Parental acceptability of COVID-19 vaccination for children under the age of 18 years in China: cross-sectional online survey

Background It is expected that COVID-19 vaccines would become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children's vaccination. Objective This study investigated parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods This is a secondary analysis of a cross-sectional closed online survey among 2053 factory workers in Shenzhen, China during September 1-7, 2020. Participants of the online survey were full-time employees aged ≥18 years who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examination once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a sub-sample of those who had at least one child under the age of 18 years (n=1052). After being briefed that COVID-19 vaccines developed by China were likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years taken up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the Theory of Planned Behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlled for significant background characteristics. Results Among the parents, the prevalence of parental acceptability of COVID-19 vaccination for their children was 72.5% (n=764). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratios [AOR] 1.70, 95%CI 1.50-1.91), perceived family member would support them to have their children taken up COVID-19 vaccination (perceived subjective norm) (AOR 4.18, 95%CI 3.21-5.43), and perceived behavioral control to have the children taken up COVID-19 vaccination (AOR 1.84, 95%CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95%CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95%CI 0.74-0.99). Conclusions Parental acceptability of COVID-19 vaccination for their children aged under 18 years was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner.