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Vaccine hesitancy (VH) has been a major contributor to large outbreaks of vaccine-preventable diseases globally, including in the United States. Data from the 2019–2022 National Immunization Surveys were analyzed to assess parental hesitancy toward routine vaccination of their children aged 6 months −17 years. Joinpoint regression was employed to investigate trends in VH from 2019 to 2022 nationally overall and among socio-demographic subgroups. Using logistic regression, the difference between the prevalence of VH before and after the authorization of the COVID-19 vaccine for children aged 6 months-4 years, 5–11 years, and 12–17 years was computed. Both unadjusted and adjusted estimates were reported. VH was also compared within each socio-demographic subgroup with a reference level, at two-time points— before and after the authorization of the COVID-19 vaccine for each age group. Overall, VH remained around 19.0 % from Q2 2019 to Q3 2022. Parents of non-Hispanic Black children had the largest average quarterly decrease in VH (β = -0.55; p < 0.05 by test for trend). After the authorization of the COVID-19 vaccine for children aged 6 months to 4 years, the adjusted percentage of children having parents that reported VH decreased by 2.2 (95 % CI: −3.9, −0.6) percentage points (pp) from 21.6 % to 19.4 %. Conversely, for children aged 5–11 years, VH increased by 1.2 (95 % CI: 0.2, 2.3) pp, from 19.8 % to 21.0 %. VH among parents of non-Hispanic Black children decreased after the authorization of the COVID-19 vaccine for adolescents aged 12–17 years but remained significantly higher compared to parents of non-Hispanic White children before and after authorization of the COVID-19 vaccine for all age groups. About 1 in 5 children had parents reporting VH from 2019 to 2022. Parental VH increased after the authorization of the COVID-19 vaccine for children aged 5–11 years and declined for children aged 6 months-4 years.

Parental vaccine hesitancy is a key factor influencing children’s vaccination against infectious diseases such as the COVID-19. The current study aims to investigate how parent’s health literacy and health belief affect parental hesitancy toward the COVID-19 vaccination, and navigate effective measures to help parents make vaccination decision for children. A mixed-mode web survey was conducted among parents of children aged 3–11 years. Parental vaccine hesitancy, health literacy, and health beliefs were assessed. Parallel mediation model examined whether the association between parent's health literacy and vaccine hesitancy was mediated by health beliefs. In total, 11.3% of the 346 participants reported vaccine hesitancy. Hesitant parents were more likely to be he mother (Father: 4.5%; Mother: 12.9%) and with children having allergic issues (Allergic: 18.3%; Non-allergic: 9.8%). Meanwhile, parents with lower health literacy were more likely to show hesitancy towards vaccinating their children (β = −6.87, 95% CI = [−10.50, −3.11]). This relationship was partially mediated by more perceived barriers in vaccination (β = −2.53, 95%CI = [−4.09, −1.02]), but not other health beliefs. In other words, parents with better health literacy may perceive fewer barriers in making vaccination decision for their children, thus being less hesitant. Accordingly, healthcare professionals and policy makers could design education service to promote parents’ health literacy, and remove the perceived barriers as well as increase their confidence in following the COVID-19 vaccine guidance for children.

Vaccination has dramatically reduced the global burden of pediatric vaccine-preventable diseases, yet a decline in immunization rates in recent years has led to the re-emergence of diseases once nearing eradication, such as measles and pertussis. This trend is of particular concern for children with chronic conditions or those who are immunocompromised, as they face elevated risks of severe illness and complications. Parental vaccine hesitancy (PVH) plays a central role in this decline and is a multifactorial phenomenon shaped by demographic and socioeconomic factors, the child's health condition, parental attitudes and personal experiences, perceived disease risk and trust in the government and healthcare system. This targeted literature review demonstrates a consistent association between prior experiences of vaccine reactogenicity among parents or caregivers and subsequent hesitancy to vaccinate their children. Even mild or anticipated adverse events following immunization (AEFIs) can trigger emotional aversion or anxiety, lead to overestimation of the likelihood and severity of future reactions, erode trust in the healthcare system and vaccine safety information, and open susceptibility to anti-vaccine rhetoric, particularly when experienced by parents or their children. These experiences often outweigh clinical evidence in shaping vaccine decisions and contribute to long-term hesitancy. Addressing PVH requires a multifaceted approach. Healthcare providers must engage in empathetic, transparent communication, offering clear information about expected side effects and differences in vaccine platforms. Where feasible, offering less reactogenic vaccine options may help mitigate concerns. Additionally, proactively optimizing vaccine formulations for low reactogenicity in early development could reduce downstream hesitancy and improve public confidence. By acknowledging the emotional and experiential dimensions of PVH, public health strategies can better support informed parental decision-making and improve vaccine uptake in vulnerable pediatric populations.

