Abstract

     With approval of more COVID-19 vaccines for children, vaccine attributes may influence parental acceptance and choices. We aimed to assess effects of vaccine attributes and information on herd immunity on childhood COVID-19 vaccine acceptance. A survey experiment was conducted with caregivers of children aged 6 months to 11 years old and health care workers (HCWs) in China from September 14 to November 18, 2021. Respondents were randomly assigned to receive differing information on herd immunity (> 80% of the entire population must be vaccinated; or no information). Respondents then completed eight discrete choice tasks to assess vaccine acceptance based on attributes. 2331 (90.07%) of 2588 surveyed caregivers and 1576 (92.71%) of 1700 surveyed HCWs would accept COVID-19 vaccination for children, respectively. High Odds Ratios (OR) were found for acceptance of a vaccine with 90% over 50% efficacy (OR 6.70 [95% CI 6.11–۷٫۳۵] for caregivers; 11.44 [10.12–۱۲٫۹۵] for HCWs); and risk of adverse reactions to be 1 over 10 in 10,000 (3.96 [3.72–۴٫۲۲] for caregivers; 2.98 [2.76–۳٫۲۲] for HCWs). To achieve herd immunity target (> 80% vaccination coverage), vaccine efficacy should reach over 70% and risk of adverse reactions lower than 1 in 10,000. Knowledge on herd immunity target increased the odds of vaccine acceptance (1.82 [1.34–۲٫۴۶] for caregivers; 2.42 [1.58–۳٫۷۲] for HCWs). Childhood COVID-19 vaccine acceptance was high in China, independent of child’s age, and depended on vaccine attributes.

Introduction

     Vaccines are essential to control the global COVID-19 pandemic (Graham, 2020). Following widespread COVID-19 vaccination in adults and the elderly, vaccination of children and adolescents is recommended to protect them against COVID-19 (Nikolopoulou and Maltezou, 2022). In the United States, the COVID-19 vaccine was approved for emergency use in adolescents aged 12-to-15 years in May and children aged 5-to-11 years in October 2021 (FDA, 2021a, FDA, 2021b). In China, its emergency use was approved in children aged 3-to-17 years in June 2021 (The State Council of China, 2021a). China launched mass vaccination for children aged 12-to-17 years from late July, and for children aged 3-to-11 years from late October (The State Council of China, 2021b).

     Parents may be more cautious about vaccinating their children than vaccinating themselves (Rane et al., 2022), especially when children appear to be less susceptible to COVID-19 than adults (Ludvigsson, 2020). A scoping review from 35 surveys found that, the median rate of parents’ willingness to vaccinate their children against COVID-19 was 59.3% globally, lower than that for vaccinating themselves (Pan et al., 2021). Parental acceptance for childhood vaccination witnessed substantial variation across countries, ranging from 24% to 89% (Rane et al., 2022; Szilagyi et al., 2021; Bell et al., 2020; Kishore et al., 2021; Hetherington et al., 2021; Montalti et al., 2021; Aldakhil et al., 2021). Even in the same countries, parental acceptance of children’s COVID-19 vaccines was significantly lower than their acceptance for routine childhood vaccines (Temsah et al., 2021).

Conclusion

     In summary, this survey and DCE experiment show high acceptance of childhood COVID-19 vaccine among Chinese caregivers and HCWs, which was undifferentiated across children aged 6 months to 11 years. Vaccine acceptance depends on its attributes such as efficacy and safety. To achieve herd immunity target with above 80% vaccination coverage, the efficacy of COVID-19 vaccine should reach over 70% and the risk of adverse reactions should be lower than 1 in 10,000.