Parental vaccine hesitancy and influenza vaccine type preferences during and after the COVID-19 Pandemic

Seasonal influenza vaccine (SIV) greatly reduces disease burden among school-aged children, yet parental vaccine hesitancy remains a persistent challenge. Two types of SIV are available for children in Hong Kong and other locations: inactivated influenza vaccine (IIV), administered through intramuscular injection, and live attenuated influenza vaccine (LAIV), administered via nasal spray. We aimed to understand how vaccine hesitancy shaped parental preference for LAIV versus IIV, particularly amidst important public health events, such as the COVID-19 pandemic and the massive rollout of COVID-19 vaccination campaigns. We employed a concurrent mixed-methods design. The quantitative part involves longitudinal surveys spanning three years, from pre-pandemic to post-pandemic periods, tracking parental vaccine hesitancy and preference for SIV types. The qualitative part involves 48 in-depth interviews, providing insights into parental preference for SIV types, underlying reasons, and related values. Our quantitative analyses show an overall increase in parental vaccine hesitancy and preference for LAIV over IIV after the onset of the COVID-19 pandemic and especially after the rollout of the COVID-19 vaccination campaign. Further logistic regression modelling based on the cohort data shows that higher vaccine hesitancy, coupled with the COVID-19 vaccination campaign rollout, predicts a greater preference for LAIV over IIV. The qualitative analysis complements these results, highlighting that LAIV’s non-invasive nature aligns with parental values of prioritizing natural immunity and concerns about overmedication, leading to a more acceptable attitude towards LAIV. Leveraging the higher acceptability of LAIV compared to IIV among parents with high vaccine hesitancy could promote childhood vaccination uptake. We examined how parents’ concerns about vaccines and major public health events affected their preference for different types of seasonal influenza vaccines for children. Currently, children can receive either an injected vaccine or a nasal-spray vaccine. We tracked parental vaccine hesitancy and their preferences for different types of vaccines over three years covering a period before the COVID-19 pandemic and a period during the pandemic. Parents became more hesitant about seasonal influenza vaccines for children after the start of the COVID-19 pandemic and the rollout of COVID-19 vaccines. Higher vaccine hesitancy and the rollout of COVID-19 vaccines predicted a greater preference for nasal-spray vaccines for children among parents. Parents preferred the non-invasive nature of the nasal-spray vaccines and were concerned about overmedication, particularly vaccines that were administered via injection. We suggest that the nasal-spray vaccines could be one option offered to address high parental vaccine hesitancy. Yuan et. al examine how parental vaccine hesitancy and the rollout of COVID-19 vaccination programs affected preferences for the type of childhood seasonal influenza vaccines. Results provide insights for future vaccination programs by examining reasoning behind parental decisions.