DÄ internationalArchive9/2022COVID-19 Vaccination in Children—Vaccination Status, Intention to Vaccinate, and Ways To Promote Informed Parental Decision-Making

Research letter

COVID-19 Vaccination in Children—Vaccination Status, Intention to Vaccinate, and Ways To Promote Informed Parental Decision-Making

Dtsch Arztebl Int 2022; 119: 142. DOI: 10.3238/arztebl.m2022.0118

Muschalik, C; Orth, B; Merkel, C; De Bock, F; von Rüden, U

LNSLNS

Germany’s Standing Vaccination Committee (STIKO) issued a vaccination recommendation for children aged 12–17 on 16 August 2021 (1). For children aged 5–11 years with previous disease the recommendation was issued in the middle of December 2021. (Inter)national studies so far have shed light on parents’ intention to vaccinate their child and factors associated with this—but this happened before a vaccine had been approved for use in children. Reliable data on whether parents decide to vaccinate their underage children after approval and recommendation by the STIKO and what factors play into this have not been collected in Germany so far. This article aims to identify factors and starting points to support parental decision-making.

Methods

The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) carried out a nationwide representative survey among 1500 German-speaking parents of underage children (n=279 from a migrant background) from 7 September 2021 to 5 October 2021. Parents were defined as persons in charge of caring for underage (physical, adopted) children or stepchildren, who were at least 16 years old themselves. One parent was interviewed in each family, regardless of whether one or two parents lived in any one household at the time. The data were collected by means of computer aided telephone interviews (CATI, n-750); response rate 11%) and web based online surveys (CAWI, n=750).

The interviews recorded vaccination status, intention to vaccinate, risk assessment, attitudes and opinions towards COVID-19 vaccination for children (2) and towards childhood vaccination in general (3). The attitudes of parents who were unvaccinated themselves were compared with those of vaccinated parents. The significance of differences between groups were studies by means of the intersections of the 95% confidence intervals (95% CI). Because of the complex sampling design, we used procedures for complex samples (SPSS CSTABULATE) to evaluate the data. The data were weighted according to the distribution of age, sex, level of education and federal state (Bundesland) of all parents in Germany.

Results

Vaccination status and intention to vaccinate

According to self-reports, 81% (95% CI: [79; 83]) of all parents had been vaccinated at least once and 76% [74; 79] had received all doses of the vaccine. Of the children aged 12–17, the parents reported that 52% [47; 57] had received at least one dose and 39% [34; 43] had received all doses of the vaccine. Of the children of vaccinated parents, 62% [57; 67] had received one vaccine dose, whereas this was the case for only 3% [1; 12] of the children of unvaccinated parents. Relative to as yet unvaccinated children, notably more vaccinated parents than unvaccinated parents intended to have their child older than 11 (sooner) vaccinated (40% [31; 49] versus 2% [1; 6]). More than half of the vaccinated parents intended to have their children under the age of 12 vaccinated (55% [51; 60]); among unvaccinated parents this was the case for only 9% [5; 16].

Risk estimate

Unvaccinated parents rarely perceived it as (very) likely that their own children might be infected with the coronavirus (17% [13; 23]) compared with vaccinated parents (48% [45; 51]). They more rarely rated the coronavirus as (very) dangerous for their child (10% [7; 15] versus 30% [27; 33]). Furthermore they more rarely deemed it (very) likely that their child might develop long COVID (4% [2; 7] versus 26% [23; 29]).

Attitudes towards and opinions on COVID-19 vaccination in children and on childhood vaccinations in general

Vaccinated parents were in more cases convinced that the vaccine is safe for children and that vaccination contributes to containing the pandemic and returning to normal life than unvaccinated parents (Table 1). Unvaccinated parents were more likely than vaccinated parents to state the opinion that natural immunization as a result of infection with the virus is beneficial for their child. They generally are more commonly of the opinion that vaccinations against childhood diseases may lead to long term health harms (Table 2).

Agreement scores of vaccinated/unvaccinated parents re: attitudinal items regarding COVID-19 vaccination of their own children
Table 1
Agreement scores of vaccinated/unvaccinated parents re: attitudinal items regarding COVID-19 vaccination of their own children
Agreement scores among vaccinated/unvaccinated parents regarding childhood vaccinations in general
Table 2
Agreement scores among vaccinated/unvaccinated parents regarding childhood vaccinations in general

Discussion

Parents who are vaccinated themselves are more likely to decide to have their children vaccinated. It therefore remains crucial to educate the unvaccinated adult population about the benefits of being vaccinated for themselves and their children. It should be borne in mind when talking to such parents that in making decisions about vaccinating their children, short term impairments (for example, adverse effect such as a fever) and safety concerns carry more weight than in the decision about being vaccinated themselves (4)—one might, for example, explain that adverse effects indicate that the immune system is reacting as desired and that such effects usually wane after a few days.

