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Article: Understanding paediatric COVID-19 vaccination during the pandemic: a prospective cohort and a population-based registry study

TitleUnderstanding paediatric COVID-19 vaccination during the pandemic: a prospective cohort and a population-based registry study
Authors
KeywordsChildren
COVID-19 vaccine
Epidemiology
Longitudinal
Registry
School vaccination policy
Vaccine pass
Vaccine refusal
Issue Date1-Feb-2024
PublisherElsevier
Citation
The Lancet Regional Health - Western Pacific, 2024, v. 43 How to Cite?
Abstract

Background: Despite the early demonstrated safety and effectiveness of COVID-19 vaccines in children, uptake was slow throughout the pandemic and remains low globally. Understanding vaccine refusal could provide insights to improving vaccine uptake in future pandemics. Methods: In a population-wide registry of all COVID-19 paediatric vaccination appointments, we used interrupted time series analysis to evaluate the impact of public policies. In a population-based cohort of adults, we used population attributable fractions to assess the individual and joint contributions of potential determinants to paediatric COVID-19 vaccination, and used mediation analysis to identify modifiable mediators between political views and paediatric vaccination. Findings: School vaccination requirements were associated with an increase in vaccination appointments by 278.7% (95% CI 85.3–673.9) in adolescents aged 12–17 and 112.8% (27.6–255.0) in children aged 5–11. Government-mandated vaccine pass, required for entry into restaurants, shopping malls and supermarkets, was associated with increased vaccination appointments by 108.7% (26.6–244.0) in adolescents. The following four determinants may explain 82.5% (63.5–100.0) of the reasons why children were unvaccinated: familial political views, vaccine hesitancy for children, mistrust in doctors and academics, and vaccine misconceptions. The influence of political views may be mitigated since 95.9% (76.4–100.0) of its association with vaccine reluctance for adolescents was mediated by modifiable factors such as mistrust in health authorities and low vaccine confidence. Interpretation: School vaccination requirements and vaccine passes were associated with increased vaccine uptake. Clinicians should recognise that factors beyond health, such as political views, can influence paediatric vaccine uptake to a significant extent. Nonetheless, such influences could be mitigated by targeted interventions and public policies. Funding: Hong Kong Jockey Club Charities Trust, Research Grants Council, University Grants Committee, and Health Bureau.


Persistent Identifierhttp://hdl.handle.net/10722/340183
ISSN
2023 Impact Factor: 7.6
2023 SCImago Journal Rankings: 2.197
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorNi, Yanyan-
dc.contributor.authorFlores, Francis P-
dc.contributor.authorLun, Phyllis-
dc.contributor.authorNing, Ke-
dc.contributor.authorChow, Mathew SC-
dc.contributor.authorTian, Linwei-
dc.contributor.authorLin, Sheng-Hsuan-
dc.contributor.authorLam, Hugh S-
dc.contributor.authorCowling, Benjamin J-
dc.contributor.authorBishai, David M-
dc.contributor.authorLeung, Gabriel M-
dc.contributor.authorNi, Michael Y-
dc.date.accessioned2024-03-11T10:42:17Z-
dc.date.available2024-03-11T10:42:17Z-
dc.date.issued2024-02-01-
dc.identifier.citationThe Lancet Regional Health - Western Pacific, 2024, v. 43-
dc.identifier.issn2666-6065-
dc.identifier.urihttp://hdl.handle.net/10722/340183-
dc.description.abstract<p>Background: Despite the early demonstrated safety and effectiveness of COVID-19 vaccines in children, uptake was slow throughout the pandemic and remains low globally. Understanding vaccine refusal could provide insights to improving vaccine uptake in future pandemics. Methods: In a population-wide registry of all COVID-19 paediatric vaccination appointments, we used interrupted time series analysis to evaluate the impact of public policies. In a population-based cohort of adults, we used population attributable fractions to assess the individual and joint contributions of potential determinants to paediatric COVID-19 vaccination, and used mediation analysis to identify modifiable mediators between political views and paediatric vaccination. Findings: School vaccination requirements were associated with an increase in vaccination appointments by 278.7% (95% CI 85.3–673.9) in adolescents aged 12–17 and 112.8% (27.6–255.0) in children aged 5–11. Government-mandated vaccine pass, required for entry into restaurants, shopping malls and supermarkets, was associated with increased vaccination appointments by 108.7% (26.6–244.0) in adolescents. The following four determinants may explain 82.5% (63.5–100.0) of the reasons why children were unvaccinated: familial political views, vaccine hesitancy for children, mistrust in doctors and academics, and vaccine misconceptions. The influence of political views may be mitigated since 95.9% (76.4–100.0) of its association with vaccine reluctance for adolescents was mediated by modifiable factors such as mistrust in health authorities and low vaccine confidence. Interpretation: School vaccination requirements and vaccine passes were associated with increased vaccine uptake. Clinicians should recognise that factors beyond health, such as political views, can influence paediatric vaccine uptake to a significant extent. Nonetheless, such influences could be mitigated by targeted interventions and public policies. Funding: Hong Kong Jockey Club Charities Trust, Research Grants Council, University Grants Committee, and Health Bureau.</p>-
dc.languageeng-
dc.publisherElsevier-
dc.relation.ispartofThe Lancet Regional Health - Western Pacific-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectChildren-
dc.subjectCOVID-19 vaccine-
dc.subjectEpidemiology-
dc.subjectLongitudinal-
dc.subjectRegistry-
dc.subjectSchool vaccination policy-
dc.subjectVaccine pass-
dc.subjectVaccine refusal-
dc.titleUnderstanding paediatric COVID-19 vaccination during the pandemic: a prospective cohort and a population-based registry study-
dc.typeArticle-
dc.identifier.doi10.1016/j.lanwpc.2023.100976-
dc.identifier.scopuseid_2-s2.0-85177839218-
dc.identifier.volume43-
dc.identifier.isiWOS:001125288500001-
dc.identifier.issnl2666-6065-

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