2, including the continued emergence of new variants, reaching younger children will be important for population health. Health providers should continue to work with government institutions to ensure clear communication regarding the safety, efficacy, and importance of child vaccines for reaching public health goals.

Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.

Time-to-completion of COVID-19 vaccination primary series varies by HIV viral load status among people who inject drugs in Baltimore, Maryland

People who inject drugs (PWID) may have diminished access to essential preventive services like COVID-19 vaccination given structural and substance use barriers. We aimed to assess the role of HIV on COVID-19 vaccination uptake among adult PWID participating in the ALIVE cohort study in Baltimore, Maryland who were alive as of April 2021. We abstracted COVID-19 vaccination data from electronic medical records via the regional health information exchange. We used Kaplan-Meier method to estimate time from universal vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series (1 dose J&J or 2 doses mRNA) by HIV viral load status (uninfected, PWH [HIV-RNA < 400 copies/mL], PWH [HIV-RNA ≥ 400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounders. Our sample (N = 960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 (27%) people living with HIV (PWH) in our sample, 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were more likely to complete the primary series (Adjusted Hazard Ratio [aHR]:1.23,95% Confidence Interval [95 %CI]:1.07,1.50), while PWH who were not virally suppressed were less likely (aHR:0.72,95 %CI:0.45,1.16), although this was not statistically significant. We conclude that among PWID, HIV infection and viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Targeted improvements along the HIV care continuum may bolster vaccine uptake.

Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador

Background

Equity in vaccination against COVID-19 is a public health concern. The objective of this study was to analyze socioeconomic inequalities related to vaccination for the first and second doses from primary series against COVID-19 in Ecuador.

Methods

Secondary database study in 12,743,507 respondents from 15 years and over. The COVID-19 section of the National Survey of Employment, Unemployment and Underemployment (ENEMDU) was analyzed. Socioeconomic characteristics and vaccination against COVID-19 were associated with the at least one dose and second dose. Poisson regressions for complex samples were obtained.

Results

As of the date of the survey, 87.3% of the sample (95% CI 86.7%-87.8%) had received at least one vaccine against COVID-19. A lower probability of having received at least one vaccine against COVID-19 was found in rural areas (PR 0.82, 95% CI 0.74-0.91), indigenous population (PR 0.43, 95% CI 0.29-0.64), no level of education (PR 0.25, 95% CI 0.14-0.43), and the lowest economic income (PR 0.42, 95% CI 0.35-0.52). A significantly lower probability of vaccination with two or more doses was found in rural vs urban area (PR 0.88, 95% CI 0.80-0.96), women vs men (PR 0.85, 95% CI 0.77-0.91), indigenous population vs white (PR 0.44, 95% CI 0.33-0.59) and individuals in the lowest income quartile vs highest income quartile (PR 0.48, 95% CI 0.42-0.55). Underemployment, population economically inactive (PR 0.77, 95% CI 0.67-0.88 and PR 0.71, 95% CI 0.61-0.83) and individuals with no level of education (PR 0.39, 95% CI 0.27-0.58) also were less likely to complete the primary phase of vaccination compared with individuals in the highest income quartile, employment and postgraduate level of education.

Conclusions

There were socioeconomic inequalities with the primary series of vaccine against COVID-19, with a greater disadvantage for rural residents, women, indigenous populations, lower economic income and lower levels of education.

Predictors of Intention to Vaccinate or Continue to Vaccinate Children Against SARS-CoV-2 During the Fifth Wave of the COVID-19 Pandemic in the USA

The Centre for Disease Control recommends vaccination of children against SARS-CoV-2 to reduce the severity of COVID-19 disease and reduce the likelihood of associated complications. Vaccination of children requires the consent of parents or guardians, and levels of consent may ebb and flow over the course of the pandemic. This exploratory study examines predictors of parental intentions to vaccinate their children and the speed with which they would have them vaccinated during the fifth wave of the pandemic when vaccines were just being approved for use in children using a convenience sample of 641 parents reporting on 962 children. Multi-level regression analyses demonstrated regional differences in likelihood, with those in the Northeast reporting higher likelihood than those in the West. Parents with a conservative belief system were less likely to want to have their children vaccinated. Parents were more likely to have their child vaccinated if the child had COVID-19-related health risks, their child had a more complete vaccination history, and COVID-19 was perceived to be a greater threat to oneself and one's family. Faster intended vaccination speed was associated with regional urbanicity, liberal belief systems, more complete vaccination histories, and parental COVID-19 vaccination history. Higher levels of parental anxiety and lower levels of perceived vaccine danger were associated with increased speed. The severity of the COVID-19 pandemic within one's county was marginally related to speed, but not likelihood. These results underscore the importance of regular assessment of parental intentions across the pandemic, for practitioners to probe parental anxiety levels when discussing vaccination, to explicitly address risk/benefit analyses when communicating with parents, and to target previously routine unvaccinated parents and those in more rural areas to increase vaccine uptake. Comparisons are made with Galanis et al.'s (2022) recent meta-analysis on the topic.

Review: Factors influencing parents' decisions to vaccinate children against COVID-19

INTRODUCTION

Vaccination is a cornerstone of public health, significantly safeguarding children's health. Despite the imperative of achieving extensive COVID-19 vaccine coverage, vaccine hesitancy poses a major challenge.

OBJECTIVE

This review's aim is to analyze parental COVID-19 vaccine acceptance and hesitancy during the COVID-19 pandemic and elucidate the factors that influenced their decisions.

METHODS

A search of Medline (PubMed), Embase, and Psycinfo was conducted on February 1, 2022. The inclusion criteria were limited to observational studies that specifically evaluated parental COVID-19 vaccine acceptance or hesitancy for children, published in English. Studies that did not focus on this specific assessment, interventional studies, clinical trials, and secondary literature were excluded.

RESULTS

In reviewing 27 articles, parental vaccination acceptance rates were found to be different worldwide. Despite this, most of the articles found the same set of factors impacting parental COVID-19 vaccine acceptance and hesitancy. Parents' age, education, race, children's age, and annual household income were the main sociodemographic factors in vaccination decisions. Other common factors were the perceived risk and benefits of the COVID-19 vaccine, the source of information, parents' acceptance of receiving vaccinations themselves, and previous acceptance of the influenza vaccine. By reviewing parents' willingness to accept the COVID-19 vaccine for their children, it became clear that a lack of information about vaccine safety and efficacy was the most common factor affecting their decision.

CONCLUSION

This review identified critical factors affecting parents' vaccination behavior for their children. Awareness of these factors may reduce parents' COVID-19 vaccine refusal for their children and guide future planning and development of public health studies.

Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study

BACKGROUND

Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities.

METHODS

Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section.

RESULTS

The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination.

CONCLUSIONS

While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic?

OBJECTIVES

We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic.

METHODS

We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group.

RESULTS

The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust.

CONCLUSION

The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.

Paediatric COVID-19 vaccination coverage and associated factors among migrant and non-migrant children aged 5-11 years in Aotearoa New Zealand: A population-level retrospective cohort study

OBJECTIVE

Children with migrant and refugee backgrounds may experience immunisation inequities due to barriers to accessing and accepting vaccines. In Aotearoa New Zealand (NZ), national reporting can mask inequities in coverage by migration background. This study explored paediatric COVID-19 vaccine uptake among children with migrant and refugee backgrounds.

METHODS

This population-level retrospective cohort study compared rates and determinants of paediatric COVID-19 vaccine uptake as of July 2022 amongst migrant and non-migrant children who were aged between 5 and 11 years as of January 2022. Linked de-identified administrative and health data available in Statistics NZ's Integrated Data Infrastructure were used, and univariate and multivariable logistic regression were conducted to determine associations.

RESULTS

Of the total study population (N = 451,323), 3.5% were overseas-born migrant children, 31.3% were NZ-born migrant children, and 65.3% were NZ-born non-migrant children. Only 50.8% (229,164 out of 451,323) of children had received at least one dose. Migrant children were significantly more likely to have received a COVID-19 vaccination than non-migrant children. Logistic modelling revealed that all factors, including ethnicity, gender, age, family type, household income, deprivation, region, parent COVID-19 vaccination status, and child's previous COVID-19 infection, significantly influenced COVID-19 vaccine uptake. The largest contributing factor was parents' COVID-19 vaccination status.

CONCLUSIONS

The findings suggest that NZ's paediatric COVID-19 vaccination programme was able to address logistical and motivational barriers commonly identified amongst migrants and refugees.

IMPLICATIONS FOR PUBLIC HEALTH

As parents' vaccination status is an important factor in vaccinating their own children, continuous efforts are needed to support confident parental COVID-19 vaccine decision-making. To address social inequities, engagement with marginalised communities to co-design tailored and localised approaches is recommended.

Factors associated with COVID-19 vaccine uptake in adolescents: a national cross-sectional study, August 2021-January 2022, England

OBJECTIVES

To assess socioeconomic and geographical factors associated with COVID-19 vaccine uptake in pupils attending state-funded secondary schools in England.

DESIGN

Cross-sectional observational study.

SETTING

State-funded schools in England.

PARTICIPANTS

Pupils aged 12-17 years attending state-funded schools in England for the academic year 2021/2022.

OUTCOME MEASURES

Demographic, socioeconomic and geographical factors associated with vaccination uptake. We linked individual-level data from the English Schools Census to the National Immunisation Management System to obtain COVID-19 vaccination status of 3.2 million adolescents. We used multivariable logistic regression to assess demographic, socioeconomic and geographical factors associated with vaccination.

RESULTS

By 9 January 2022, 56.8% of adolescents aged 12-17 years old had received at least one dose, with uptake increasing from 48.7% in those aged 12 years old to 77.2% in those aged 17 years old. Among adolescents aged 12-15 years old, there were large variations in vaccine uptake by region and ethnic group. Pupils who spoke English as an additional language (38.2% vs 55.5%), with special educational needs (48.1% vs 53.5%), eligible for free school meals (35.9% vs 58.9%) and lived in more deprived areas (36.1% in most deprived vs 70.3% in least deprived) had lower vaccine uptake. Socioeconomic variables had greater impact on the odds of being vaccinated than geographical variables. School-level analysis found wide variation in vaccine uptake between schools even within the same region. Schools with higher proportions of pupils eligible for free school meals had lower vaccine uptake.

CONCLUSIONS

We found large differences in vaccine uptake by geographical region and ethnicity. Socioeconomic variables had a greater impact on the odds of being vaccinated than geographical variables. Further research is required to identify evidence-based interventions to improve vaccine uptake in adolescents.

Correlates of COVID-19 Vaccine Acceptance and Hesitancy in Rural Communities in Western Kenya

Vaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24-1.59, p < 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16-4.40, p < 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28-10.88 p < 0.02), and have low income (KES 0-999 (USD 0-9.16)), (AOR: 2.35, 95% CI: 1.13-3.47, p < 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0-999 (USD 0-9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination.

Parents' Uptake and Willingness towards Recommended Vaccinations for Their Children with Underlying Chronic Medical Conditions in Italy

This cross-sectional survey was conducted to investigate the willingness and uptake of recommended vaccinations against influenza, meningococcal B and ACWY, pneumococcal, rotavirus and the influencing factors among 565 parents of children aged 6 months to 5 years with chronic medical conditions in Italy. Only 34.9% of the sample received all vaccinations. Parents whose selected child was vaccinated against the five diseases were those who had received recommendations from physicians, who did not believe that children should get fewer vaccinations at the same time, those whose child was aged 2-3 and 4-5 years compared to 6 months-1 year, and those who acquired information from physicians. Only 17.9% were willing to vaccinate their child. Parents with a university degree, those who acquired information from physicians, and those whose child had a more recent diagnosis were more likely to be willing to vaccinate their child. Parents who believed that children should get fewer vaccines at the same time, those without a university degree, and those who did not acquire information from physicians were more likely to not have vaccinated their child because they were concerned about vaccines' side effects. Public health policymakers should provide efforts to promote the uptake for an adequate protection of this high-risk group.

Social inequalities and the early provision and dispersal of COVID-19 vaccinations in the United States: A population trends study

BACKGROUND

In December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and racial/ethnic inequalities would emerge in vaccination distribution.

METHODS

Population vaccination rates reported at the county level by the Centers for Disease Control and Prevention across 46 states on 3/30/2021. Correlates included SES, the share of the population who were Black, Hispanic, Female, or aged ≥65 years, and urbanicity (thousands of residents per square mile). Multivariable-adjusted analyses relied on zero-inflated negative binomial regression to estimate the odds of providing any vaccine, and vaccination rate ratios (aVRR) comparing the distribution rate for vaccinations across the U.S.

