Parental attitudes toward routine childhood vaccination in the post-COVID-19 pandemic era

Abstract This study assessed parental attitudes toward routine childhood vaccination in five Arab countries (Egypt, Jordan, Saudi Arabia, Syria, and Libya) and explored factors associated with vaccine hesitancy in the post-coronavirus disease 2019 (COVID-19) pandemic period. Using a cross-sectional design, 2095 parents or guardians of children aged ≤ 4 years were surveyed via online and face-to-face interviews. The Arabic version of the Parent Attitudes about Childhood Vaccines Scale was used to measure parental vaccine hesitancy. Overall, 18.8% of parents were classified as vaccine hesitant. In multivariable modified Poisson regression analysis, residing in Libya was associated with a significantly lower prevalence of vaccine hesitancy compared with Egypt (adjusted prevalence ratio (aPR): 0.14, 95% CI 0.07–0.28; p <0.001), whereas rural residence (aPR: 1.28, 95% CI 1.03–1.58; p = 0.024), unemployment (aPR: 1.26, 95% CI 1.01–1.56; p = 0.040), having a child born after the COVID-19 pandemic (aPR: 1.54, 95% CI 1.22–1.94; p <0.001), family history of COVID-19-related death (aPR: 1.34, 95% CI 1.08–1.65; p = 0.007), lack of parental COVID-19 vaccination (aPR: 1.56, 95% CI 1.26–1.92; p <0.001), and lower confidence in vaccinations provided by the health system (aPR: 2.24, 95% CI 1.77–2.83; p < 0.001) were independently associated with higher parental vaccine hesitancy. Mediation analyses found no significant indirect associations through parental vaccine hesitancy on the relationships between education, country income, parental COVID-19 vaccination or infection history, and childhood vaccination. However, education, country income, and parental COVID-19 infection demonstrated significant direct effects on childhood vaccination status. These findings emphasize the importance of strengthening confidence in health systems and addressing socioeconomic disparities to reduce parental vaccine hesitancy and support childhood immunization programs in the post-pandemic era.