Decoding the Factors Influencing Parental Vaccine Decision-Making: Insights from Saudi Arabia on COVID-19 Vaccination for Children—Lessons for Future Pandemics

Background: In Gulf nations such as Saudi Arabia, where COVID-19 vaccination is optional, parental decision-making regarding vaccinating children is critical. Understanding the psychological factors that drive these decisions can shape future vaccination strategies. Methods: Between November 2021 and January 2022, a cross-sectional, web-based validated survey was conducted using chain-referral (snowball) sampling across multiple social media platforms. A total of 2176 parents residing in Saudi Arabia with children aged 5–18 years participated. The 5C psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility) were assessed. Multinomial logistic regression was employed to determine factors influencing parental decision-making across three child age groups: 5–11 years only, 12–18 years only, and both age ranges (5–18 years). Results: Overall, 77.9% of parents agreed to receive all scheduled doses of the COVID-19 vaccine themselves, while 58.6% agreed to vaccinate children aged 12 years or older, and only 41.9% agreed to vaccinate children younger than 12 years. Fathers were significantly more likely to accept vaccination [Odds ratio (OR) = 17.48, p = 0.01] compared to mothers, who showed higher reluctance (OR = 15.08, p = 0.01). Having a child aged 5–11 years increased reluctance threefold (OR = 3.16, p = 0.01). Parents who believed that returning to school was safe showed increased vaccine acceptance (OR = 4.32, p = 0.01). Confidence and collective responsibility were the strongest positive predictors of vaccine acceptance, particularly for younger children, with OR estimates of 1.23–1.53 for confidence and 1.33–2.13 for collective responsibility. Conversely, extensive information seeking (calculation) was associated with lower acceptance (OR = 0.09, p = 0.03). A history of COVID-19 hospitalization among family or friends was significantly associated with increased parental reluctance (p = 0.03). Conclusions: This study identifies key psychological and demographic factors influencing parental decisions regarding COVID-19 vaccination for children. Building parental confidence and fostering collective responsibility are essential for increasing vaccination rates, particularly among parents of younger children aged 5–11 years. Healthcare authorities should address vaccine safety concerns, provide clear and accurate information, and tailor strategies to parents who remain hesitant.