Factors influencing pediatric COVID-19 vaccination uptake: a quantitative investigation in the Philippines

Background: COVID-19 vaccines were recommended for the pediatric population in the Philippines in February 2022, after adults, due to both the direct and indirect effects of COVID-19. Despite ongoing vaccination efforts in the Philippines, pediatric COVID-19 vaccination uptake remains low. As such, this study aimed to determine the enablers and barriers of pediatric COVID-19 vaccination uptake amongst children 5–11 years in the Philippines. Methods: A cross-sectional survey among 546 caregivers of children aged 5–11 years was conducted onsite in three selected regions in the Philippines with low COVID-19 vaccine coverage between July and October 2023. Multivariable logistic regression was performed to identify factors associated with pediatric COVID-19 vaccination uptake. Results: Of the respondents, 143 caregivers had at least one child vaccinated against COVID-19, while 395 had none. The most common reasons for vaccination were protection against COVID-19 (93.7%), influence of government-mandated regulations (48.3%), and recommendation of healthcare workers (19.6%). High vaccine confidence (79%), high perceived vaccine benefit (81.1%), and perceived need for vaccination (78.3%) were enablers of vaccination. Among those who did not vaccinate, the most common reasons were distrust in vaccine safety (58.5%), perception that the child was too young (25.3%), and the child not wanting to get vaccinated (18.2%). Caregivers who decided not to vaccinate also had concerns about side effects (35.7%), low perceived need for COVID-19 vaccination (21.5%), and disagreed at requiring vaccinations for schooling (26.3%). Caregiver age [aOR = 3.00; 95% CI 1.65–5.46 for adults 30–45 years vs. aOR = 2.65; 95% CI 1.17–5.5.99 for adults 46–59 years], and perceived need for vaccination (OR = 2.56; 95% CI 1.31–5.03) were associated with pediatric COVID-19 vaccination uptake in the multivariable analysis. These factors were compared to caregivers aged 18–29 and those who responded ‘neutral’ to the survey, respectively. Conclusions: Key factors associated with COVID-19 pediatric vaccination uptake in the Philippines were perceived protection against COVID-19 illness, government mandated regulations and healthcare worker recommendations, while non-vaccination was associated with safety concerns, and children’s age and preference to not be vaccinated. Understanding the social and behavioral drivers among caregivers may help policy decision-makers and implementers develop targeted interventions to enhance uptake of COVID-19 and routine childhood vaccines.