Parents’ Willingness to Vaccinate Children against COVID-19 in Saudi Arabia: A Cross-Sectional Study

Round 1

Reviewer 1 Report

This is an interesting manuscript that reports on survey research of parents in Saudi Arabia regarding their willingness to get their children vaccinated for COVID-19.

While interesting, the manuscript has several issues that need to be discussed.

• The scientific merit of the research would benefit from providing a larger, theoretical context for the research. Missing from the literature review is a review of prior research on vaccine acceptance more generally. What do we know from other studies about the factors behind and likelihood of parental support for vaccination? What studies have looked at responses to pandemics in the past? Without a more generalized theoretical context, this study seems to be just a "fishing expedition" to find factors that matter rather than to test factors that are theoretically important or that have been studied before.
• More methodological information on the study is needed. The authors should provide more information about how the survey was conducted.
• Most importantly, the authors need to discuss exactly how the sample was selected. This appears to be a convenience sample. For this reason, this in no way can represent parents in Saudi Arabia. The authors need to discuss this limitation in even greater detail than they do (lines 339+). Technically, they cannot use statistical tests, as such tests presume probability sampling. To what population can such inferences be made in this case? We have no way of knowing who these particular people represent in terms of a larger population.

Some issues that are more minor but nonetheless should be addressed:

• The authors keep referring to their "univariate" analysis. However, when they are using this term, it is more appropriate to talk about it as bivariate analysis. Two variables are being assessed in each case--e.g., how does age impact support for vaccination? That is not a single or "uni" variable; rather, that is two variables. 
• Line 137 -- The % for married does not match what is reported in the table
• Line 185 -- a p value of .084 means that this is NOT statistically significant based on their stated criteria of p<.05. Therefore, this variable should not have been included in the regression analysis per their inclusion criteria.
• The variable regarding willingness to vaccinate with domestic or imported brand does not seem to have the correct attribute labels in Tables 3 and 4. Rather than yes/no, shouldn't this be domestic vs imported?
• Line 204 -- the percentage reported here is different than what is reported in the table
• Line 216 -- A p value of .057 is NOT statistically significant based on their stated criteria
• Figures 1 and 2 need labels to show the values represented by the bars

Author Response

Date: January 4, 2022

We have submitted a manuscript entitled" Parents' willingness to vaccinate children against COVID-19 in Saudi Arabia: A cross-sectional study" for publication in your journal: Vaccines (ID:-1494114). We thank you for your interest to our work and for the valuable remarks and comments you have made to ameliorate our paper.

Enclosed please find the details of the revisions to the manuscript and the responses to the referees’
comments.

Reviewer 1:

1-The scientific merit of the research would benefit from providing a larger, theoretical context for the research. Missing from the literature review is a review of prior research on vaccine acceptance more generally. What do we know from other studies about the factors behind and likelihood of parental support for vaccination? What studies have looked at responses to pandemics in the past? Without a more generalized theoretical context, this study seems to be just a "fishing expedition" to find factors that matter rather than to test factors that are theoretically important or that have been studied before.

Reply: Yes I agree and I thank you for this valuable comment. The requested information were added in the edited version of the paper.

In the section "Study design and participants" detailed information about how the survey was conducted were provided and edited in the corrected manuscript:

- The questionnaire was designed "using the SurveyMonkey program, for security purposes, the questionnaire link was sent to the respondents via social media: Twitter, Facebook, WhatsApp, and email lists. A request to share the survey hyperlink was also sent to the participants. The survey tool was available both in Arabic and English" (line 109-114 from the edited version of the paper).

- "the parents provided their consent in an online questionnaire. The survey validity was tested using a pilot version for all items..." (line 102-103 from the edited version of the paper).

- The inclusion criteria were specified (line 97-87 from the edited version of the paper). 

If you recommend any special information to be added to this section, it will be our pleasure to add it. 

2- Most importantly, the authors need to discuss exactly how the sample was selected. This appears to be a convenience sample. For this reason, this in no way can represent parents in Saudi Arabia. The authors need to discuss this limitation in even greater detail than they do (lines 339+). Technically, they cannot use statistical tests, as such tests presume probability sampling. To what population can such inferences be made in this case? We have no way of knowing who these particular people represent in terms of a larger population.

