Caregivers' Willingness to Vaccinate Their Children Against COVID-19 in Saudi Arabia: A Cross-Sectional Survey

Evaluating COVID-19 vaccine acceptance among parents in Saudi Arabia: a systematic review examining attitudes, hesitancy, and intentions

Introduction

The COVID-19 pandemic, affecting adults and children equally, has caused significant disruption to countries worldwide, including Saudi Arabia. In Saudi Arabia, the fast preventative measures and mass vaccine enrollment were vital to contain the devastating impact of the pandemic. However, vaccine hesitancy, especially among parents toward vaccinating their children, was a significant obstacle to vaccine uptake.

Methods

This systematic review followed PRISMA guidelines to assess parental willingness to vaccinate their children against COVID-19, determine the key determinants influencing such intention and attitudes, and underline the significant concerns and misconceptions regarding the vaccine among parents. The Joanne Briggs Institute (JBI) checklist for prevalence studies was used to assess included studies for risk of bias.

Results

Twenty-three studies were included in this systematic review, representing a total of 20,926 participants, with over 66% of them were female. Over 37% of the participants were willing to vaccinate their children against COVID-19. Parents' age, gender, level of education, and income were the main determinants of their intention to vaccinate their children. The parents' main concerns were the potential vaccine side effects, safety, and efficacy. Major misconceptions about the COVID-19 vaccine included it being dangerous to children and that children are at lower risk of severe infection; hence, vaccines were not needed.

Discussion

This seminal review provides insights to public health policymakers, which should be considered and taken together in light of other studies addressing parental vaccine hesitancy.

Parental Willingness and Factors Influencing COVID-19 Vaccination for Children in Saudi Arabia

Purpose

The study aimed to examine the parents' willingness and its association with demographic factors, attitudes, and practices to vaccinate their child against COVID-19.

Patients and Methods

The study involved 2500 participants from various regions of Saudi Arabia and was conducted between July 1, 2021, and August 31, 2021. Information was gathered via an online questionnaire comprising 26 questions, distributed across social media platforms. Informed consent was obtained from all participants before the commencement of the study. A chi-square test was applied to analyze the association among variables, utilizing a subset of 2127 participants based on study inclusion criteria. A chi-square test was applied to observe the association.

Results

The willingness of parents to vaccinae their children against COVID-19 was found 61%. The main reason for taking was "Protect the child" by 1094 (51.4%%) and the main reason for refusing was "Side effects/safety concerns" by 477 (22.4%). 1846 (86.8%) participants, received the COVID-19 vaccine or were planning to receive it.

Conclusion

Our study concluded that parent's willingness to vaccinate their children against COVID-19 was relatively high in our sample as about two-thirds of them accept the vaccine for their child once it is available. The use of the health belief model demonstrated the urgent requirement for awareness and education campaigns in the private and public sectors to increase awareness of parents not only related to COVID-19 but also to cater to any unexpected or suspected pandemic of infectious disease in the future full capacity.

Fight Against the Mandatory COVID-19 Immunity Passport on Twitter: Natural Language Processing Study

BACKGROUND

To contain and curb the spread of COVID-19, the governments of countries around the world have used different strategies (lockdown, mandatory vaccination, immunity passports, voluntary social distancing, etc).

OBJECTIVE

This study aims to examine the reactions produced by the public announcement of a binding political decision presented by the president of the French Republic, Emmanuel Macron, on July 12, 2021, which imposed vaccination on caregivers and an immunity passport on all French people to access restaurants, cinemas, bars, and so forth.

METHODS

To measure these announcement reactions, 901,908 unique tweets posted on Twitter (Twitter Inc) between July 12 and August 11, 2021, were extracted. A neural network was constructed to examine the arguments of the tweets and to identify the types of arguments used by Twitter users.

RESULTS

This study shows that in the debate about mandatory vaccination and immunity passports, mostly "con" arguments (399,803/847,725, 47%; χ26=952.8; P<.001) and "scientific" arguments (317,156/803,583, 39%; χ26=5006.8; P<.001) were used.

CONCLUSIONS

This study shows that during July and August 2021, social events permeating the public sphere and discussions about mandatory vaccination and immunity passports collided on Twitter. Moreover, a political decision based on scientific arguments led citizens to challenge it using pseudoscientific arguments contesting the effectiveness of vaccination and the validity of these political decisions.