RESULTS

Across the U.S., 16.3 % of adults and 37.9 % of adults aged 65 and older were vaccinated in lower SES counties, while 20.45 % of all adults and 48.15 % of adults aged 65 and older were vaccinated in higher SES counties. Inequalities emerged after 41 days, when < 2 % of Americans were vaccinated. Multivariable-adjusted analyses revealed that higher SES was associated with improved vaccination distribution (aVRR = 1.127, [1.100-1.155], p < 1E-06), while increases in the percent reporting Black or Hispanic race/ethnicity was associated with lower vaccination distribution (aVRR = 0.998, [0.996-0.999], p = 1.03E-04).

CONCLUSIONS

Social inequalities in COVID-19 vaccines reflect an inefficient and inequitable distribution of these technologies. Future efforts to improve health should recognize the central role of social factors in impacting vaccine delivery.

Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study

BACKGROUND

People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making.

METHODS

Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework.

RESULTS

Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD.

CONCLUSION

PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.

COVID-19 Vaccine Uptake in Immigrant, Refugee, and Nonimmigrant Children and Adolescents in Ontario, Canada

Importance

COVID-19 vaccinations are recommended for minors. Surveys indicate lower vaccine acceptance by some immigrant and refugee groups.

Objective

To identify characteristics in immigrant, refugee, and nonimmigrant minors associated with vaccination.

Design, Setting, and Participants

This retrospective cohort study used linked, population-based demographic and health care data from Ontario, Canada, including all children aged 4 to 17 years registered for universal health insurance on January 1, 2021, across 2 distinct campaigns: for adolescents (ages 12-17 years), starting May 23, 2021, and for children (ages 5-11 years), starting November 25, 2021, through April 24, 2022. Data were analyzed from May 9 to August 2, 2022.

Exposures

Immigrant or refugee status and immigration characteristics (recency, category, region of origin, and generation).

Main Outcomes and Measures

Outcomes of interest were crude rates of COVID-19 vaccination (defined as ≥1 vaccination for children and ≥2 vaccinations for adolescents) and adjusted odds ratios (aORs) with 95% CIs for vaccination, adjusted for clinical, sociodemographic, and health system factors.

Results

The total cohort included 2.2 million children and adolescents, with 1 098 749 children (mean [SD] age, 7.06 [2.00] years; 563 388 [51.3%] males) and 1 142 429 adolescents (mean [SD] age, 14.00 [1.99] years; 586 617 [51.3%] males). Among children, 53 090 (4.8%) were first-generation and 256 886 (23.4%) were second-generation immigrants or refugees; among adolescents, 104 975 (9.2%) were first-generation and 221 981 (19.4%) were second-generation immigrants or refugees, most being economic or family-class immigrants. Immigrants, particularly refugees, were more likely to live in neighborhoods with highest material deprivation (first-generation immigrants: 18.6% of children and 20.2% of adolescents; first-generation refugees: 46.4% of children and 46.3% of adolescents; nonimmigrants: 18.5% of children and 17.2% of adolescents) and COVID-19 risk (first-generation immigrants; 20.0% of children and 20.5% of adolescents; first-generation refugees: 9.4% of children and 12.6% of adolescents; nonimmigrants: 6.9% of children and 6.8% of adolescents). Vaccination rates (53.1% in children and 79.2% in adolescents) were negatively associated with material deprivation. In both age groups, odds for vaccination were higher in immigrants (children: aOR, 1.30; 95% CI, 1.27-1.33; adolescents: aOR, 1.10; 95% CI, 1.08-1.12) but lower in refugees (children: aOR, 0.34; 95% CI, 0.33-0.36; adolescents: aOR, 0.88; 95% CI, 0.84-0.91) compared with nonimmigrants. In immigrant- and refugee-only models stratified by generation, region of origin was associated with uptake, compared with the overall rate, with the lowest odds observed in immigrants and refugees from Eastern Europe (children: aOR, 0.40; 95% CI, 0.35-0.46; adolescents: aOR, 0.41; 95% CI, 0.38-0.43) and Central Africa (children: aOR, 0.24; 95% CI, 0.16-0.35; adolescents: aOR, 0.51,CI: 0.45-0.59) and the highest odds observed in immigrants and refugees from Southeast Asia (children: aOR, 2.68; 95% CI, 2.47-2.92; adolescents aOR, 4.42; 95% CI, 4.10-4.77). Adjusted odds of vaccination among immigrants and refugees from regions with lowest vaccine coverage were similar across generations.

Conclusions and Relevance

In this cohort study using a population-based sample in Canada, nonrefugee immigrants had higher vaccine coverage than nonimmigrants. Substantial heterogeneity by region of origin and lower vaccination coverage in refugees persisted across generations. These findings suggest that vaccine campaigns need precision public health approaches targeting specific barriers in identified, undervaccinated subgroups.

Utilizing the theory of planned behavior to predict COVID-19 vaccination intention: A structural equational modeling approach

It is essential to achieve herd immunity in order to control the COVID-19 pandemic, and this requires a high level of vaccination rate. Despite the importance of vaccination, hesitancy and unwillingness in receiving the COVID-19 vaccine still exists. It is therefore crucial to comprehend the intentions of adults regarding COVID-19 vaccination, which is beneficial for establishing community immunity and an efficient future pandemic response. An online survey was administered to 2722 adults in Vietnam. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were used to test the reliability and validity of the developed scales. Then, structural equational modeling (SEM) was employed to test correlations. This study found that favorable attitudes toward COVID-19 vaccines played the most important role in shaping adults' intention to receive these vaccines, followed by perceived behavioral control, perceived benefits of COVID-19 vaccines, and subjective norms. Concurrently, all three core dimensions of the theory of planned behavior mediated the link between the perceived benefits of COVID-19 vaccines and the intention to receive them. Also, there were significant differences between males and females in the way they formed this intention. The findings of this study offer valuable guidance for practitioners on how to encourage adults to receive COVID-19 vaccinations, as well as how to limit the transmission of the COVID-19 virus.