Reply: The sample was selected from the general population using an online questionnaire. Due to social distancing and restriction of the face-to-face contact, a snow ball method was applied to recruit participants. Data collected from the participants were first analyzed to assess the intention of the general population in Saudi Arabia to vaccinate against COVID-19. The results were published in Frontiers in Public Health. 2021 June 24; volume 9: 698106. doi: 10.3389/fpubh.2021.698106. eCollection 2021. Then, from the original sample, only data of parents with children aged 18 years and below were used to understand parental willingness to vaccinate their children (the present study).

More details were given in the limitation section of the edited paper regarding the number of participants.

Even if this sample doesn't represent the general population in Saudi Arabia, the results gave preliminary data about the parents' acceptance of COVID-19 vaccine for their children. Larger studies with high participation rates are necessary to better analyze parents' willingness to participate in vaccination campaigns during pandemics.

 

3- The authors keep referring to their "univariate" analysis. However, when they are using this term, it is more appropriate to talk about it as bivariate analysis. Two variables are being assessed in each case--e.g., how does age impact support for vaccination? That is not a single or "uni" variable; rather, that is two variables.

Reply: To determine factors associated with the parents' willingness for vaccines, the univariate analysis was applied using different statistical test (according to the type of the variable studied): the independent t-test for normally distributed continuous variables, the Mann-Whitney U-test for non-normally distributed continuous variables and the chi-square test or Fisher exact test for categorical variables.

4- Line 137 -- The % for married does not match what is reported in the table

Reply: Yes I agree, it was a typing error. Corrected in the edited paper.

5- Line 185 -- a p value of .084 means that this is NOT statistically significant based on their stated criteria of p<.05. Therefore, this variable should not have been included in the regression analysis per their inclusion criteria.

Reply: Corrected according to the reviewer's comment.

6- The variable regarding willingness to vaccinate with domestic or imported brand does not seem to have the correct attribute labels in Tables 3 and 4. Rather than yes/no, shouldn't this be domestic vs imported?

Reply: Yes I agree, an explanation was added in table 3 and 4 as a footnote under the tables in the edited paper. In fact, No and Yes refers to the refusal and acceptance of a domestic vaccine, respectively.

7- Line 204 -- the percentage reported here is different than what is reported in the table

Reply: Corrected in the edited paper.

 

8- Line 216 -- A p value of .057 is NOT statistically significant based on their stated criteria

Reply: Corrected in the edited paper.

9- Figures 1 and 2 need labels to show the values represented by the bars

Reply: Labels were added in the edited paper.

Thank you.

Sincerely,

Mohammed AL-Mohaithef, PhD

Vice Dean

Department of Public Health

College of Health Sciences

Saudi Electronic University

Riyadh-

Saudi Arabia

 

 

 

Reviewer 2 Report

Vaccines peer review 12/14/2021 vaccines-1494114

Manuscript: “Parents' willingness to vaccinate children against COVID-19 in Saudi Arabia: A cross-sectional study” by authors Soukaina Ennaceur and Mohammed AL-Mohaithef

General Comments.  This manuscript meets the standards of this reviewer.  Information is of interest, of use, and timely.  Suggest the authors use the same orthography, spelling, style, throughout the manuscript and eliminate non-essential words.  Suggest the authors re-read the Discussion Section and correct typographic errors and eliminate any non-essential, adjectival, superlative, or duplicative words or phrases.

Lines 8-10 is written in a way that there is redundancy between the phrases "study aimed to investigate parents' willingness to vaccinate their children" and the phrase "study investigated parents' willingness to vaccinate their children". Suggest condensing this writing to avoid duplication of words in such close proximity.

Line 10-12 is written that "Univariate analysis" and "Multivariate regression analysis" were used. Suggest here writing specific numerical results and confidence interval and p value immediately followed by the name of statistical test used.

