Knowledge, Attitude, and Practices of Paediatricians in the West Bank, Palestine, Regarding COVID-19 Vaccination Among Children Younger than 12 Years: A Cross-Sectional Study, October to November 2023

<b>Background/Objectives</b>: Paediatricians' recommendations influence parental decisions to vaccinate their children. On 19 January 2022, the World Health Organization authorized the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) under Emergency Use Listing for children under 12 years as a measure to mitigate disease spread and direct protection for children with underlying conditions. We assessed knowledge, attitudes, and practices (KAP) of Palestinian paediatricians regarding COVID-19 vaccination for children under 12 years and identified factors affecting support for vaccination. <b>Methods</b>: From 1 October to 8 November 2023, we surveyed paediatricians across the West Bank using structured telephone interviews. We collected data on sociodemographic characteristics and KAP regarding COVID-19 vaccination and calculated KAP scores from eight, nine, and nine items, respectively, with total scores categorized as poor/moderate/good. We performed bivariable and multivariable analyses to identify factors associated with paediatricians supporting COVID-19 vaccination for children under 12 years. <b>Results</b>: Of the 367 eligible paediatricians, 323 (88%) responded; the median age was 51 years (range: 28-70); 27% supported COVID-19 vaccination for children. Mean scores for knowledge (range 0-8), attitude (0-9), and practice (0-9) were 3.0 ± 2.1, 3.9 ± 2.4, and 4.0 ± 1.7, respectively. The mean overall KAP score (0-26) was 11 ± 4.8. Safety and efficacy concerns and lack of long-term data were the main reasons for hesitancy. Higher knowledge scores (PR = 1.8, 95% CI: 1.3-2.5, <i>p</i> = 0.001) and positive attitudes (PR = 1.6, 95% CI: 1.1-2.3, <i>p</i> = 0.01) were significantly associated with paediatricians' support for vaccination. After adjustment for other factors, participants with regular continuing medical education attendance (aPR = 1.4, 95% CI: 1.0-2.6, <i>p</i> = 0.045), trusting WHO recommendations (aPR = 3.1, 95% CI: 1.4-7.8, <i>p</i> = 0.047), having a positive attitude score (aPR = 1.3, 95% CI: 0.4-4.4, <i>p</i> = 0.041), and a good total KAP score (aPR = 1.1, 95% CI: 1.0-1.2, <i>p</i> = 0.044) supported COVID-19 vaccination for children. <b>Conclusions</b>: Support for COVID-19 vaccination among Palestinian paediatricians was low, associated with their knowledge, attitudes, and trust in health authorities. The revised WHO recommendations from 10 November 2023, decreasing the priority of vaccinating healthy children, could influence the opinion of paediatricians. However, the low support for COVID-19 vaccinations could affect the performance of other vaccination programmes and should be carefully addressed through targeted education.