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April 2023, Volume 73, Issue 4


COVID-19 vaccination in paediatric age group- parental hesitancy justified?

Laraib Malik  ( Basic Health Unit, Khalid Jameel dispensary, Karachi )
Sina Aziz  ( Consultant Paediatrician, Karachi-Pakistan )


The pandemic of COVID 19 has given rise to a large number of deaths and disease complications.1,2 Of the over 615 million cases worldwide to date as of September 2022,3 1.57 million have been in Pakistan.4 Moderately a lot of significant public health measures have been found effective in alleviating the spread of the COVID-19 pandemic. This includes wearing masks, maintaining social distance and vaccination. Approximately 67% of the population needs to be vaccinated in order to achieve herd immunity and vaccine effectiveness.5

When the vaccine initially received emergency authorization, vaccines were being administered to priority groups such as health care professionals, essential workers, and individuals over the age of 65, with guidelines subsequently expanding.5 Vaccine data from clinical trials has shown promise in preventing recipients from morbidity and mortality due to COVID19 and there is hope for decreasing viral transmission and therefore disease volume and burden.5 In order for a vaccine to be effective in controlling the spread of COVID-19 it is estimated that 67% of the population will need to receive the vaccine to reach herd immunity.6 Pakistani population comprises of more than half of children less than 19 years of age,7 hence vaccination of children is of prime importance for protection against COVID-19. Also, as of this reason and also adult’s reluctancy towards vaccination; it seems very unlikely the Pakistan can ever attain herd immunity.

Regrettably, routine immunizations and the annual influenza vaccine for both children and adults have emerged as a major public health problem due to vaccine hesitancy, skepticism, and refusal.8 Certain sociodemographic groups including racial/ethnic minorities9 and those with lower socioeconomic status shows a lower vaccine confidence.10

Children spread COVID-19 less easily than the influenza virus.11 It is difficult to validate COVID-19 vaccine in children for a disease that appears to be mild in most children, particularly if they play a nominal role in spreading the infection to others.12

The CDC recommends that children ranging from 6 months to 4 years should get their primary series doses of Covid-19. Children aged 5 years older should get their primary series plus the booster. Children from age group 5 to 11years are currently recommended to get the original monovalent booster. Those who are 12 years and above should receive Pfizer or Moderna (bivalent) booster.13 The U.S. government, through USAID, is supporting the Government of Pakistan’s COVID-19 paediatric vaccination campaign for 5- to 11-year-old children. The campaign took place in Islamabad and selected districts of Sindh and Punjab provinces on 19th September 2022.14

Successful propagation and implementation of public health policies to eradicate the global pandemic have been affected by vaccine hesitancy. Since children contribute to half of Pakistan’s population, it is vital to include children and their parents in efforts to achieve herd immunity and eventually disease eradication, which are the goals of every vaccination programme. The demographic groups that have been the most adversely affected by the pandemic exhibit the highest rates of hesitancy and this could potentially push us further from health equity. Also, this hesitancy is fragile and should not be taken for granted; communities and families must be incorporated into decision making to ensure that whole populations move together in solidarity. Efforts to disseminate information regarding the COVID-19 vaccine should be culturally tailored and delivered through effective sources to decrease the COVID-19 illness burden in disproportionately affected groups.15






1.      Centers for Disease Control and Prevention (CDC). CDC COVID Data Tracker: Centers for Disease Control and Prevention; 2020. [updated 2020 Nov 23, cited 2021 July 6. Available from:

2.      Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 020;20: 5334.

3.      Novel Coronavirus (COVID-19) Cases reported worldwide available from:  Cited on 11.January, 2023

4.      Novel Coronavirus (COVID-19) Cases in Pakistan. Available from:  Cited on 11.January, 2023.

5.      Randolph HE, Barreiro LB. Herd immunity: understanding COVID-19. Immunity. 2020;52:73741. 012.Cited on 11.January, 2023

6.      Zimmer C, Corum J, Wee SL. Coronavirus Vaccine Tracker The New York Times; 2020. [updated 2020 Nov 24, cited 2021 Jul 6]. Available from: 2020/science/coronavirus-vaccine-tracker.html?name=styln-coronavirus-vaccines®ion=TOP_BANNER&block=storyline_ menu_recirc&action=click&pgtype=Article&impression_id=73d1ac50-2b6e-11eb-9a15-5767dafb2b73&variant=1_Show Cited on 11-01-2023.

7.      UNICEF in Pakistan. Available at; media/596/file/Situation%20Analysis%20of%20Children%20in%20Pakistan.pdf Cited on 11-01-2023.

8.      Quinn SC, Jamison A, An J, Freimuth VS, Hancock GR, Musa D. Breaking down the monolith: understanding flu vaccine uptake among African Americans. SSM Popul Health. 2018;4:25– 36.

9.      Jamison AM, Quinn SC, Freimuth VS. “You don’t trust a government vaccine”: narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med. 2019;221:87–94.

10.    Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, et al. Parental hesitancy about routine childhood and influenza vaccinations: A national survey. Pediatrics. 2020;146:e20193852.

11.    .Danis K, Epaulard O, Bénet T, et al; Investigation Team. Cluster of coronavirus disease 2019 (COVID-19) in the French Alps, 2020. Clin Infect Dis. 2020;71:825-832. doi:10.1093/cid/ciaa424

12.    Opel DJ, Diekema DS, Ross LF. Should we mandate a COVID-19 vaccine for children?. JAMA pediatrics. 2021;175:125-6.

13.    CDC up-to-date vaccination. Available at: coronavirus/2019-ncov/vaccines/stay-up-to-date.html Cited on 11-01-2023

14.    United States and Government of Pakistan Partner to Launch Pediatric Vaccination Campaign. Available at: coronavirus/2019-ncov/vaccines/stay-up-to-date.html Cited on 11, January 2023

15.    Bhopal S, Nielsen M. Vaccine hesitancy in low-and middle-income countries: potential implicationsfor the COVID-19 response. Archives of Disease in Childhood. 2021;106:113-4.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: