Parental Beliefs and Attitudes towards Pediatric Vaccination in a Country with High Vaccine Coverage

Background: Anti-vaccination movements are rising in different European and Western countries, causing a decline in the rate of pediatric vaccination. Portugal has one of the highest vaccine coverage rates among countries with non-mandatory pediatric vaccination, and overall higher levels of vaccine confidence. However, anti-vaccination ideas are spreading among parents of young children.

Aim: This study aimed to characterize parental beliefs and attitudes towards vaccination in Portugal and to explore its association with vaccine hesitation.

Methods: Based on the relevant literature, we developed a questionnaire to assess vaccines` safety and efficacy perception, perception of severity of vaccine-prevented diseases, conspiracy theory ideas, beliefs about immunizations requirements, social norms and relationship with health professionals. This questionnaire was disseminated online using the snowball method and several parenting social media groups. Parents of children 0-12 years old were invited to participate.

Results: The questionnaire showed good validity and reliability. A sample of 1118 parents aged 18 to 58 years old filled the questionnaire, and only 3.1% reported vaccine hesitancy regarding an eventual future child. All the evaluated dimensions showed discriminant power. A binary logistic regression was performed to test for discriminative power and predict vaccine hesitation. Perception of vaccine`s safety and efficacy, and positive attitudes towards vaccination requirements predicted the intention to adhere to the recommended immunization plan in the event of having another child.

Conclusions: The large majority of Portuguese parents of young children hold vaccine-favorable beliefs and attitudes. All dimensions evaluated were significantly different for parents who would not vaccinate a new child compared to those who would. Beliefs regarding vaccine`s safety and efficacy and acceptance of school or health services requirements were the most relevant dimensions for this choice.