Parental Hesitancy and Attitude Concerning COVID-19 Vaccine and Its Side Effects in Saudi Arabia, Eastern Region

Background Vaccine hesitancy poses a substantial challenge to the field of public health. There are various factors that influence the willingness of parents to vaccinate their children. Addressing the factors contributing to vaccine hesitancy within the community has the potential to facilitate the development of more effective approaches for global vaccination initiatives. This study aims to assess parents' perspectives regarding the immunization of children aged five to 12 against COVID-19, including their experiences with adverse effects, as well as the factors that influence their hesitancy or acceptance of the vaccine in the Eastern Province of Saudi Arabia. Methods A web-based, cross-sectional study utilized an independently administered online questionnaire. The validated questionnaire was distributed to study participants through social networking platforms in order to recruit individuals from various locations in the eastern region of Saudi Arabia, such as Dammam, Al-Hassa, Al-Jubail, Ras Tanura, Dhahran, Al-Khobar, and Al-Qatif. Results The study encompassed a total of 399 participants. The most commonly reported adverse effects among the first and second children were pain at the injection site (1st child: 267 (66.70%), second child: 263 (66.20%)) and fever (1st child: 171 (43.10%), second child: 187 (47.50%)). A significant proportion of the participants, specifically 139 individuals (35%), expressed apprehension regarding immunization. This concern stemmed from various factors, including the fear of experiencing adverse effects, skepticism regarding the vaccine's efficacy, and exposure to potentially harmful information about the vaccine. Ninety-nine participants, accounting for 25% of the sample, indicated their agreement with the safety of COVID-19. Additionally, 104 participants, constituting 26% of the sample, held the belief that receiving vaccination aids in the prevention of severe illnesses caused by COVID-19. Notably, the most prevalent reason for vaccine hesitancy among participants was the fear of experiencing adverse effects. A total of 132 individuals, accounting for 33% of the participants, identified healthcare providers, including physicians and scientists, as reliable and trustworthy sources of vaccine information. A statistically significant correlation was observed between the demographic variables of the participants and their acceptance of the vaccine. Conclusion The study observed an acceptable vaccination rate among children aged five to 12 for the COVID-19 vaccine. Based on the investigation results, the primary apprehension expressed by parents regarding the immunization of their offspring pertained to the potential negative consequences associated with the vaccine. Nonetheless, it was observed that adverse effects were reported in less than fifty percent of vaccinated children. Addressing the concerns pertaining to the COVID-19 vaccination can enhance global participation in the immunization program aimed at mitigating future pandemics.

Parents' perception of COVID-19 risk of infection and intention to vaccinate their children

Background

Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs.

Objective

Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children.

Method

Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire.

Results

Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766).

Conclusion

Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.

Predictors of Parents' Willingness to Vaccinate Their Children Against COVID-19 in India: A Web-Based Cross-Sectional Survey

Background

Parents are more concerned about the available evidence of the safety, efficacy, and tolerability of the pediatric COVID-19 vaccine.

Aim

To assess the parents' willingness to vaccinate their children against COVID-19 and associate it with health belief model constructs.

Materials and Methods

A countrywide, online, self-administered, cross-sectional survey was conducted from December 15, 2021 to March 8, 2022. The HBM approach was used as a theoretical context to assess the predictors of parents' willingness to vaccinate their children against COVID-19.

Results

The majority (1,563; 95.4%) of parents are intended to immunize their children against COVID-19. Parent education, financial status, job, number of children, age-related vaccination status of the child, and household suffering from chronic disorders were significantly associated with a parent's willingness to recommend the COVID-19 vaccine for their children. The findings of HBM constructs indicated that perceived benefits (OR 14.222; 95% CI 7.192-28.124) of the COVID-19 vaccine in children, susceptibility (OR 7.758; 95% CI 3.508-17.155) of children toward COVID-19, and severity (OR 3.820; 95% CI 2.092-6.977) of COVID-19 infection in children were significantly associated with parent acceptance to vaccinate their children. Parents' higher perception of barriers (OR 0.609; 95% CI 0.372-0.999) to vaccination reduces the intention to vaccinate children against COVID-19.

Conclusion

The findings of our study reveal that the value of HBM constructs in the identification of predictors associated with the parents' willingness to encourage COVID-19 vaccine for their children. It is important to improve health and reduce the barriers to COVID-19 vaccination among Indian parents having children less than 18 years.

Parents' perception of COVID-19 risk of infection and intention to vaccinate their children

Background

Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs.

Objective

Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children.

