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BACKGROUND: Parents are the primary decision makers for their children's vaccination, yet, we have limited knowledge on what influences their decision making related to COVID-19 vaccination. The study aimed to understand these different considerations that shape the decisions of parents of children aged 5-11 years old. METHODS: We conducted a qualitative study that included online focus group discussions (FGDs) with parents of children aged 5-11 years old. Data was collected between July 26th, 2022, and February 15th, 2023. A total of eight FGDs were conducted, audio-recorded and transcribed verbatim. Thematic analysis was conducted, and peer debriefing was used to ensure methodological rigor. RESULTS: Findings revealed that parents of vaccinated and unvaccinated children employed language of risk-benefit analysis to inform their decision-making. Parents of vaccinated children highlighted concerns about spreading COVID-19, family member's health, and long COVID-19. For parents of unvaccinated children, they perceived potential vaccine side effects as more harmful than the risks associated with COVID-19. Participants contended that there was a lack of transparency from the government and public health agencies, highlighting inconsistent messaging which had fractured their trust in COVID-19-related recommendations and mandates. CONCLUSIONS: Our results indicate that improved transparency on how evidence is developed and why recommendations and mandates shift during the pandemic would foster trust in the government and public health agencies. Open communication with health providers on the potential risks and benefits would also improve caregivers confidence in the vaccine.
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INTRODUCTION: Although COVID-19 vaccine safety in 5-11-year-old children has been documented, half of Ontarian children this age remain unvaccinated. This study aimed to assess caregivers' vaccine acceptance for 5-11-year-old children and identify factors associated with vaccine non-acceptance. METHODS: A multi-language self-administered survey was sent to caregivers of 5-11-year-old children through schools and community health centers within the Greater Toronto Area from April-July 2022. Sociodemographic characteristics and immunization behaviours were collected for caregivers, their 5-11-year-old children, and any older siblings. The primary outcome, COVID-19 vaccine acceptance, was previous uptake of COVID-19 vaccine or caregiver intent to vaccinate for their 5-11-year-old child. Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS: In total, 807 caregivers were included in analysis. Although 93â¯% of caregivers had received two doses of COVID-19 vaccine, 77â¯% had a 5-11-year-old child who received at least one dose of vaccine. Caregivers age was associated with vaccine acceptance (vs.â¯<â¯40â¯years; adjusted odds ratio [aOR] 2.1, 95â¯% confidence interval [CI] 1.4-3.1 for ages 40-49; aOR 2.8, 95â¯% CI 1.1-7.1 for ages ≥50â¯years). Immunization factors associated with vaccine acceptance included caregiver COVID-19 vaccination (aOR 38.1 vs. unvaccinated caregivers; 95â¯% CI 15.8-92.3), older siblings COVID-19 vaccination (aOR 49.2 vs. unvaccinated siblings; 95â¯% CI 18.3-132.3), and recent influenza vaccination for the child (aOR 6.9 vs. no influenza vaccine; 95â¯% CI 4.6-10.5). Among 189 caregivers with unvaccinated 5-11-year-old children, the most common reasons for non-acceptance were concerns about long-term side effects (59â¯%), lack of experience vaccinating children (41â¯%), and concerns that vaccines were developed too quickly (39â¯%). CONCLUSION: Acceptance of COVID-19 vaccination for 5-11-year-old children were associated with caregiver vaccine behaviors and sociodemographic factors. These findings highlight groups of caregivers that can be targeted for educational interventions and concerns that may be addressed to increase vaccine confidence.