A survey study of vaccine hesitancy among children to COVID-19 vaccination and the roles of parental and social media influence.

INTRODUCTION

The COVID-19 pandemic brought unprecedented shifts in public health measures, including accelerated mass vaccination programmes. Although most children with COVID-19 are asymptomatic or have mild disease, they may act as reservoirs for SARS-CoV-2 transmission. Furthermore, multisystem inflammatory syndrome in children (MIS-C) can cause serious complications. COVID-19 vaccines became available in 2022 for Malaysian children aged 5-18, sparking public discussions on safety and necessity, which may have contributed to modest uptake in younger children. As most vaccine hesitancy studies focus on adults, our study aimed to assess hesitancy among children aged 10-17 and explore parental and social media influences on minors' assent to vaccination.

MATERIALS AND

METHODS

This study was conducted in the outpatient clinic of a tertiary and academic children's specialist hospital. A total of 200 parent-child pairs participated in a survey using an adapted and translated questionnaire in the Malay language, comprising 35-items divided into three sections with the attendance of a trained interviewer. Vaccine hesitancy was assessed using a 5-point Likert scale adapted from the Oxford COVID-19 Vaccine Hesitancy Scale.

RESULTS

The parent-participants were predominantly mothers (81%) and child-participants were equally distributed between primary and secondary schoolers. Vaccine hesitancy rates were 50% and 46% among parents and children, respectively. The overall vaccine hesitancy score was graded as moderate (mean score, 2.44; SD 0.43) among the children. Parents who were unemployed or homemakers were significantly associated with vaccine hesitancy in the child when compared with those on fulltime jobs (69.4% versus 30.6%, p=0.010). Parental history of COVID-19 was significantly associated with vaccine hesitancy (p=0.025), whereas parental hesitancy to vaccinate their child was associated with increased child vaccine hesitancy (p=0.004). Primary school than secondary school children were more likely to be vaccine hesitant (56% versus 36%, p=0.005). Vaccine hesitancy was negatively associated with the child's full-vaccination status (p=0.021). More than half of the children surveyed spent at least 6 hours daily on their smart devices, with one-third spending at least three hours on social media. However, their preferred choice of media platforms to seek Covid-19 information, was television (20.5%), followed by social media (17%) and printed media (11.5%). Of note, children in the non-vaccine hesitant group preferred COVID-19 information accessed from television and printed media (t=2.755, p=0.006 and t=2.539, p=0.011, respectively).

CONCLUSION

This study demonstrates that vaccine hesitancy in children negatively impacted the uptake of COVID-19 vaccine. Parental hesitancy significantly influences the child's hesitancy to vaccination. Health promotion programmes on vaccination may need to be intensified to the more at-risk for vaccine hesitancy among parents who are unemployed or homemakers and primary school children. Addressing vaccine hesitancy incorporating the child's agency in this respect for assent to vaccination may be a positive strategy in enhancing its uptake. While social media is undeniably an important channel, traditional media such as television remains an established and trusted option for dissemination of health policies and recommendations.