Table 1 Determinants of parental hesitancy to vaccinate their children against COVID-19

Individual/group determinants

Beliefs, attitudes about health and prevention

 Belief that COVID-19 is not a serious illness

-

USA, Italy

[15, 16]

 Belief that children were not susceptible to infection

-

USA

[17]

 COVID-19 fear

+

Germany

[18]

 Acceptance and adherence to vaccination policies

+

Germany

[18]

Experience with past vaccination

 Parents’ past experiences of vaccination

+

USA, Germany

[17, 18]

 Children’s past experiences with vaccination

+

USA

[19]

Other factors

 A low proportion of COVID-19 among family members

-

China

[20]

Contextual determinants

Perception of the pharmaceutical industry/government

 Distrust in government, science, or the pharmaceutical industry

-

USA, Germany

[17, 18]

Communication and media environment

 Obtain information about COVID-19 vaccine from the government and public health agencies

+

Thailand

[21]

 Conflicting media messaging

-

Italy, USA, China

[16, 17, 22]

Policies/politics

 Mandatory vaccination

-

Hong Kong (China)

[23]

 School resumption

+

Hong Kong (China)

[23]

Sociodemographic related

 Female

-

USA

[19, 24]

 Higher education level

-

Hong Kong (China), USA, China

[15, 20, 23]

+

Italy, USA, Thailand, Japan

[16, 17, 21, 25]

 High income

-

China, Hong Kong (China)

[20, 23]

+

USA, Japan

[17, 25]

 Lower socioeconomic status

-

USA, Thailand, Japan

[17, 21, 25]

 Married/cohabitant

+

Italy

[16]

 Parents older age

+

USA, Germany

[17, 18]

 Asian

+

USA

[17, 24]

 Black/Hispanic parents

-

USA

[15, 17, 19]

 Single child

+

Italy

[16]

 Children’s poor health

-

China

[20]

 Younger children

-

USA, China

[17, 22]

Vaccine determinants

Risk/benefit (scientific evidence)

 Concern of efficacy of COVID-19 vaccines

-

Italy, USA, Thailand, Canada

[16, 17, 21, 26]

 Lack of long-term study results on vaccine efficacy

-

Thailand

[21]

 Vaccine no longer worked against new variants

-

USA, China

[17, 22]

 Concern of safety of COVID-19 vaccines

-

USA, Germany, Thailand, Canada

[15, 17, 18, 21, 26]

 Concern about vaccination side effects

-

USA, Thailand

[15, 21]

Cost

 Free vaccination

+

USA

[15]

Role of healthcare professional

 Having their child’s doctor who recommended the vaccine

+

Italy

[16]

Other factors

 Lack of community and family support for pediatric vaccination

-

USA

[17]

 Lack of choices of vaccine

-

Hong Kong (China)

[23]

 Rapid development of vaccine

-

Canada

[26]