A cross-sectional study to assess childhood vaccine hesitancy in the Maltese Islands

Abstract

Background: Literature on vaccine hesitancy in the Maltese Islands is limited to perspectives from local healthcare professionals or students amidst the COVID-19 pandemic, or as part of international studies which compare various countries. Aim: The main aim of this dissertation was therefore to gain more insight into local vaccine hesitancy by focusing mainly on parents’/guardians’ views and perceptions on childhood vaccines at a point in time (during late 2023). Specific objectives were to assess whether they prioritised certain vaccines over others and whether they believed that there are other important vaccines besides those on the National Immunisation Schedule. Methodology: For this quantitative cross-sectional study, Google Forms was used to create an English and Maltese version of the questionnaire and the URL links were then distributed online through reputable Facebook groups. Its sections were demographics, the validated PACV (Parental Attitudes about Childhood Vaccinations) tool and a section on local vaccination settings. Other methods of data collection were the involvement of proxies (nurses) working at the National Immunisation Service (NIS) who shared QR codes to both language versions, with parents/guardians who attended the site with their children. An email invitation containing the URL links, was sent to all parents/guardians who use the free childcare scheme. Results and Discussion: A total of 1112 individuals responded to the questionnaire, out of which 912 (82.0%) suited the inclusion criteria and completed it. The necessary weighting was carried out. Many participants always chose to vaccinate their children (79.2%) and without delay (76.7%) and many also trusted their children’s doctors (81.3%) and confided with them on issues regarding childhood vaccines (89.2%). Such findings were similar to those from other vaccine hesitancy studies which also used the PACV tool. However, there were also several hesitant findings mainly in the questions on safety and efficacy of childhood vaccines from the PACV tool. Although some of these issues were also expressed in certain studies, others contrasted quite significantly. The most alarming of these was that only 9.4% of participants believed that children do not need to receive fewer vaccines over a short period of time. Key themes that emerged from the results were the tendency to opt for natural childhood immunity rather than vaccines (in 40.5% of participants), the MMR vaccine not being among the top 3 prioritised vaccines, and the influenza nasal spray not influencing perceptions on the importance of the childhood influenza vaccine (no influence in 61.0% of those in favour and in 71.1% of those against). Hesitancy was also observed in the final section on local vaccination settings, particularly towards the adult influenza and COVID-19 vaccines. Vaccine hesitancy was especially prevalent in the 18-24 age group, those whose education was up till secondary level, and the Gozo district. Educational level and District were each found to have an independent effect upon vaccine hesitancy. Overall PACV scores were statistically associated with different age categories (p-value: 0.029), different levels of education (p-value: <0.001) and different districts (p-value: <0.001). Mitigating the above hesitancies among the population will therefore help to enhance local vaccine confidence. Various recommendations for doing so have been outlined at the end of this dissertation.