Line 12- 19 in the Abstract section, Results section, suggest that specific numbers, percentages, and statistical significances be added, such as was done in previous work by some of the same authors in print as: "Multivariable logistic regression analysis was performed to compute the predictors of vaccination intention among the study participants. Results: Six hundred fifty-eight participants completed the survey (females = 47.4%). Of the 658 participants, 351 (53.3%) have shown intent to be vaccinated. Five hundred nineteen (78.8%) of the participants were reported to be at high risk of COVID-19, and 307 (46.6%) were reported to trust the healthcare system in the country. The multivariable analysis shows respondents with a high-risk perception (OR: 2.27, 95% CI: 1.49-3.48); higher trust in the healthcare system (OR: 3.24, 95% CI: 2.32-4.61) was found to be the significant factor affecting the decision in acceptance of the COVID-19 vaccine in Saudi Arabia." Mohammed Al-Mohaithef, Bijaya Kumar Padhi, Soukaina Ennaceur. Socio-Demographics Correlate of COVID-19 Vaccine Hesitancy During the Second Wave of COVID-19 Pandemic: A Cross-Sectional Web-Based Survey in Saudi Arabia.

Frontiers in Public Health. 2021 June 24; volume 9: 698106. doi: 10.3389/fpubh.2021.698106. eCollection 2021, which is reference 7, line 388 to 289 in this present manuscript.

Line 16 to 17 is written that "The most important reason for accepting children’s vaccination was to protect other family members from infection (40.9%)". "The most important reason" is an linguistically inflated substitute for what was more specifically "the most frequent reply" among parents for being willing. Suggest avoiding subjective adjectives and adverbs. Suggest reporting numbers whenever possible.

Lines 16 to 20 is written "The most important reason for accepting 16 children’s vaccination was to protect other family members from infection (40.9%). The most important reason for refusing vaccinating children was concerns about the side effects of the vaccine (22.2%). Conclusion: Parents' willingness to vaccinate their children with a COVID-19 vaccine is relatively important ". This is redundant use of words. Suggest rewriting that "Among parents, the most frequent (40.9%) reason for vaccinating children was to prevent infection in other family members. What may underlie this is that some parents understand that children can carry pathogens from persons in school to persons at home. The most frequent (22.2%) reason for refusing vaccination was concern about side effects of vaccine" and "Conclusion: Parents have differing opinions on frequencies and risks of coronavirus disease transmission and medical complications and of effectiveness and adverse effects of a vaccine" "These results could be of use in designing public health information campaings

Supplementary Table 2 includes numbers less than 5, which raises the issue of whether or not Fisher's Exact Test should be applied. For this issue, this reviewer suggests that a professional statistician check this manuscript.

Supplementary Table 2 has a remarkable result, that there was no statistically significant difference for vaccine willingness between those working in health care services and those not working in health care services. This reviewer expected that those trained and experienced with diseases that are potentially deadly would have an appreciation for preventing those diseases or preventing those deaths.

Supplementary Table 3 is notable that the differences were an "order of magnitude", ten times, 10 x, for some opinions held, but not for other opinions held:

1) Among 167 "Willing to vaccinate the child", only 11 had no "Willingness to vaccinate themselves".

2) Among 212 "Not willing to vaccinate the child", only 10

had "Willingness to participate in a COVID-19 vaccine clinical trial".

3) Among 167 "Willing to vaccinate the child", only 10 "Refused a vaccine for themselves...because they considered it useless or dangerous".

Supplementary Table 6 "Quotes from those not willing to participate in a COVID-19 vaccination campaign" is particularly valuable information.

Lines 40-41 “A COVID-19 free vaccine booking service was provided to get an appointment in advance to receive the vaccine at the nearest vaccine center.”  This sentence reads that the booking service was free but the reader doesn’t know that the receipt of vaccine is free.  If a main point of this sentence is that vaccine was at no cost to recipients, suggest rewording sentence to read: “A COVID-19 vaccine booking service was provided to get an appointment in advance to receive the vaccine, at no cost, at the nearest vaccine center.” 

Line 63 Typographical error “againstCOVID-19”.

Lines 69-71 “The questionnaire was used to determine the prevalence of parents' accept-69 ability of the COVID-19 vaccine for their children and to study the reasons behind their opinions and views.”  This is the first time the reader is told there is a questionnaire.  Suggest to replace “The questionnaire” with “A questionnaire…”.

Lines 87-89 “For security purposes, a questionnaire link was created once the survey questions were created and managed and sent to…”. 

Lines 93-94 “The ethical approval of the present study was obtained from the Ethics Committee of the Saudi Electronic University (SEUREC-CHS20118).”  As the first sentence of the Materials Section “Data Collection”, this seems out of place when compared with the sentences that follow.  Suggest moving this sentence to a suitable location within the “Materials” Section “Study design and participants”.