Symptom-Specific Hospital Contacts in 12-18-Year-Olds Vaccinated against COVID-19: A Danish Register-Based Cohort Study

In this register-based real-life cohort study, changes in symptom-specific hospital contacts among 12-18-year-olds following two doses of the BNT162b2 COVID-19 vaccine compared to unvaccinated peers were investigated. Using national register data, vaccinated and unvaccinated adolescents were sex and age-matched each week during the inclusion period from May to September 2021. Symptom-specific hospital contacts covering ICD-10 R diagnoses were assessed before first the vaccine dose and after the second vaccine dose. Taking previous rates of symptom-specific hospital contacts into account, differences between vaccinated and unvaccinated adolescents were found. For some hospital contacts, higher rates were seen among the vaccinated, and for others, higher rates were seen among the unvaccinated. Unspecific cognition symptoms may be important to monitor in vaccinated girls, and likewise for throat and chest pain in vaccinated boys within the first months post-vaccination. In perspective, symptom-specific hospital contacts after vaccination against COVID-19 must be assessed by taking the risk of infection and symptoms following COVID-19 infection into account.

COVID-19 vaccination rates among adolescents (12-17 years) by immigrant background and sociodemographic factors: A nationwide registry study in Norway

PURPOSE

Lower COVID-19 vaccination rates have been observed among some adult immigrant populations in Norway, and there appears to be an association with sociodemographic factors. However, knowledge is lacking on the distribution of vaccination rates and role of sociodemographic factors among adolescents. This study aims to describe COVID-19 vaccination rates among adolescents according to immigrant background, household income, and parental education.

METHODS

In this nationwide registry study, we analyzed individual-level data on adolescents (12-17 years) from the Norwegian Emergency preparedness register for COVID-19 until September 15th, 2022. We estimated incidence rate ratios (IRR) for receiving at least one COVID-19 vaccine dose by country background, household income and parental education, using Poisson regression, adjusting for age, sex, and county.

RESULTS

The sample comprised 384,815 adolescents. Foreign-born and Norwegian-born with foreign-born parents, had lower vaccination rates (57 % and 58 %) compared to adolescents with at least one Norwegian-born parent (84 %). Vaccination rates by country background varied from 88 % (Vietnam) to 31 % (Russia). Variation and associations by country background, household income, and parental education were greater among 12-15-year-olds than 16-17-year-olds. Household income and parental education were positively associated with vaccination. Compared to the lowest income and education category, IRRs for household income ranged from 1.07 (95 % CI 1.06-1.09) to 1.31 (95 % CI 1.29-1.33) among 12-15-year-olds, and 1.06 (95 % CI 1.04-1.07) to 1.17 (95 % CI 1.15-1.18) among 16-17-year-olds. For parental education, from IRR 1.08 (95 % CI 1.06-1.09) to 1.18 (95 % CI 1.17-1.20) among 12-15-year-olds, and 1.05 (95 % CI 1.04-1.07) to 1.09 (95 % CI 1.07-1.10) among 16-17-year-olds.

CONCLUSION

COVID-19 vaccination rates varied by immigrant background and age group, with lower rates especially among adolescents with background from Eastern Europe and among younger adolescents. Household income and parental education were positively associated with vaccination rates. Our results may help target measures to increase vaccination rates among adolescents.

Parental willingness to have children vaccinated against COVID-19 in Geneva, Switzerland: a cross-sectional population-based study

OBJECTIVE

We aimed to examine factors associated with parental willingness to vaccinate their children against COVID-19.

METHODS

We surveyed adults included in a digital longitudinal cohort study composed of participants in previous SARS-CoV-2 serosurveys conducted in Geneva, Switzerland. In February 2022, an online questionnaire collected information on COVID-19 vaccination acceptance, parental willingness to vaccinate their children aged ≥5 years and reasons for vaccination preference. We used multivariable logistic regression to assess the demographic, socioeconomic and health-related factors associated with being vaccinated and with parental intention to vaccinate their children.

RESULTS

We included 1,383 participants (56.8% women; 69.3% aged 35-49 years). Parental willingness to vaccinate their children increased markedly with the child's age: 84.0%, 60.9% and 21.2%, respectively, for parents of adolescents aged 16-17 years, 12-15 years and 5-12 years. For all child age groups, unvaccinated parents more frequently indicated not intending to vaccinate their children than vaccinated parents. Refusal to vaccine children was associated with having a secondary education (1.73; 1.18-2.47) relative to a tertiary education and with middle (1.75; 1.18-2.60) and low (1.96; 1.20-3.22) household income relative to high income. Refusal to vaccine their children was also associated with only having children aged 12-15 years (3.08; 1.61-5.91), aged 5-11 years (19.77; 10.27-38.05), or in multiple age groups (6.05; 3.22-11.37), relative to only having children aged 16-17 years.

CONCLUSION

Willingness to vaccinate children was high for parents of adolescents aged 16-17 years but decreased significantly with decreasing child age. Unvaccinated, socioeconomically disadvantaged parents and those with younger children were less likely to be willing to vaccinate their children. These results are important for vaccination programs and developing communication strategies to reach vaccine-hesitant groups, both in the context of COVID-19 and in the prevention of other diseases and future pandemics.

Coronavirus Disease-2019 Vaccine Hesitancy

Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, before coronavirus disease-2019 (COVID-19) vaccines were authorized, surveys began tracking public acceptance of a hypothetical COVID-19 vaccine. As vaccines became more widely available, the focus shifted from evaluating premeditative thoughts about COVID-19 vaccines to observing behaviors, measuring uptake, and characterizing factors associated with acceptance. A wealth of peer-reviewed literature examining the complexities of COVID-19 vaccine acceptance has emerged, but our understanding of COVID-19 vaccine acceptance is constantly evolving. In this article, we review the current state of knowledge regarding COVID-19 vaccine hesitancy, with an emphasis on pediatric vaccination.

Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis

Currently, the best method to well control the spread of COVID-19 without severe mental health problems is to reach herd immunity. Therefore, the vaccination rate of the COVID-19 vaccine is critical. Among the populations, children are the vulnerable ones to get vaccinated; therefore, it is important to assess parents’ and guardians’ willingness to have their children vaccinated. The present systematic review and meta-analysis synthesized evidence to estimate the parents’ acceptance rate of COVID-19 vaccination toward their children. Additionally, factors explaining the acceptance rate were investigated. Four academic databases (PubMed, Scopus, Web of Science, and ProQuest) together with Google Scholar were searched, and the references of the included publications were searched as well. Using the PECO-S framework (population, exposure, comparison, outcome, and study design), observational studies of cross-sectional, cohort, or case-control studies were included. The outcome was parents’ or guardians’ willingness to let their children be vaccinated. The studies included in the present review were restricted to English and peer-reviewed papers published between December 2019 and July 2022. A total of 98 papers across 69 different countries with 413,590 participants were included. The mean age of the parents was 39.10 (range: 18–70) years and that of their children was 8.45 (range: 0–18) years. The pooled estimated prevalence of parental acceptance to vaccinate their children with the COVID-19 vaccine was 57% (98 studies, 95% CI: 52–62%, I2: 99.92%, τ2: 0.06). Moreover, data collection time was a significant factor explaining parental willingness in the multivariable meta-regression, with a 13% decrease in parental willingness by each month increase in time, explaining 11.44% of variance. Qualitative synthesis results showed that parents’ COVID-19 vaccine knowledge, trust in theCOVID-19 vaccine, and facilitators in vaccination (e.g., low cost, good vaccine accessibility, and government incentive) were significant factors for higher willingness, while mental health problems (e.g., having worries and psychological distress) were significant factors for lower willingness. Given that the acceptance rate was relatively low (57%) and does not achieve the requirement of herd immunity (i.e., 70%), governments and healthcare authorities should try to elevate parents’ knowledge and trust in the COVID-19 vaccine, facilitate in vaccination, and reduce their mental difficulties to improve the overall vaccination rate among children.

Parents' perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis

BACKGROUND

Uptake of the SARS-CoV-2 vaccine for children aged 5-11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, parental decisions regarding vaccinations have not been studied in-depth. We sought to explore reasons why parents chose to vaccinate or not vaccinate their children against SARS-CoV-2 to better understand their decisions.

METHODS

We conducted a qualitative study involving in-depth individual interviews with a purposive sample of parents in the Greater Toronto Area, Ontario, Canada. We conducted interviews via telephone or video call from February to April 2022 and analyzed the data using reflexive thematic analysis.

RESULTS

We interviewed 20 parents. We found that parental attitudes toward SARS-CoV-2 vaccinations for their children represented a complex continuum of concern. We identified 4 cross-cutting themes: the newness of SARS-CoV-2 vaccines and the evidence supporting their use; the perceived politicization of guidance for SARS-CoV-2 vaccination; the social pressure surrounding SARS-CoV-2 vaccinations; and the weighing of individual versus collective benefits of vaccination. Parents found making a decision about vaccinating their child challenging and expressed difficulty sourcing and evaluating evidence, determining the trustworthiness of guidance, and balancing their own conceptions of health care decisions with societal expectations and political messaging.

INTERPRETATION

Parents' experiences making decisions regarding SARS-CoV-2 vaccination for their children were complex, even for those who were supportive of SARS-CoV-2 vaccinations. These findings provide some explanation for the current patterns of uptake of SARS-CoV-2 vaccination among children in Canada; health care providers and public health authorities can consider these insights when planning future vaccine rollouts.

Recommending COVID-19 vaccination for adolescents in primary care

BACKGROUND

COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake.

OBJECTIVE

We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents.

METHODS

Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression.

RESULTS

The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%).

CONCLUSION

Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.

The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort

BACKGROUND

The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined.

OBJECTIVE

We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort.

METHODS

A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)-a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years).

RESULTS

The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11-year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families.

CONCLUSIONS

This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity.

Perceived Barriers and Intentions to Receive COVID-19 Vaccines: Psychological Distress as a Moderator

A high vaccination uptake degree is crucial to achieve herd immunity to COVID-19 and restrict the spread of the COVID-19 pandemic. However, little is known about the antecedents that reduce or contribute to shaping the intention to receive COVID-19 vaccines, as well as how psychological distress-a mental health problem-can reinforce or dampen the translation from antecedents into intention to receive COVID-19 vaccines. The objective of this study was to explore the effects of perceived clinical and access barriers, self-efficacy, and attitudes towards COVID-19 vaccines on the intention to receive COVID-19 vaccines. Simultaneously, the moderation effects of psychological distress on this relationship were also examined. Using a sample of 2722 Vietnamese adults and structural equation modeling (SEM), this study illustrated that self-efficacy and attitudes towards COVID-19 vaccines were significantly interrelated with intention to receive COVID-19 vaccines. Self-efficacy, attitudes towards COVID-19 vaccines, and intention to receive COVID-19 vaccines were negatively influenced by perceived access barriers but were positively associated with perceived clinical barriers. Importantly, our study reported that when psychological distress was higher, the link between self-efficacy and intention to receive COVID-19 vaccines will become weaker, but the effect of perceived clinical barriers on intention to receive COVID-19 vaccines will be reinforced. Moreover, self-efficacy and attitudes towards COVID-19 vaccines served as mediators in the linkages between perceived barriers and intention to receive COVID-19 vaccines. Besides providing contributions to the extant COVID-19 vaccine literature, this study provides useful recommendations for practitioners and policymakers to foster adults' COVID-19 vaccine acceptance.

Mind the gap: Data availability, accessibility, transparency, and credibility during the COVID-19 pandemic, an international comparative appraisal

Data transparency has played a key role in this pandemic. The aim of this paper is to map COVID-19 data availability and accessibility, and to rate their transparency and credibility in selected countries, by the source of information. This is used to identify knowledge gaps, and to analyse policy implications. The availability of a number of COVID-19 metrics (incidence, mortality, number of people tested, test positive rate, number of patients hospitalised, number of patients discharged, the proportion of population who received at least one vaccine, the proportion of population fully vaccinated) was ascertained from selected countries for the full population, and for few of stratification variables (age, sex, ethnicity, socio-economic status) and subgroups (residents in nursing homes, inmates, students, healthcare and social workers, and residents in refugee camps). Nine countries were included: Bangladesh, Indonesia, Iran, Nigeria, Turkey, Panama, Greece, the UK, and the Netherlands. All countries reported periodically most of COVID-19 metrics on the total population. Data were more frequently broken down by age, sex, and region than by ethnic group or socio-economic status. Data on COVID-19 is partially available for special groups. This exercise highlighted the importance of a transparent and detailed reporting of COVID-19 related variables. The more data is publicly available the more transparency, accountability, and democratisation of the research process is enabled, allowing a sound evidence-based analysis of the consequences of health policies.