It is also important to emphasize clearly the long-term benefits of vaccinating children. Even if mild disease courses ago hand in hand with a high degree of immunization in the children (5), the risk is that the children may develop long COVID and, furthermore, contribute to the spread of the virus. COVID-19 vaccination therefore reduces the risk for long COVID, protects vulnerable groups, and enables a faster return to normal everyday life—for the entire family. It seems essential that parental trust in the safety of the COVID-19 vaccine is strengthened. In this context, the focus on the positive risk-benefit ratio noted by the European Medicines Agency (EMA) for vaccinating children too should be strengthened and supported by primary care physicians or pediatricians. Further important access points for addressing parents on children in a targeted manner are children’s day centers and schools. The BZgA provides target-group specific information and motivational services to this end.

Carolin Muschalik, Boris Orth, Christina Merkel, Freia de Bock, Ursula von Rüden

Federal Centre for Health Education; carolin.muschalik@bzga.de

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 9 December 2021, revised version accepted on 24 January 2022.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Muschalik C, Orth B, Merkel C, de Bock F, von Rüden U: COVID-19 vaccination in children—vaccination status, intention to vaccinate, and ways to promote informed parental decision-making. Dtsch Arztebl Int 2022; 119: 142–3. DOI: 10.3238/arztebl.m2022.0118

1.
Robert Koch-Institut: Mitteilung der STIKO zur Aktualisierung der COVID-19-Impfempfehlung für Kinder und Jugendliche (16.8.2021). www.rki.de/DE/Content/Kommissionen/STIKO/Empfehlungen/PM_2021-08-16.html (last accessed on 26 January 2022).
2.
Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R: Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PloS One 2018; 13: e0208601 CrossRef MEDLINE PubMed Central
3.
Martin LR, Petrie KJ: Understanding the dimensions of anti-vaccination attitudes: the vaccination attitudes examination (VAX) scale. Ann Behav Med 2017; 51: 652–60 CrossRef MEDLINE
4.
Damnjanović K, Graeber J, Ilić S, et al.: Parental decision-making on childhood vaccination. Front Psychol 2018; 9: 735 CrossRef MEDLINE PubMed Central
5.
Dowell AC, Butler MS, Jinks E, et al.: Children develop robust and sustained cross-reactive spike-specific immune responses to SARS-CoV-2 infection. Nat Immunol 2022; 23: 40–9 CrossRef MEDLINE PubMed Central
Agreement scores of vaccinated/unvaccinated parents re: attitudinal items regarding COVID-19 vaccination of their own children
Table 1
Agreement scores of vaccinated/unvaccinated parents re: attitudinal items regarding COVID-19 vaccination of their own children
Agreement scores among vaccinated/unvaccinated parents regarding childhood vaccinations in general
Table 2
Agreement scores among vaccinated/unvaccinated parents regarding childhood vaccinations in general
1.Robert Koch-Institut: Mitteilung der STIKO zur Aktualisierung der COVID-19-Impfempfehlung für Kinder und Jugendliche (16.8.2021). www.rki.de/DE/Content/Kommissionen/STIKO/Empfehlungen/PM_2021-08-16.html (last accessed on 26 January 2022).
2.Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R: Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PloS One 2018; 13: e0208601 CrossRef MEDLINE PubMed Central
3.Martin LR, Petrie KJ: Understanding the dimensions of anti-vaccination attitudes: the vaccination attitudes examination (VAX) scale. Ann Behav Med 2017; 51: 652–60 CrossRef MEDLINE
4.Damnjanović K, Graeber J, Ilić S, et al.: Parental decision-making on childhood vaccination. Front Psychol 2018; 9: 735 CrossRef MEDLINE PubMed Central
5.Dowell AC, Butler MS, Jinks E, et al.: Children develop robust and sustained cross-reactive spike-specific immune responses to SARS-CoV-2 infection. Nat Immunol 2022; 23: 40–9 CrossRef MEDLINE PubMed Central