Line 103 Typographical error “were:"Yes"

Line 115 "It might cost too much" the vaccine is free.  How many respondents selected this answer?

Lines 123-124 “The statistical analysis of the data was performed using the IBM, SPSS V. 28.0 pack-123 age program.” Please include a reference.

Lines 74-78 “Parents were provided with the necessary information about the study: the objectives of the study, the research team identity, their right to discontinue their participation, confidentiality and data protection, and they were informed that only complete registered data would be considered for data analysis.” Here it specifies that “only complete registered data would be considered for data analysis”.  Table 1 “Other b” “b Other: Didn't specify the region.”  Does this suggest that “complete registration data” was not provided by some respondents and their answers were considered for data analysis?

Lines 142-143 “Only 16.4% of those who completed the survey are working in the healthcare system.”  Here, “healthcare”.  In Table 1 “health care”.  At line 158 “healthcare”. In Table 2 “HCS: Healthcare System”.  Figure 1 “health care”.

Table 1 “Table 1. Socio-demographic characteristics of the parents.”  Suggest expanding this title similar to the wording of the titles of Table2 and Table 3.  Suggest to add the words “children” and “COVID-19 vaccine” to the Table 1 title.

Tables: “Non Saudi” “Non-Saudi”

Line 149 to 151 is written "There were 167 parents out of 379 (44%) who reported that they would accept to 149 vaccinate their children under the age of 18 with a COVID-19 vaccine and 212 parents 150 (56%) were not willing or hesitated to vaccinate their children".  Suggest rewriting something similar to: Among 379 parents, 167 (44%) were willing to allow their children to receive a vaccine, but 212 (56%) were not willing [this direct percentage result did not require a sophisticated statistical test].

Lines 152-153 “The univariate analysis showed that greater acceptance of children vaccination with a COVID-19 vaccine was associated …”.  Suggest rewording as The univariate analysis showed that greater acceptance of vaccination of children with a COVID-19 vaccine was associated ….

Table 2 “Nationality” “Saudi” “135” “182” This is a total of 317 persons.  In Table 1 “Nationality” “Saudi” “316”.

Table 2 “Nationality” “Non Saudi” “33” “29” This is a total of 62 persons.  In Table 1 “Nationality” “Non-Saudi” “63”.

Table 2 “Maritalstatus”

Table 2, Footnote “a” “… their child/ren with a COVID-19 vaccine.”

Table 3, Footnote “a” “…their child/ren with a COVID-19 vaccine.”

Table 1 “High school and below”.  Table 2 “High school or below”. Line 168 “with high school education or below”.

Lines 164-165 “…among parents having more than four members in their families (33.2%)…”. To match the survey wording, suggest changing this to “…among parents having four or more members in their families (33.2%)…”.

Table 3 “Received” check word for typographic error such as a stray underline symbol.

Lines 194-196 “When questioned about their concern of somebody in their families or themselves getting infected with the coronavirus, only 21.9% of the parents showed such a concern.”  Suggest removing the word “only”.  Suggest replacing “showed such a” with “indicated”.

Lines 207-210 “Parents who had received the seasonal flu vaccine were more convinced that vaccinating their children with a COVID-19 vaccine was the most protective strategy (33.3%) compared those who were not enrolled in a seasonal flu vaccination program (16.6%) (p=.013).”   Remove the phrase “were more convinced” and replace with “responded”.

Line 266 “…COVID-19 vaccine campaigns[11].”  Insert space before “[11}”.

Lines 274-278 “However, the willingness to vaccinate children rate in our sample was lower than rates registered in recent studies conducted in the US (63%) [12], China (72.6%)[13], England (48.2%) [14], and in an international study conducted in six countries and showing 65% intent rate to vaccinate children against COVID-19 [15].”  This sentence structure can be improved.

Lines 281-283 “The main factors found to be associated with parents' willingness to vaccinate their children with a COVID-19 vaccine were the parents' age: young parents were more likely to accept a COVID-19 vaccine to be administered to their children than older ones.”  Sentence structure could be improved.  Consider “… young parents, rather than older parents, were more likely to accept a COVID-19 vaccine to be administered to their children.” 

