COVID-19 vaccination recommendations for children: drivers and barriers among pediatricians, Tunisia

Introduction

Pediatric COVID-19 vaccination has raised concerns among parents, particularly due to the perceived low severity of the disease in children and uncertainties about long-term vaccine safety. Pediatricians’ recommendations play a key role in parental acceptance. In Tunisia, vaccination coverage remains low despite authorization, suggesting hesitancy among healthcare professionals. This study aimed to identify the main motivations and barriers influencing pediatricians’ recommendations for COVID-19 vaccination in children.

Methods

A national descriptive cross-sectional study was conducted between July and October 2023 among pediatricians in the public and private sectors in Tunisia. Participants were selected by simple random sampling from the national physician directory. Data were collected through face-to-face interviews using a standardized questionnaire. Results are presented as simple frequencies and percentages with their 95% confidence intervals.

Results

A total of 192 pediatricians responded (a mean age= 50.9 ±12.9 years;female majority (57.3%)). Among participants, 40.6%; [33.7–47.6] reported recommending COVID-19 vaccination in children under 16, of whom two-thirds only for those with chronic diseases (65.4%; [54.3–75.0]). The main reasons for not recommending were fear of vaccine adverse effects (38.2%; [30.8–45.8]) and the absence of severe COVID-19 cases in children (36.4%; [29.0–43.8]). Motivations for recommending included protection against severe disease (40.5%; [32.6–48.5]) and the possibility of a worsening epidemiological situation (28.4%; [21.1–35.6]). Notably, 21.3%; [15.4–27.8] stated that no argument would lead them to recommend COVID-19 vaccination in children.

Conclusions

Pediatricians’ recommendations for COVID-19 vaccination in children remain limited and conditional. Addressing safety concerns, improving access to evidence, and strengthening the communication of national guidelines are essential to support vaccine promotion.

Key messages

• Only 40.6% of Tunisian pediatricians recommend COVID-19 vaccination in children, with hesitancy driven mainly by safety concerns and low perceived disease severity.

• Boosting pediatrician confidence requires updated scientific training, clearer national guidelines, and greater involvement of clinicians in vaccine policy development.