Acceptance of COVID-19 vaccination among parents of children with autism and other neurodevelopmental disorders in Saudi Arabia: a cross-sectional study | BMC Public Health

This study is one of the first studies measuring the difference in COVID-19 vaccination acceptance rate between parents of autism and other neurodevelopmental disorders and other parent groups in Saudi Arabia. As vaccination has a crucial role in controlling highly infectious diseases, it is important to study vaccination acceptance rates in the population [2].

The results suggested that most parents of both diagnosed and healthy children’s groups would vaccinate their children (54.8%), with the highest level of acceptance shown by parents of healthy children (32.5%) as shown in (Fig. 2). Similar to a recent study in Saudi Arabia reported (53.7%) of parents with healthy children were willing to vaccinate their children among 333 respondents [15]. Another study in China reported (72.6%) an acceptance rate of COVID-19 vaccination among the general population [16]. The difference in the acceptance rate is likely related to the different targeted populations, and possibly because the COVID-19 vaccine is considered a new vaccine compared with other vaccines. Unlike the previous studies, which focus on the general population, this study is more specific to target both parents of healthy children and neurodevelopmental disorders children.

Showing the percentage of acceptance, hesitancy or refusal of COVID-19 vaccination among parents of healthy children vs parents of children with neurodevelopmental disorders

Even though the majority of respondents showed a high acceptance rate, If the hesitant parents were added with parents who refused to vaccinate their children to create one group, around 45.14% (the total number (n) 172 out of 381) will be almost equal to the number of parents who accept to vaccinate their children 54.85% (n = 209 out of 381) with a small difference between these two groups. These findings play a crucial role in showing the importance of establishing new interventions and campaigns to increase their education about vaccines.

One way ANOVA test was done as a part of the multivariate analysis; shows that parents’ perception about the COVID-19 pandemic as well as not vaccinating the child for reasons other than illness or allergy has a direct relationship with parents’ decision whether to vaccinate or not in both parents groups.

In this study, a demonstration of a correlation between parents’ perception of the COVID-19 pandemic and their decision to vaccinate their children of both groups, is shown in Table 3. Most parents in this study who thought the COVID-19 pandemic was dangerous would vaccinate their children (50.3%). In contrast, most parents who believed that the pandemic was exaggerated would not vaccinate their children (9.1%), and one of the causes was that they thought it was better for their children to develop immunity by getting sick than to get vaccinated, in addition to long term side effects. In another study done in the United Kingdom, addressing parental vaccine hesitancy and childhood influenza vaccine, parents believed that their children should build immunity by getting sick rather than getting vaccinated confirming the existence of this belief [17].

There was no significant relationship between being a parent working in the health field and accepting COVID-19 vaccination, as shown in Table 3. This result could be impacted by the low number of parents working in the health field involved in this study. However, is similar to a study conducted in China, which revealed that Chinese healthcare workers showed relatively low parental acceptability of COVID-19 vaccination for children under the age of 18 years [18]. On the other hand, being a parent with a relative who is a healthcare worker showed a significant relationship with the COVID-19 decision-making process, as these parents were more likely to vaccinate their children. These results are similar to another study done in Turkey, which showed that the vaccine uptake of children with parents who have a healthcare worker, friend, or relative was higher [19].

Parents’ age seemed to affect their vaccination decision. The majority of parents who would vaccinate their children were above 35 years of age for both diagnosed and healthy groups. Similar to the study that has been conducted among parents of children with unspecified health status in the Eastern Mediterranean region, this can be explained by several factors including educational, social, and personal effects [12]. This finding was in contrast with a study conducted in the United Arab Emirates, showing that parental vaccine hesitancy has no significant association with parents’ age [14].

In contrast to the non-significant association between the educational level and the parents’ decision in this study; a study in the United States revealed that the level of parental education is a contributing factor to vaccine hesitancy [20]. Several studies demonstrated that parents with less formal education have greater distrust in the medical community, express more concerns about vaccine safety, and have less belief in the necessity and efficacy of vaccines. Also, it has been found that parents with less than 12 years of education were more likely to report not having enough vaccination information compared with parents with some graduate school education [21,22,23,24,25].

As with many other studies, this study’s results have revealed that parents of both diagnosed and healthy groups who are willing to vaccinate their children were influenced by doctors’ recommendations, as shown in Table 2. Similar results were found in a study in Turkey, showing that physicians had a positive effect on the parents who accepted the vaccine [19]. The role of healthcare providers is crucial to overcome vaccine risks and to benefit from communication with the parents in the matter of influencing their decision of vaccinating their children [26, 27]. Other studies discussing vaccines preventing otitis media and seasonal influenza revealed that parents valued their physicians’ recommendations and are influenced by them [28, 29]. In relation to perception, parents of healthy children who thought that the pandemic was dangerous were affected by doctors’ recommendations and would vaccinate their children. However, parents of healthy children who believed that the pandemic was exaggerated were not affected by these recommendations. According to parents of diagnosed children, there was no relation between doctor’s recommendations and parents’ perceptions.

More than half of parents (60%) from both groups who refused the new COVID-19 vaccine expressed their fear about the safety and long-term side effects of the vaccine on their children, especially since this vaccine is still under trial for this age group and there are not enough studies about it. Another possible reason for the high rejection rate is that many parents, particularly those with affected children, believe that vaccines cause neurodevelopmental disorders in their children and since COVID-19 is a newly discovered virus, many people believe it never existed in the first place and that it is a conspiracy to destroy humanity. It could also be linked to the fact that many parents are waiting for some time before deciding to vaccinate their child since they want to make sure it is devoid of side effects first. A national survey involving more than 11,000 parents in the USA identified that parents who delayed and refused vaccines were more likely to have vaccine safety concerns and perceived fewer benefits associated with vaccines [30]. Similar results have been found in another study which reported that vaccine safety issues were one of the parents’ top concerns [14].