Line 288 delete the word “Finally”.

Lines 321-322 check for typographic or formatting errors.

Lies 323-324 “…the main reasons to refuse a COVID-19 to be administered…”  There is a word missing “vaccine” or “vaccination”.

Lines 350-352 “Finally, data were collected during the second COVID-19 wave and parents' willingness might change over time and the strategies of the health authorities could impact parents' attitudes towards their vaccination intentions for their children.”  Suggest deletion of ”Finally” and consider replacement with the word “Last,”.  Please add clarification to “the second COVID-19 wave” by adding a date or time span, even if approximate.

Author Response

Date: January 4, 2022

We have submitted a manuscript entitled" Parents' willingness to vaccinate children against COVID-19 in Saudi Arabia: A cross-sectional study" for publication in your journal: Vaccines (ID:-1494114). We thank you for your interest to our work and for the valuable remarks and comments you have made to ameliorate our paper.

Enclosed please find the details of the revisions to the manuscript and the responses to the referees’
comments.

Reviewer 2

1- Lines 8-10 is written in a way that there is redundancy between the phrases "study aimed to investigate parents' willingness to vaccinate their children" and the phrase "study investigated parents' willingness to vaccinate their children". Suggest condensing this writing to avoid duplication of words in such close proximity.

Reply: Corrected according to the reviewer's comment.

2- Line 10-12 is written that "Univariate analysis" and "Multivariate regression analysis" were used. Suggest here writing specific numerical results and confidence interval and p value immediately followed by the name of statistical test used.

Reply: The statistical test and p-value were added. Since this section in the abstract is for methods, the detailed results were added immediately is the next section (Results section of the abstract).

3- Line 12- 19 in the Abstract section, Results section, suggest that specific numbers, percentages, and statistical significances be added, such as was done in previous work by some of the same authors in print as: "Multivariable logistic regression analysis was performed to compute the predictors of vaccination intention among the study participants. Results: Six hundred fifty-eight participants completed the survey (females = 47.4%). Of the 658 participants, 351 (53.3%) have shown intent to be vaccinated. Five hundred nineteen (78.8%) of the participants were reported to be at high risk of COVID-19, and 307 (46.6%) were reported to trust the healthcare system in the country. The multivariable analysis shows respondents with a high-risk perception (OR: 2.27, 95% CI: 1.49-3.48); higher trust in the healthcare system (OR: 3.24, 95% CI: 2.32-4.61) was found to be the significant factor affecting the decision in acceptance of the COVID-19 vaccine in Saudi Arabia." Mohammed Al-Mohaithef, Bijaya Kumar Padhi, SoukainaEnnaceur. Socio-Demographics Correlate of COVID-19 Vaccine Hesitancy During the Second Wave of COVID-19 Pandemic: A Cross-Sectional Web-Based Survey in Saudi Arabia. Frontiers in Public Health. 2021 June 24; volume 9: 698106. doi: 10.3389/fpubh.2021.698106. eCollection 2021, which is reference 7, line 388 to 289 in this present manuscript.

Reply: Corrected according to the reviewer's comment.

4- Line 16 to 17 is written that "The most important reason for accepting children’s vaccination was to protect other family members from infection (40.9%)". "The most important reason" is an linguistically inflated substitute for what was more specifically "the most frequent reply" among parents for being willing. Suggest avoiding subjective adjectives and adverbs. Suggest reporting numbers whenever possible.

Reply: Corrected according to the reviewer's comment.

5- Lines 16 to 20 is written "The most important reason for accepting 16 children’s vaccination was to protect other family members from infection (40.9%). The most important reason for refusing vaccinating children was concerns about the side effects of the vaccine (22.2%). Conclusion: Parents' willingness to vaccinate their children with a COVID-19 vaccine is relatively important ". This is redundant use of words. Suggest rewriting that "Among parents, the most frequent (40.9%) reason for vaccinating children was to prevent infection in other family members. What may underlie this is that some parents understand that children can carry pathogens from persons in school to persons at home. The most frequent (22.2%) reason for refusing vaccination was concern about side effects of vaccine" and "Conclusion: Parents have differing opinions on frequencies and risks of coronavirus disease transmission and medical complications and of effectiveness and adverse effects of a vaccine" "These results could be of use in designing public health information campaigns

Reply: Corrected according to the reviewer's comment.