BNT162b2 COVID-19 vaccination uptake, safety, effectiveness and waning in children and young people aged 12-17 years in Scotland

Background

The two-dose BNT162b2 (Pfizer-BioNTech) vaccine has demonstrated high efficacy against COVID-19 disease in clinical trials of children and young people (CYP). Consequently, we investigated the uptake, safety, effectiveness and waning of the protective effect of the BNT162b2 against symptomatic COVID-19 in CYP aged 12-17 years in Scotland.

Methods

The analysis of the vaccine uptake was based on information from the Turas Vaccination Management Tool, inclusive of Mar 1, 2022. Vaccine safety was evaluated using national data on hospital admissions and General Practice (GP) consultations, through a self-controlled case series (SCCS) design, investigating 17 health outcomes of interest. Vaccine effectiveness (VE) against symptomatic COVID-19 disease for Delta and Omicron variants was estimated using a test-negative design (TND) and S-gene status in a prospective cohort study using the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. The waning of the VE following each dose of BNT162b2 was assessed using a matching process followed by conditional logistic regression.

Findings

Between Aug 6, 2021 and Mar 1, 2022, 75.9% of the 112,609 CYP aged 16-17 years received the first and 49.0% the second COVID-19 vaccine dose. Among 237,681 CYP aged 12-15 years, the uptake was 64.5% and 37.2%, respectively. For 12-17-year-olds, BNT162b2 showed an excellent safety record, with no increase in hospital stays following vaccination for any of the 17 investigated health outcomes. In the 16-17-year-old group, VE against symptomatic COVID-19 during the Delta period was 64.2% (95% confidence interval [CI] 59.2-68.5) at 2-5 weeks after the first dose and 95.6% (77.0-99.1) at 2-5 weeks after the second dose. The respective VEs against symptomatic COVID-19 in the Omicron period were 22.8% (95% CI -6.4-44.0) and 65.5% (95% CI 56.0-73.0). In children aged 12-15 years, VE against symptomatic COVID-19 during the Delta period was 65.4% (95% CI 61.5-68.8) at 2-5 weeks after the first dose, with no observed cases at 2-5 weeks after the second dose. The corresponding VE against symptomatic COVID-19 during the Omicron period were 30.2% (95% CI 18.4-40.3) and 81.2% (95% CI 77.7-84.2). The waning of the protective effect against the symptomatic disease began after five weeks post-first and post-second dose.

Interpretation

During the study period, uptake of BNT162b2 in Scotland has covered more than two-thirds of CYP aged 12-17 years with the first dose and about 40% with the second dose. We found no increased likelihood of admission to hospital with a range of health outcomes in the period after vaccination. Vaccination with both doses was associated with a substantial reduction in the risk of COVID-19 symptomatic disease during both the Delta and Omicron periods, but this protection began to wane after five weeks.

Funding

UK Research and Innovation (Medical Research Council); Research and Innovation Industrial Strategy Challenge Fund; Chief Scientist's Office of the Scottish Government; Health Data Research UK; National Core Studies - Data and Connectivity.

Reasons underlying the intention to vaccinate children aged 5-11 against COVID-19: A cross-sectional study of parents in Israel, November 2021

Vaccination is a key tool to mitigate impacts of the COVID-19 pandemic. In Israel, COVID-19 vaccines became available to adults in December 2020 and to 5-11-year-old children in November 2021. Ahead of the vaccine roll-out in children, we aimed to determine whether surveyed parents intended to vaccinate their children and describe reasons for their intentions. We collected information on parental socio-demographic characteristics, COVID-19 vaccine history, intention to vaccinate their children against COVID-19, and reasons for parental decisions using an anonymous online survey. We identified associations between parental characteristics and plans to vaccinate children using a logistic regression model and described reasons for intentions to vaccinate or not. Parental non-vaccination and having experienced major vaccination side effects were strongly associated with non-intention to vaccinate their children (OR 0.09 and 0.18 respectively, p < .001). Parents who were younger, lived in the socio-economically deprived periphery, and belonged to the Arab population had lower intentions to vaccinate their children. Reasons for non-intention to vaccinate included concerns about vaccine safety and efficacy (53%, 95%CI 50-56) and the belief that COVID-19 is a mild disease (73%, 95%CI 73-79), while a frequent motive for vaccination was the return to normal social and educational life (89%, 95%CI 87-91). Understanding rationales for COVID-19 vaccine rejection or acceptance, as well as parental demographic data, can pave the way for intentional educational campaigns to encourage not only vaccination against COVID-19, but also regular childhood vaccine programming.

A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada

Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.

Prevalence and factors related to COVID-19 vaccine hesitancy and unwillingness in Canada: A systematic review and meta-analysis

This systematic review and meta-analysis examined the prevalence and factors associated with vaccine hesitancy and vaccine unwillingness in Canada. Eleven databases were searched in March 2022. The pooled prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy and unwillingness was estimated. Subgroup analyses and meta-regressions were performed. Out of 667 studies screened, 86 full-text articles were reviewed, and 30 were included in the systematic review. Twenty-four articles were included in the meta-analysis; 12 for the pooled prevalence of vaccine hesitancy (42.3% [95% CI, 33.7%-51.0%]) and 12 for vaccine unwillingness (20.1% [95% CI, 15.2%-24.9%]). Vaccine hesitancy was higher in females (18.3% [95% CI, 12.4%-24.2%]) than males (13.9% [95% CI, 9.0%-18.8%]), and in rural (16.3% [95% CI, 12.9%-19.7%]) versus urban areas (14.1% [95%CI, 9.9%-18.3%]). Vaccine unwillingness was higher in females (19.9% [95% CI, 11.0%-24.8%]) compared with males (13.6% [95% CI, 8.0%-19.2%]), non-White individuals (21.7% [95% CI, 16.2%-27.3%]) than White individuals (14.8% [95% CI, 11.0%-18.5%]), and secondary or less (24.2% [95% CI, 18.8%-29.6%]) versus postsecondary education (15.9% [95% CI, 11.6%-20.2%]). Factors related to racial disparities, gender, education level, and age are discussed.

