DISCUSSION:
Our study documents the factors associated with accepting or rejecting a
COVID-19 vaccine in a priority paediatric population and is a timely
study given many of the leading COVID-19 vaccine producing
pharmaceutical companies are now considering extending their COVID-19
vaccine to the paediatric population. The findings highlight that the
vast majority (~80%) of the parents/carers of children
with CLDs are willing to get their child vaccinated against COVID-19.
This is in stark contrast to previous studies that have reported that
only around 40% parents/carers of children with chronic condition
intended to get their children vaccinated against other severe
respiratory viral disease like influenza (7). Risk perception is a major
driver in health behaviour and the fact that
more than 80% of parents/carers
in our study believed that children with CLDs are at greater risk of
COVID-19 infection than children without CLD may act as a key factor in
increasing vaccine coverage in high-risk children (8) when a COVID-19
vaccine will be rolled to wider paediatric populations.
However, one third of the parents (30%) who were likely to get their
child with CLD vaccinated against COVID-19 were unsure if the vaccine
would be safe for the child. Concerns around the safety and side effects
of the vaccine were also some of the major reasons cited by
parent/carers who not likely to get their child with CLD vaccinated
against COVID-19. Similar reasons have also been reported by mothers
unwilling to get their children vaccinated against COVID-19 in another
study (9). Additionally, half of the parents/carers who were not likely
to get their child vaccinated were concerned about their child getting
an illness other than COVID-19 from the vaccine and one third of them
were willing to keep their children at home to protect than from
COVID-19 rather than getting them vaccinated. These lines of evidence
suggest that while there is consensus among parents/carers of children
with CLD regarding the severity of COVID-19, the major issue around
uptake of COVID-19 vaccine for children with CLDs is probably around
safety of the vaccine (10). These concerns might be further enhanced by
the recent reports of unusual blood clots associated with COVID-19
vaccine (11). Risk communication messages highlighting the safety
profile and the efficacy of the vaccine specifically in high-risk
children may improve uptake.
The majority of the parents/carers reported that advice from the child’s
specialist/paediatricians or GP will positively impact their decision to
get their child vaccinated. Healthcare worker’s recommendation has been
consistently identified as a major predictor of vaccine uptake for other
diseases as well(12). Children with CLDs are different from children
without a CLD in the sense that they require ongoing follow-up visits
with their paediatricians/specialists or GPs. GPs and paediatricians
could use scheduled follow-up visits of children with CLDs to promote
COVID-19 vaccine and explain to their parents/carers how the rare side
effects outweigh the benefits of the vaccine(13).
One of the major limitations of our study is that the survey
participants were recruited from one hospital, however SCH is a major
hospital with a large diverse catchment population. Also, we do not know
the characteristics of the parents/carers who did not participate in the
survey and can be very different from those who did. Nevertheless, our
study has identified important factors that can be used in designing
public health messages to improve COVID-19 vaccine uptake in this
specific high-risk group of children when it becomes widely available
for clinical use.
Acknowledgement: The authors would like to thank all the
parents/carers of children with chronic lung disease for their valued
time and participation in the study. We are also grateful for the
support of the nursing staff at Sydney Children’s Hospital, Randwick.
Funding source: There was no funding source specific to this
study. NH is supported by a research fellowship of the National Health
and Medical Research Council of the Australian Government (APP1158646).
Financial disclosure: The authors have indicated they have no
financial relationships relevant to this article to disclose.
Potential conflict of interest: The authors have no conflicts
of interest relevant to this article to disclose.