6- Supplementary Table 2 includes numbers less than 5, which raises the issue of whether or not Fisher's Exact Test should be applied. For this issue, this reviewer suggests that a professional statistician check this manuscript.

Reply: Yes the Fisher's exact test was used for categorical variables, and Yes the paper was reviewed by a statistician.

7- Supplementary Table 2 has a remarkable result, that there was no statistically significant difference for vaccine willingness between those working in health care services and those not working in health care services. This reviewer expected that those trained and experienced with diseases that are potentially deadly would have an appreciation for preventing those diseases or preventing those deaths.

Reply: This result could be explained by the fact that healthcare worker are more afraid about the side effects of new medications mainly new vaccines, that's why their intention to vaccinate their children is not really different from those not working in the healthcare field.

8- Supplementary Table 3 is notable that the differences were an "order of magnitude", ten times, 10 x, for some opinions held, but not for other opinions held:

1) Among 167 "Willing to vaccinate the child", only 11 had no "Willingness to vaccinate themselves".

2) Among 212 "Not willing to vaccinate the child", only 10 had "Willingness to participate in a COVID-19 vaccine clinical trial".

3) Among 167 "Willing to vaccinate the child", only 10 "Refused a vaccine for themselves...because they considered it useless or dangerous".

Reply: Yes correct. The fact is exactly like the reviewer notice this 10 time magnitude is not correct for all opinions.

9- Supplementary Table 6 "Quotes from those not willing to participate in a COVID-19 vaccination campaign" is particularly valuable information.

Reply: Yes, I agree. Thank you.

10- Lines 40-41 “A COVID-19 free vaccine booking service was provided to get an appointment in advance to receive the vaccine at the nearest vaccine center.”  This sentence reads that the booking service was free but the reader doesn’t know that the receipt of vaccine is free.  If a main point of this sentence is that vaccine was at no cost to recipients, suggest rewording sentence to read: “A COVID-19 vaccine booking service was provided to get an appointment in advance to receive the vaccine, at no cost, at the nearest vaccine center.” 

Reply: Corrected according to the reviewer's comment.

11- Line 63 Typographical error “againstCOVID-19”.

Reply: Corrected according to the reviewer's comment.

12- Lines 69-71 “The questionnaire was used to determine the prevalence of parents' accept-69 ability of the COVID-19 vaccine for their children and to study the reasons behind their opinions and views.”  This is the first time the reader is told there is a questionnaire.  Suggest to replace “The questionnaire” with “A questionnaire…”.

Reply: Corrected according to the reviewer's comment.

13- Lines 87-89 “For security purposes, a questionnaire link was created once the survey questions were created and managed and sent to…”. 

Reply: Corrected according to the reviewer's comment.

14- Lines 93-94 “The ethical approval of the present study was obtained from the Ethics Committee of the Saudi Electronic University (SEUREC-CHS20118).”  As the first sentence of the Materials Section “Data Collection”, this seems out of place when compared with the sentences that follow.  Suggest moving this sentence to a suitable location within the “Materials” Section “Study design and participants”.

Reply: Corrected according to the reviewer's comment.

15- Line 103 Typographical error “were:"Yes"

Reply: Corrected according to the reviewer's comment.

16- Line 115 "It might cost too much" the vaccine is free.  How many respondents selected this answer?

Reply: The questionnaire was designed before information regarding the cost of the vaccine was declared by the Ministry of Health. That is why this item was added to the questionnaire to know about the participants' opinion regarding this item.  

Only two respondents selected this answer

17- Lines 123-124 “The statistical analysis of the data was performed using the IBM, SPSS V. 28.0 pack-123 age program.” Please include a reference.

Reply: This sentence was written by the authors and not taken from another reference. 

18- Lines 74-78 “Parents were provided with the necessary information about the study: the objectives of the study, the research team identity, their right to discontinue their participation, confidentiality and data protection, and they were informed that only complete registered data would be considered for data analysis.” Here it specifies that “only complete registered data would be considered for data analysis”.  Table 1 “Other b” “b Other: Didn't specify the region.”  Does this suggest that “complete registration data” was not provided by some respondents and their answers were considered for data analysis?