Method

Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire.

Results

Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766).

Conclusion

Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.

Cutaneous reactions post‐COVID‐19 vaccination. Case series and literature review

Background

In Saudi Arabia, three approved vaccines against severe acute respiratory syndrome coronavirus 2 (AstraZeneca [AZD1222], Pfizer‐BioNTech [BNT162b2] and [Ad26. COV 2‐S] Moderna vaccine) have been administered to the population.

Objective

To characterise cutaneous adverse events associated with COVID‐19 vaccines.

Methodology

We collected information on 26 patients presented to two secondary health care facilities, over the period extending from mid of December 2020 to the 1st of January 2022 with cutaneous reactions after COVID‐19 vaccine administration. Data were descriptively analysed using Statistical Package for the Social Sciences, SPSS 23rd version.

Results

A total of 53.8% of the patients were male; 31% of the patients reported having at least one chronic illness. Reactions were most frequent after the first dose (57.6% of the patients). Messenger RNA‐based vaccines were the most frequently noted vaccines associated with the reactions (76.9% of the cases). The most common reactions were cutaneous small‐vessel vasculitis (19.2%), interface/lichenoid reactions (19.2%), psoriasis (15.4%), and acute urticaria (11.5%). Only 11.5% patients required admission to the hospital for their clinical presentation.

Conclusion

Most of our patients had mild reactions and were successfully managed with supportive treatments. However, still some patients may experience severe or long‐lasting reactions requiring systemic therapies.

Parents' views on the acceptability of a COVID-19 vaccine for their children: A cross-sectional study in Abu Dhabi-United Arab Emirates

BACKGROUND

The United Arab Emirates had approved the COVID-19 vaccine for children. Assessing parents' acceptance of the vaccine for their children will influence decision-making in the COVID-19 vaccine roll-out.

METHOD

Parents registered inthe AbuDhabiDepartmentofEducation (12,000 families) were invitedtocompleteanonlinequestionnaire from 8th September 2021 to 17th October 2021. Out of the 12,000 families, 2510 (21%) participants answered the survey. The questionnaire investigated the parents' attitudes and beliefs regarding the COVID-19 vaccine.

RESULTS

The vaccination rate among this group of respondents was high, with 2255 (89.9%) having received two doses and 1002 (45.5%) having already received a booster dose. Acceptance of the respondents to vaccinate their children was high, (75.1%) said they would vaccinate their children, with 64.4% reporting that they would immediately vaccinate their children if the vaccine were made available. Determinants of COVID-19 child vaccination acceptance included the respondent's vaccination status-i.e., if the respondent is already vaccinated (OR 4.96 [2.89-8.53]) or has taken the third dose (OR 2.37 [1.4-4.01])-their children's age (OR 1.11 [1.30-1.18] for older children), and their trust in the following information sources: the government (OR 2.53 [1.61-3.98]), health care providers (OR 1.98 [1.2-3.24]), or social media (OR 2.17 [1.22-3.88]). Increased level of education had a negative impact on the acceptance of giving the vaccine to children (OR 0.63 [0.52-0.77]); fear of side effects OR 0.000164 (0.000039-0.001) was another determinant. The main factor that encouraged parents to give their children the vaccine was to protect their child's health as reported by 1537 (55.5%) participants.

CONCLUSION

The Abu Dhabi community is highly accepting of the vaccine for their children. Future studies of how this vaccine acceptance can influence the pandemic are needed.

The willingness of parents to vaccinate their children younger than 12 years against COVID-19: a cross-sectional study in Malaysia

Background

The initiation of a new drug, for instance, the coronavirus disease 2019 (COVID-19) vaccine in children could be a source of major concern for parents. This study aims to determine the willingness of parents in Malaysia to vaccinate their children younger than 12 years against COVID-19.

Methods

An online cross-sectional survey was conducted nationwide in Malaysia from August 29, 2021, to October 17, 2021. Parents with children younger than 12 years were enrolled via the snowball sampling method.