Vaccination of children in marginalized neighbourhoods: Equity and diversity challenges with COVID-19 vaccination campaigns

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated social inequities along ethnic, racial and socio-economic lines, with significant harmful consequences for children. Building on the lessons learned from community-based initiatives, this commentary proposes a reflection around equity, diversity, and inclusion challenges embedded in child vaccination campaigns during an emergency context. We argue that building equitable and inclusive practices around marginalized communities' child vaccination is a multifaceted challenge. Beyond good intentions-wanting to protect children-the risks and benefits associated with highlighting diversity in each intervention need to be carefully considered, especially when it comes to a contested/polarizing procedure such as vaccination with a novel type of vaccine. Often, a one-size-fits-all approach negates and perpetuates structural inequities. In other cases, highlighting diversity and inequities may inadvertently increase stigma and discrimination, and further harm or infantilize targeted communities. By providing multiple perspectives, a transdisciplinary approach can support decision-making in a crisis context.

Understanding the influence of online information, misinformation, disinformation and reinformation on COVID-19 vaccine acceptance: Protocol for a multicomponent study

Background

The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children.

Objective

The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines.

Methods

Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature.

Results

As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months.

Conclusions

The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/41012

Covid-19 in children aged 5-11: Examining the issues surrounding vaccination and public health policy

BACKGROUND

Children under 12 are now the largest unvaccinated group. Following FDA approval, vaccination of 5-11 year olds is now being encouraged in some countries. We present data on child COVID-related morbidity in Israel and discuss the complexities surrounding vaccinating children aged 5-11.

METHODS

Data were obtained from Israel's open COVID database regarding new confirmed daily COVID-19 cases, severe hospitalized cases and deaths by age group in Israel from February 2020-November 2021, as well as vaccination rate and adverse events following vaccination.

RESULTS

In 5-11 year olds, there were 460 hospitalizations, including 72 moderate to critical (0.007% population rate), with 3 deaths (0.0003% population rate). Children (0-19) made up the largest proportion (41%) of cases, but comprised just <0.1% of deaths, and <1% of severe cases. Post-vaccine myocarditis was much lower than severe COVID risk except in boys aged 12-19 where it was equivalent to the risk of mechanical ventilation due to COVID in boys aged 10-19 (12 per 100,000). High numbers of children were quarantined.

CONCLUSIONS

COVID risk is minimal for most children though rare complications do occur. Israeli and US pediatric associations have recommended vaccinating children, particularly in high-incidence scenarios where risk-benefit balance is more clear-cut. However only a quarter of eligible parents have vaccinated their children. Parents may consider health grounds but also restrictions on children, population vaccination levels, waning immunity and new variants, and should be provided with clear information to help them make an informed decision. Policymakers should reevaluate the need for isolations, testing and mask-wearing in school age children, which are detrimental to their wellbeing.

Parental decision and intent towards COVID-19 vaccination in children with asthma: an econometric analysis

Objective

Vaccination will be instrumental in controlling the COVID-19 pandemic, and vaccination of children will be necessary to achieve herd immunity. Given that children with chronic health conditions may be at increased risk of COVID-19, it is crucial to understand factors influencing parental decisions about whether to have their child vaccinated. The study objectives were to measure parental intent to have their child with asthma vaccinated against COVID-19 and identify the determinants of their vaccination decision.

Study design

This study is based on a cross-sectional exploratory observational online survey assessing parents' risk perception in the context of COVID-19.

Methods

In this study conducted in August 2020, the primary outcome was parent’s answer to the question on their intention to get their child vaccinated if a vaccine against COVID-19 was available. Participants were also asked about their intention to get vaccinated themselves. Independent variables studied included sociodemographic, clinical data (e.g. presence of other chronic diseases), psychological, cognitive and risk perception related to COVID-19. Simultaneous equations models (3SLS) and seemingly unrelated regressions model (SUR) were carried out to identify factors associated with intention to have the child vaccinated and participants’ intention to get vaccinated themselves against COVID-19.

Results

A total of 305 participants completed the survey. Overall, 19.1% of participants reported being unlikely or very unlikely to vaccinate their child against COVID-19 if a vaccine was available. Similarly, 21.0% were unlikely or very unlikely to get vaccinated themselves. The following factors were significantly associated with parents’ decision to have their child vaccinated: parental level of education (p = 0.003), employment status (p < 0.001), sex of the child (p = 0.019), presence of other chronic diseases (p = 0.028), whether or not the child had been vaccinated against influenza in the past (p < 0.001), parental anxiety (p = 0.046), and consultation with a health professional since the beginning of the pandemic (p = 0.009). There was a strong relationship between likelihood of not intending to have one’s child vaccinated and personal intent not to get vaccinated.

Conclusion

These findings are essential in planning for the communication and dissemination of COVID-19 vaccination information to parents, especially for children with asthma or other chronic medical conditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13933-z.

Parents' perceptions on COVID-19 vaccination as the new routine for their children ≤ 11 years old

Canadian children 5-11 years old became eligible for COVID-19 vaccination on November 19, 2021, with eligibility for younger children expected later. We aimed to descriptively assess parents' COVID-19 vaccine intentions and acceptability of future doses, including co-administration and annual vaccination for their children. We conducted a cross-sectional Canadian online survey of parents from October 14-November 12, 2021, just prior to authorization of the pediatric formulation of the BNT162b2 COVID-19 vaccine for children aged 5-11 years. We assessed parents' intention to vaccinate their children aged 5-11 years, 2-4 years, and 6-23 months; reasons for their intention; and preferences for delivery and access to vaccines. Of 1129 parents, 56% intended to vaccinate their child aged 5-11 years against COVID-19; intentions were lower for children aged 6-23 months (41.9%) and 2-4 years (45.4%). Most parents who intended to vaccinate supported co-administration with routine (61.1%) or influenza (55.4%) vaccines, administration at school (63.6%), receipt of booster doses of COVID-19 vaccine (57.8%), and annual vaccination (56.4%) for their child. Despite parents' high COVID-19 vaccination uptake for themselves (88.8%), intentions for children aged 5-11 years was low. Currently, 56.9% of Canadian children aged 5-11 years have received one dose of a COVID-19 vaccine, and only 37.1% are fully vaccinated. Given that intentions for children <5 years was lower than those 5-11 years, we can also expect low uptake in this group. Parents' preferences regarding delivery and access to COVID-19 vaccination should be considered by public health officials when planning vaccination strategies for children.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents’ willingness to vaccinate their adolescents and their point of view regarding adolescents’ involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16–18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents’ involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents’ involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents’ COVID-19 perceived threat and adolescent vaccination, as well as between parents’ trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents’ vaccination adherence. Considering the importance of adolescents’ involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

