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.