Results

The analysis included data from 3,528 parents (79.5%) of the 4,438 survey responses received. Of these parents, 2,598 (73.6%) were willing, 486 (13.8%) were not willing, and 444 (12.6%) were still hesitant to vaccinate their children against COVID-19. Single parents (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.32–3.04; P = 0.001), parents with secondary or lower education (OR, 1.5; 95% CI, 1.21–1.96; P < 0.001), healthcare workers (OR, 1.7; 95% CI, 1.34–2.26; P < 0.001), parents who had significant contact with COVID-19 (OR, 1.3; 95% CI, 1.09–1.63; P = 0.006), and parents who had been vaccinated against COVID-19 (OR, 15.4; 95% CI, 9.76–24.33; P < 0.001) were found more willing to immunize their children. The common reasons for vaccination given by parents who were willing to immunize their children include protection of children (99.4%), protection of other family members (99.3%), and effectiveness (98.2%). The common reasons against vaccination given by parents who were not willing to immunize their children were uncertainty about the new vaccine (96.1%), concerns about vaccine contents (93.2%), limited vaccine information from physicians (82.3%), and the belief of vaccine was unsafe (79.8%).

Conclusions

In this study, nearly three-quarters of parents were willing to vaccinate their children younger than 12 years against COVID-19. The parents’ history of COVID-19 vaccination was the strongest independent predictor of their willingness to vaccinate their children. Therefore, future health education for the COVID-19 vaccine should focus on parents who are prone to vaccine refusal or hesitation, address the common reasons for vaccine refusal, and highlight the vaccine’s benefits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13682-z.

Willingness, refusal and influential factors of parents to vaccinate their children against the COVID-19: A systematic review and meta-analysis

We aimed to estimate parents' willingness and refusal to vaccinate their children against the COVID-19, and to investigate the predictors for their decision. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched Scopus, Web of Science, Medline, PubMed, CINAHL and medrxiv from inception to December 12, 2021. We applied a random effect model to estimate pooled effects since the heterogeneity was very high. We used subgroup analysis and metaregression analysis to explore sources of heterogeneity. We found 44 studies including 317,055 parents. The overall proportion of parents that intend to vaccinate their children against the COVID-19 was 60.1%, while the proportion of parents that refuse to vaccinate their children was 22.9% and the proportion of unsure parents was 25.8%. The main predictors of parents' intention to vaccinate their children were fathers, older age of parents, higher income, higher levels of perceived threat from the COVID-19, and positive attitudes towards vaccination (e.g. children's complete vaccination history, history of children's and parents' vaccination against influenza, confidence in vaccines and COVID-19 vaccines, and COVID-19 vaccine uptake among parents). Parents' willingness to vaccinate their children against the COVID-19 is moderate and several factors affect this decision. Understanding parental COVID-19 vaccine hesitancy does help policy makers to change the stereotypes and establish broad community COVID-19 vaccination. Identification of the factors that affect parents' willingness to vaccinate their children against COVID-19 will provide opportunities to enhance parents' trust in the COVID-19 vaccines and optimize children's uptake of a COVID-19 vaccine.

Parents’ and Guardians’ Willingness to Vaccinate Their Children against COVID-19: A Systematic Review and Meta-Analysis

COVID-19 vaccination for children is crucial to achieve herd immunity. This is the first systematic review and meta-analysis to estimate parents’ and guardians’ willingness to vaccinate their children against COVID-19 and identify the determinants of vaccination intention. Systematic research was performed on the two databases (PubMed and EMBASE) from inception to 6 November 2021. Acceptance rates were pooled by use of a random-effects model and all predictors of vaccine acceptance were identified according to the health belief model (HBM) framework. This analysis was registered with PROSPERO (CRD42021292326) and reported in compliance with the PRISMA guidelines. Of 452 identified records, 29 eligible studies were included (N = 68,327 participants). The estimated worldwide vaccination acceptance rate was 61.40% (95% CI: 53.56–68.69%, I² = 99.3%), ranging from 21.6% to 91.4% across countries and regions. In the determinant assessment, the age of parents and guardians, access to scientific information and recommendations, routine and influenza vaccination behavior, and the willingness of parents and guardians to vaccinate themselves were potentially significant predictors of the vaccination willingness. Given the limited quality and quantity of included articles, future studies with a rigorous design will be necessary for the confirmation of our findings.

Barriers and facilitators of childhood COVID-19 vaccination among parents: A systematic review

BACKGROUND

The acceptance of vaccination against COVID-19 among parents of young children plays a significant role in controlling the current pandemic. A wide range of factors that influence vaccine hesitancy in adults has been reported worldwide, but less attention has been given to COVID-19 vaccination among children. Vaccine hesitancy is considered a major challenge in achieving herd immunity, and it is more challenging among parents as they remain deeply concerned about their child's health. In this context, a systematic review of the current literature is inevitable to assess vaccine hesitancy among parents of young children to ensure a successful ongoing vaccination program.