Mental Health and Health-Related Quality of Life in German Adolescents after the Third Wave of the COVID-19 Pandemic

Evaluations after the first and second waves of the COVID-19 pandemic in Germany showed an increase in mental health problems and a reduction in health-related quality of life (HRQoL). The aim of the study was to assess those aspects after the third wave of COVID-19 in adolescents who decided to receive a vaccination. In students aged 12–17 years recruited from schools in one German region, mental health (by the strengths and difficulties questionnaire, SDQ) and HRQoL (by KIDSCREEN-10) were assessed by both a self- and parental report. Data from 1412 adolescents (mean age 14.3 years, SD = 1.64) and 908 parents were collected. The mean self-reported HRQoL was T = 53.7 (SD = 11.2), significantly higher in boys than in girls and higher in younger (12–14 years) than in older (15–17 years) adolescents. In total, 18.7% of adolescents reported clinically relevant psychological symptoms, especially peer problems (23.5%), emotional problems (17.4%), and hyperactivity (17.1%). Comparing the present data to evaluations after the first and second waves of COVID-19, adolescents rated a higher HRQoL and reported less mental health problems after the third wave. After 1.5 years of living with the pandemic, adolescents have adapted to the changes in everyday life. Further, the relaxation of restrictions, better school organization, and the prospect of the vaccination may have increased optimism, wellbeing, and contentment, leading to declining but still alarming rates of psychological symptoms.

Using human-centred design to tackle COVID-19 vaccine hesitancy for children and youth: a protocol for a mixed-methods study in Montreal, Canada

INTRODUCTION

To successfully combat COVID-19 vaccine hesitancy and increase uptake, research has demonstrated that interventions are most effective when tailored to meet local needs through active engagement and co-development with communities. This mixed-methods project uses a human-centred design (HCD) approach to understand local perspectives of COVID-19 vaccine hesitancy and develop strategies to enhance vaccine confidence for children and adolescents.

METHODS AND ANALYSIS

Project ECHO (Étude Communautaire sur l'Hésitation vaccinale contre la COVID-19) combines population-based surveys of parents and adolescents with community-based participatory action research to design and pilot strategies to enhance COVID-19 vaccine confidence in two underserved and ethnoculturally diverse neighbourhoods of Montreal, Canada. Two surveys conducted 6 months apart through primary and secondary schools are used to monitor vaccine acceptance and its social determinants among children and youth. Analyses of survey data include descriptive and inferential statistical approaches. Community-led design teams of parents and youth from the two participating neighbourhoods, supported by academic researchers, design thinking experts and community partners, use an HCD approach to: (1) gather data to understand COVID-19 vaccine decision-making among parents and youth in their community and frame a design challenge (inspiration phase); (2) develop an intervention to address the design challenge (ideation phase) and (3) pilot the intervention (implementation phase). Strategies to evaluate the community-led interventions will be co-developed during the implementation phase.

ETHICS AND DISSEMINATION

This study has been approved by the research ethics boards of the Sainte-Justine University Hospital Centre and the University of Montreal. Community design teams will be involved in the dissemination of findings and the design of knowledge translation initiatives that foster dialogue related to COVID-19 vaccination for children and adolescents among community, school and public health stakeholders. Findings will be disseminated through peer-reviewed publications, conference presentations, community forums, policy briefs, and social media content.

Public attitudes and influencing factors toward COVID-19 vaccination for adolescents/children: a scoping review

OBJECTIVE

This study aimed to systematically clarify attitudes and influencing factors of the public toward COVID-19 vaccination for children or adolescents.

STUDY DESIGN

This was a scoping review.

METHODS

This scoping review screened, included, sorted, and analyzed relevant studies on COVID-19 vaccination for children or adolescents before December 31, 2021, in databases, including PubMed, Elsevier, Web of Science, Cochrane Library, and Wiley.

RESULTS

A total of 34 studies were included. The results showed that the public's acceptance rate toward COVID-19 vaccination for children or adolescents ranged from 4.9% (southeast Nigerian mothers) to 91% (Brazilian parents). Parents' or adolescents' age, gender, education level, and cognition and behavior characteristics for the vaccines were the central factors affecting vaccination. The vaccine's safety, effectiveness, and potential side-effects were the main reasons affecting vaccination.

CONCLUSIONS

Realizing current public attitudes of COVID-19 vaccination for adolescents or children can effectively develop intervention measures and control the pandemic as soon as possible through herd immunity.

Evaluating COVID-19 Vaccine Willingness and Hesitancy among Parents of Children Aged 5–11 Years with Chronic Conditions in Italy

COVID-19 vaccination has been extended to include children aged 5–11 years. This cross-sectional survey evaluated parental COVID-19 vaccine willingness and hesitancy, and associated factors, for their children aged 5–11 years with chronic conditions. A telephone survey was conducted from 14 December 2021 to 4 January 2022. The questionnaire assessed participants’ socio-demographic and health-related information, attitudes towards COVID-19 infection, hesitancy, by using the PACV-5 (Parent Attitudes About Childhood Vaccines Survey Tool), and sources of information. A total of 430 answers were collected anonymously. Respondents with no cohabitant who had been infected by SARS-CoV-2 and having been vaccinated against COVID-19 had a higher concern about the severity of COVID-19. The parents’ perceived risk that the child could be infected by SARS-CoV-2 was higher in those more concerned about the severity of COVID-19, with an older child, and who had at least one cohabitant positive for COVID-19. Only 38.8% parents were willing to vaccinate their children against COVID-19. Parents who did not need additional information, those with higher education, those who have been vaccinated against COVID-19, those whose child was older, who had received information on this vaccination from physicians, with higher self-reported concern about the severity of COVID-19, and who had a higher perceived risk that their child could be infected by SARS-CoV-2, expressed a greater willingness to vaccinate their child. Overall, 26.3% were high-hesitant, with a PACV-5 score ≥ 7. Respondents who did not get the COVID-19 vaccine, were less educated, with a lower concern about severity of COVID-19, and with a lower perceived risk that their child could be infected by SARS-CoV-2, were more likely to be high-hesitant. New policies and educational programs regarding COVID-19 vaccination for children with chronic conditions are needed to reduce hesitancy and increase vaccination uptake.