Background In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). Method The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents’ Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. Results Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2–2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4–3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among immigrant parents (aOR 0.4, 95% CI 0.3–0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3–12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1–22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. Conclusion Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.

Seasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR). Through an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models. In total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32–0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35–0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49–0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58–0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41–0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09–3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33–1.84, p < 0.001). A high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

Background Little is known about parental coronavirus disease 2019 (COVID-19) vaccine hesitancy in children with neurodevelopmental disorders (NDD). This survey estimated the prevalence and predictive factors of vaccine hesitancy among parents of children with NDD. Methods A nationally representative cross-sectional survey was conducted from October 10 to 31, 2021. A structured vaccine hesitancy questionnaire was used to collect data from parents aged ≥ 18 years with children with NDD. In addition, individual face-to-face interviews were conducted at randomly selected places throughout Bangladesh. Multiple logistic regression analysis was conducted to identify the predictors of vaccine hesitancy. Results A total of 396 parents participated in the study. Of these, 169 (42.7%) parents were hesitant to vaccinate their children. Higher odds of vaccine hesitancy were found among parents who lived in the northern zone (AOR = 17.15, 95% CI = 5.86–50.09; p  < 0.001), those who thought vaccines would not be safe and effective for Bangladeshi children (AOR = 3.22, 95% CI = 1.68–15.19; p  < 0.001), those who were either not vaccinated or did not receive the COVID-19 vaccine themselves (AOR = 12.14, 95% CI = 8.48–17.36; p  < 0.001), those who said that they or their family members had not tested positive for COVID-19 (AOR = 2.13, 95% CI = 1.07–4.25), and those who did not lose a family member to COVID-19 (AOR = 2.12, 95% CI = 1.03–4.61; p  = 0.040). Furthermore, parents who were not likely to believe that their children or a family member could be infected with COVID-19 the following year (AOR = 4.99, 95% CI = 1.81–13.77; p  < 0.001) and who were not concerned at all about their children or a family member being infected the following year (AOR = 2.34, 95% CI = 1.65–8.37; p  = 0.043) had significantly higher odds of COVID-19 vaccine hesitancy. Conclusions Given the high prevalence of vaccine hesitancy, policymakers, public health practitioners, and pediatricians can implement and support strategies to ensure that children with NDD and their caregivers and family members receive the COVID-19 vaccine to fight pandemic induced hazards.

Background: Since the introduction of the SARS-CoV-2 vaccine, the incidence of complications associated with pediatric infection has markedly declined. However, there is a notable decline in vaccination coverage among younger age groups. The objective of this study was to identify the factors associated with hesitancy to receive the SARS-CoV-2 vaccine in parents of children aged 3–15 years in a Latin American context. Methods: A cross-sectional, analytical study was conducted between February and May 2023. Parents of children between the ages of 3 and 15, residing in the metropolitan region of Chile, were surveyed via an online or in-person questionnaire. Univariate analysis and a multivariate logistic regression model were performed. Results: Five hundred thirty-nine surveys were completed; 61.6% of parents were aged between 21 and 40 years, 42.3% had completed higher education, 79.4% had paid employment, and 98.1% were fully vaccinated. Age distribution of children was 36.9% for 3–5 years, 42.4% for 6–11 years, and 20.8% for 12–15 years. 87.4% was vaccinated. In the univariate analysis, vaccine hesitancy was observed in 9%, associated mainly with children 3–5 years, fewer doses in parents’ vaccination schedule, lacking risk perception and concerns about safety, and not knowing where to access pediatric vaccine formulations against COVID-19. In the multivariate analysis, the younger age, lacking risk perception, and concerns about the vaccine’s effectiveness were associated with vaccine hesitancy. Conclusion: Addressing hesitancy toward COVID-19 vaccines is of utmost importance. Educational interventions should be implemented to inform parents about the importance and effectiveness of COVID-19 vaccination in children, with special emphasis on parents of younger children, to increase vaccination coverage. Plain language summary Vaccine hesitancy in pediatric COVID-19 vaccines Background - Vaccine hesitancy is considered a threat for the public health. - SARS-CoV-2 vaccines have significantly impacted in the decrease of COVID-19 complications. - Vaccination coverage among younger age groups has declined. - This study aimed to identify factors contributing to vaccine hesitancy among parents of children aged 3 to 15 years in a Latin American context. Methods: - We conducted a cross-sectional study from February to May 2023. - We surveyed parents of children aged 3 to 15 residing in the metropolitan region of Chile, using online and in-person questionnaires. Results: - Nine% of parents showed vaccine hesitancy, mainly associated with younger children, fewer doses in the parents’ vaccination schedule, lack of risk perception, and concerns about vaccine safety and efficacy. Conclusions: - Addressing vaccine hesitancy is crucial. Educational interventions should be implemented to inform parents about the importance, safety and effectiveness of COVID-19 vaccination in children, with a special focus on parents of younger children, to support the vaccination strategy.