METHOD

A systematic search of peer-reviewed English literature indexed in Google Scholar, PubMed, Embase, and Web of science was performed using developed keywords between 1 January 2020 and August 2022. This systematic review included only those studies that focused on parental concerns about COVID-19 vaccines in children up to 12 years without a diagnosis of COVID-19. Following PRISMA guidelines, a total of 108 studies were included. The quality appraisal of the study was performed by Newcastle-Ottawa Scale (NOS).

RESULTS

The results of 108 studies depict that vaccine hesitancy rates differed globally with a considerably large number of factors associated with it. The highest vaccine hesitancy rates among parents were reported in a study from the USA (86.1%) and two studies from Saudi Arabia (>85%) and Turkey (89.6%). Conversely, the lowest vaccine hesitancy rates ranging from 0.69 and 2% were found in two studies from South Africa and Switzerland, respectively. The largest study (n = 227,740) was conducted in Switzerland while the smallest sample size (n = 12) was represented by a study conducted in the USA. The most commonly reported barriers to childhood vaccination were mothers' lower education level (N = 46/108, 43%), followed by financial instability (N = 19/108, 18%), low confidence in new vaccines (N = 13/108, 12%), and unmonitored social media platforms (N = 5/108, 4.6%). These factors were significantly associated with vaccine refusal among parents. However, the potential facilitators for vaccine uptake among respondents who intended to have their children vaccinated include higher education level (N = 12/108, 11%), followed by information obtained through healthcare professionals (N = 9/108, 8.3%) and strong confidence in preventive measures taken by the government (N = 5/81, 4.6%).

CONCLUSION

This review underscores that parents around the globe are hesitant to vaccinate their kids against COVID-19. The spectrum of factors associated with vaccine hesitancy and uptake varies across the globe. There is a dire need to address vaccine hesitancy concerns regarding the efficacy and safety of approved vaccines. Local context is inevitable to take into account while developing programs to reduce vaccine hesitancy. There is a dire need to devise strategies to address vaccine hesitancy among parents through the identification of attributing factors.

Parents' intention for their children to receive COVID-19 vaccine: Implications for vaccination program in Macao

INTRODUCTION

The decision about vaccinating children is subject to their parents' decision. To inform strategies that support full vaccination coverage, it is important to understand the parents' vaccination attitude and tendency to act. This study aims to investigate the intention and the factors affecting parents' decision-making about vaccinating their children.

METHODS

A cross-sectional, self-administered online questionnaire was completed by parents of children aged 3-12 yeas in Macao between 7 March and 17 April 2022. The survey tool was informed by the Theory of Planned Behavior (TPB) which composes of the variable "intention" and three TPB constructs (Attitude, Subjective Norm, and Perceived Behavioral Control). Respondents rated their level of agreement on the construct statements using a 5-point Likert scale. Multiple linear regression analysis was used to determine if the TPB constructs were predictors of parents' intention.

RESULTS

A total of 1,217 parents completed the questionnaire. The majority of participants were mothers (83.2%), aged 31-40 years (62.7%), having two or more children (74.1%), had at least one dose of COVID-19 vaccine (84.4%) and considered themselves knowledgeable about the vaccine (62.1%), all of which were significantly associated with the intention to vaccinate their children (all p < 0.05). Their intention varied from negative (19.1%), neutral (38.4%) to positive (42.5%). Respondents were mostly concerned about the serious side effects that the COVID-19 vaccine (mean = 3.96 ± 1.23), highly acknowledged the expectation by the school (mean = 3.94 ± 1.15) and the community (mean = 3.90 ± 1.19) of children vaccination, and rated highly the ease of making necessary arrangement (mean = 3.93 ± 1.25). In the multiple linear regression model which explained 63.5% of the variance in the intention-to-vaccinate their children, only Attitude (B = 0.52, p < 0.001) and Subjective Norm (B = 0.39, p < 0.001) were identified as strong predictors. The major reasons for not having intention were safety concerns (n = 646/699, 92.4%). Participants' most trusted local information sources were doctors (n = 682), government (n = 426) and healthcare professional organizations (n = 416).

CONCLUSIONS

Vaccinating children with COVID-19 vaccine is a complex decision-making for parents. A key to a successful COVID-19 vaccination program is effective communication about the safety profile and the usage experiences warranting the integration of reliable information sources across different healthcare sectors.