key: cord-0734301-kubqn7rr
authors: Liu, Yuxin; Ma, Qianwen; Liu, Huini; Guo, Zifen
title: Public Attitudes and Influencing Factors towards COVID-19 Vaccination for Adolescents/Children: A Scoping Review
date: 2022-02-09
journal: Public Health
DOI: 10.1016/j.puhe.2022.02.002
sha: e4023164cf5adebb961836055e41fc472119095e
doc_id: 734301
cord_uid: kubqn7rr

Objective To systematically clarify attitudes and influencing factors of the public towards COVID-19 vaccination for children or adolescents. Design A scoping review. Methods This scoping review screened, included, sorted, and analyzed relevant studies on COVID-19 vaccination for children or adolescents before 31 December 2021 in databases, including Pubmed, Elsevier, Web of Science, Cochrane Library, and Wiley. Results A total of 34 studies were included. The results showed that the public’s acceptance rate towards COVID-19 vaccination for children or adolescents ranged from 4.9% (southeast Nigerian mothers) to 91% (Brazilian parents). Parents’ or adolescents’ age, gender, education level, and cognition and behavior characteristics for the vaccines were the central factors affecting vaccination. The vaccine’s safety, effectiveness, and potential side effects were the main reasons affecting vaccination. Conclusions Realizing current public attitudes of COVID-19 vaccination for adolescents or children can effectively develop intervention measures and control the pandemic as soon as possible through herd immunity.

The coronavirus disease 2019 (COVID-19) 1 is a new strain of coronavirus called as a severe acute respiratory syndrome coronavirus (SARS-CoV-2) or COVID-19. 4 , persistent COVID-19 pandemic has generated over 4 500 000 deaths worldwide. Since the first pandemic spread, experts have always stressed the importance of personal protective measures (e.g., home quarantine, wear masks, and disinfecting) 5 . However, in essence, these physical protective measures can not eliminate the virus and restore people's everyday life. Similarly, it is also impossible for the public to abide by protective measures for many years.

Herd immunity 6, 7 is an important measure to control the pandemic situation as soon as possible from protecting susceptible individuals through a significant enough immune individual in the group. The COVID-19 vaccines' development and application may be the effective roads to curb the pandemic spread and then realize herd immunity 6 . As we know, the Pfizer-BioNTech COVID-19 vaccine was emergently approved and put into use in the U.S on 11 December 2020. After that, a -19 9 . Even so, we found that adults varied degrees of hesitation about the vaccine, and the acceptance rate ranged from 29.4% to 86% in COVID-19 vaccination studies over the past few months 10 . The majority of people hesitated because of COVID-19 vaccines' safety and side effects, which remains a principal problem for children. Today, lots of evidence about the vaccines' safety and effectiveness among children is provided, and FDA urgently approved Pfizer-BioNTech COVID-19 vaccines for application among adolescents on 10 May 2021 11 and among Children 5 through 11 years of age on 29 October 2021 12 . Experts have repeatedly stressed that child protection remains the key to reducing infection rates. Once a vaccine is available, vaccinating young people and children is necessary 13 . However, there was no high acceptance rate in Pan's 14 report. The majority of parents were skeptical and unwilling to receive emergency-approved vaccines. With the continuous fermentation of COVID-19 pandemic, the pace of vaccine development has also increased, appearing the new progress in public willingness to vaccinate children.

Until now, COVID-19 vaccination remains essential for achieving herd immunization to reduce the pandemic burden 15 . Vaccination hesitancy has been identified as a significant public health crisis. Whereas, we conducted a rapidly scoping review for the latest studies in recent months to clarify the public (including adults, parents, and adolescents themselves) attitudes and influencing factors towards COVID-19 vaccination for adolescents or children and provide information or advice for public institutions to better implement immunization plans. Considering the vaccines' rapid development and application, we mainly included studies after Pfizer-BioNTech COVID-19 vaccine first emergency approval among adults to present the latest views.

J o u r n a l P r e -p r o o f

We conducted a scoping review according to PRISMA Extension for Scoping Reviews (PRISMA-ScR) 16 

We imported retrieved literature into Endnote 9.1 and removed the duplicate; two researchers screened the title and abstract according to the principle of PICOs and cross-checked. After initial screening, we downloaded full texts. Two researchers read J o u r n a l P r e -p r o o f full texts for rescreening, and the third researcher decided on conflicts.

Included studies were produced since 2021, only in English. The study population consists of adults over 18 years old, adolescents, children, and parents (grandparents and other guardians are defined as parents in this study). Articles with incomplete or incorrect content, repeated data studies, commentary studies, and letters to editors without data were excluded to improve the included literature's quality.

We extracted relevant data through Excel (Microsoft Corporation), including the study's first author, study setting, study time, country, recruitment, study population, sample size, children or adolescents' age, COVID-19 vaccination acceptance rate, and subjective reasons or related factors associated with vaccination.

According to the extracted content, study characteristics, and influencing factors towards COVID-19 vaccines were presented in tables to clarify this scoping review's subject. In addition, the figures described influencing factors of high frequency.

According to the literature screening flow chart shown in Figure 1 , 34 studies were finally included. After removing the dropout and loss of follow-up caused by various reasons, 85 608 subjects (54 703 parents and adults, 30 905 adolescents) were left.

All included studies described survey methods and outcome indicators in detail. 72.10%). At the same time, we analyzed the data before and after the commencement of the national adolescent's COVID-19 vaccination program. The median before the approval was 49.43% (43.55%, 60.78%), and after the approval was 64.20% (48.95%, 80.20%). Even if the data has high heterogeneity, it can provide a reference in this study.

According to the studies reported, we summarized and charted the influencing factors of acceptance and hesitation for COVID-19 vaccine among the study population, divided into related factors (single factors or multi-factor statistical analysis) and related reasons (qualitative data) ( Table 2 ). Meanwhile, we summarized highfrequency factors and reasons as shown in Figure 2 and Figure 3 .

Twenty-four studies depicted sociodemographic or personal characteristics in vaccination attitudes for adolescents or children ( Figure 2 were associated with vaccine hesitation. 38 were associated with vaccine acceptance; and from wed/social media 21 or unofficial media 43 were associated with vaccine hesitation. The attention to COVID-19 vaccine-related information 22, 23, 30, 47 was also a related factor. In addition, compulsory vaccination policy 21, 30 , general favorability to vaccination 31 , trusting doctors 24, 35 , and COVID-19's tested or infected histories 40, 44 affected willingness to vaccinate children.

Twenty-one articles reported reasons associated with COVID-19 vaccination for children, see Table 1 for details; the main reasons for acceptance or hesitancy are shown in Figure 3 .

We found that most of them were associated with the vaccine characteristics among relevant reasons. Most people accepted the vaccine because of its protective effects 17, information and evidence 17, 24, 25, [37] [38] [39] .

Moreover, a small number of people preferred to vaccinate as they followed medical advices 21, 34 or mandatory policies 21, 37 , the vaccines were provided free of charge 35 , insufficient supply 17 , and they could contribute to national epidemic prevention and control 17, 25 . Equally, a small number of people were reluctant to vaccinate because of their personal beliefs 21, 27, 28 , or they had no time to vaccinate their children 17 .

This scoping review updates 34 recent studies on the public attitudes towards COVID-19 vaccination for adolescents or children. We found that the public's willingness to vaccinate children was not high, and the median acceptance rate was 53.70%. This rate is lower than the 61.40% vaccination rate for parents 14 . Snehota's systematic review 51 mentioned that percentage of people's intention to vaccinate themselves was 75%, which is also much higher than this study's results. Meanwhile, the results showed that the vaccination willingness of different study populations remains different. The median vaccination rate for children among adults and parents was 60.20%; while, the median acceptance rate among adolescents was 50.40% (in particular, these studies' time was after children's COVID-19 vaccination program).

This may be because adolescents do not fully understand COVID-19 vaccine and did not experience adequate vaccination plans' publicity like parents. In addition, the results showed that the acceptance rate after approval for children's COVID-19 vaccination was higher than before (64. According to current studies, the advantages of COVID-19 vaccine outweighed the disadvantages. Therefore, improving parents' knowledge and cognitive ability is also necessary to enhance vaccination rate 58 . Next, the pandemic risk rate in the study area was also the basis for parents' choice, which we should consider in promoting 

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Herd Immunity: Understanding COVID-19

Parents' Decisions to Vaccinate Children against COVID-19: A Scoping Review

Five Reasons Why COVID Herd Immunity is Probably Impossible

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

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J o u r n a l P r e -p r o o f 1-parents aged between 31 and 40 years old; 2-children age group was 4-12; 3-had a history of taking the seasonal influenza vaccine; 4-the scores of negative attitude scale.1-highly effective in protecting their children from COVID-19; 2-contributed to the control of COVID-19; 3-adequate supply of COVID-19 vaccination.Acceptance the scores of positive attitude scale 1-lack of information and evidence; 2-severe side effects; 3-the protection of COVID-19 vaccines will only last for a short time; 4-child was afraid of vaccination; 5-lack of time.

Awoere T. Chinawa 18 1-believed they could be infected with the COVID-19; 2-aware of someone that died from COVID- 19 1-not know where to get vaccination; 2-not know where to access good/reliable information; 3-not think vaccine was effective and necessary; 4-not think the vaccine was safe or concerned about side effects; 5-someone else told their child had a bad reaction and was not safe; 6-heard or read negative media associated with vaccine hesitancy towards childhood immunizations. 1-concerned about complications that may arise in the future; 2-the effectiveness of the preparation used.Hesitancy Pierre Verger 31 1-ttrust in institutions, sensitivity to social pressure, and general favorability to vaccination (for adolescents); 2-low perception of the risks of COVID-19 vaccines, general favorability to vaccination, and sensitivity to social pressure (for school children); 3-general favorability to vaccination, fear of contracting COVID-19, and trust in institutions (for preschoolers).-Acceptance 1-trusted in sources of COVID-19 related information other than government/public organization or public news media; 2-female gender either of parent or child; 3-parents aged ＜34 years; 4-lower household income; 5-parents are unemployed; 6-lower perceived risk of infection; 7-younger children; 8-mothers with lower satisfaction to social relationships. -Acceptance higher distress over the effects of the vaccine 1-not know enough about the harms that a vaccine has in the long run; 2-not trust the drug companies that the vaccine will be safe; 3-believed the virus is not dangerous; 4-doubt the safety of the vaccine in the short term.Hesitancy