Background: COVID-19 vaccination started in Romania in December 2020. Child vaccination started in 2021 with children aged 12–15 years in August. For children aged 5–11 years, vaccination started in January 2022. The aim of our study was to describe COVID-19 vaccination hesitancy in Romanian children and vaccine acceptability in the general population. As parental consent is required for child vaccination in Romania, these aspects have a significant association. Methods: An analytical cross-sectional survey was conducted in October and November 2021 during the peak of the 4th COVID-19 wave. Results: After validation, 1645 participants formed the main study group: median age 35 years, 72.83% women, and 35.44% from the medical domain. In total, 1311 (79.70%) participants were vaccinated against COVID-19 and 188 (11.42%) had vaccinated their 12–18-year-old children against COVID-19. Parents’ level of education, geographic area of residence, and COVID-19 vaccination status were significantly associated with COVID-19 vaccination. The hesitancy factors of child vaccination included the novelty of COVID-19 vaccines (62, 47.32%), fear of adverse reactions (32, 24.42%), and anti-vaccinism in general (29, 22.13%). In the studied group, only 188 (11.42%) participants recommended vaccination of 5–11-year-old children. Vaccine acceptability was higher in the general population (1311, 79.70%) than in the medical domain (326 out of 583, 55.91%). General vaccine hesitancy was based mainly on beliefs regarding inefficiency (131, 39.22%) and fears about the side effects of the vaccine (76, 22.75%). Conclusions: Overall, the acceptability of COVD-19 vaccines in the Romanian population was influenced by the level of education, area of residence, and being a COVID-19-vaccinated parent. Public health intervention programs are essential.

Objectives: This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination. Methods: An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children. Results: Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children’s vaccines, and participants’ generalized anxiety disorder (GAD7) score did not significantly correlate with children’s COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children. Conclusion: Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.

Objective To characterize the differences between COVID-19 vaccine-hesitant and vaccine-accepting parents in the Bay Area. Methods We analyzed a cross-sectional survey of 251 parents of children (< 18 years) from six San Francisco Bay Area counties in November of 2022. We adapted WHO’s Vaccine Hesitancy Scale (VHS) into a 9-item Likert scale measuring COVID-19 vaccine hesitancy. We assigned a VHS score to each participant, with lower VHS scores indicating higher vaccine hesitancy. We performed multiple linear regression analyses with VHS scores and children’s vaccination status as outcomes and demographic factors as predictors. Results Parents of children who had received at least one dose of the COVID-19 vaccine had a 17.1% higher VHS score compared to parents of children who had not received any dose ( p  < 0.01). Additionally, parents with annual income <$50,000 had a 9.6% lower VHS score compared to parents with income > $150,000 ( p  < 0.01), indicating higher vaccine hesitancy in lower-income parents. Conclusions Low-income parents appear to be more vaccine-hesitant than high-income parents in the Bay Area. Future public health interventions should focus on lower-income parents to improve vaccine uptake.