Reply: "Others" in Table 2 are participants who didn't specify their regions (northern or southern, eastern or western region) but they gave their cities. According to the city, these participants were classified manually by the authors in the studied regions.

19- Lines 142-143 “Only 16.4% of those who completed the survey are working in the healthcare system.”  Here, “healthcare”.  In Table 1 “health care”.  At line 158 “healthcare”. In Table 2 “HCS: Healthcare System”.  Figure 1 “health care”.

Reply: Corrected according to the reviewer's comment.

20- Table 1 “Table 1. Socio-demographic characteristics of the parents.”  Suggest expanding this title similar to the wording of the titles of Table2 and Table 3.  Suggest to add the words “children” and “COVID-19 vaccine” to the Table 1 title.

Reply: Corrected according to the reviewer's comment.

21- Tables: “Non Saudi” “Non-Saudi”

Reply: Corrected according to the reviewer's comment.

22- Line 149 to 151 is written "There were 167 parents out of 379 (44%) who reported that they would accept to 149 vaccinate their children under the age of 18 with a COVID-19 vaccine and 212 parents 150 (56%) were not willing or hesitated to vaccinate their children".  Suggest rewriting something similar to: Among 379 parents, 167 (44%) were willing to allow their children to receive a COVID-19 vaccine, but 212 (56%) were not willing [this direct percentage result did not require a sophisticated statistical test].

Reply: Corrected according to the reviewer's comment.

23- Lines 152-153 “The univariate analysis showed that greater acceptance of children vaccination with a COVID-19 vaccine was associated …”.  Suggest rewording as The univariate analysis showed that greater acceptance of vaccination of children with a COVID-19 vaccine was associated ….

Reply: Corrected according to the reviewer's comment.

24- Table 2 “Nationality” “Saudi” “135” “182” This is a total of 317 persons.  In Table 1 “Nationality” “Saudi” “316”.

Table 2 “Nationality” “Non Saudi” “33” “29” This is a total of 62 persons.  In Table 1 “Nationality” “Non-Saudi” “63”.

Reply: Yes I agree, and the mistake was corrected in Table 1.

25- Table 2 “Maritalstatus”

Reply: Corrected according to the reviewer's comment.

26- Table 2, Footnote “a” “… their child/ren with a COVID-19 vaccine.”

Table 3, Footnote “a” “…their child/ren with a COVID-19 vaccine.”

Reply: "a" represents parents who are not sure to vaccinate their children added to parents who are hesitating for the vaccine.

27- Table 1 “High school and below”.  Table 2 “High school or below”. Line 168 “with high school education or below”.

Reply: Corrected in Table 1

28- Lines 164-165 “…among parents having more than four members in their families (33.2%)…”. To match the survey wording, suggest changing this to “…among parents having four or more members in their families (33.2%)…”.

Reply: Corrected according to the reviewer's comment.

29- Table 3 “Received” check word for typographic error such as a stray underline symbol.

Reply: Word checked and corrected

30- Lines 194-196 “When questioned about their concern of somebody in their families or themselves getting infected with the coronavirus, only 21.9% of the parents showed such a concern.”  Suggest removing the word “only”.  Suggest replacing “showed such a” with “indicated”.

Reply: Corrected according to the reviewer's comment.

31- Lines 207-210 “Parents who had received the seasonal flu vaccine were more convinced that vaccinating their children with a COVID-19 vaccine was the most protective strategy (33.3%) compared those who were not enrolled in a seasonal flu vaccination program (16.6%) (p=.013).”   Remove the phrase “were more convinced” and replace with “responded”.

Reply: Corrected according to the reviewer's comment.

32- Line 266 “…COVID-19 vaccine campaigns[11].”  Insert space before “[11}”.

Reply: Corrected according to the reviewer's comment.

33- Lines 274-278 “However, the willingness to vaccinate children rate in our sample was lower than rates registered in recent studies conducted in the US (63%) [12], China (72.6%)[13], England (48.2%) [14], and in an international study conducted in six countries and showing 65% intent rate to vaccinate children against COVID-19 [15].”  This sentence structure can be improved.

Reply: The sentence was re-structured and improved.

34- Lines 281-283 “The main factors found to be associated with parents' willingness to vaccinate their children with a COVID-19 vaccine were the parents' age: young parents were more likely to accept a COVID-19 vaccine to be administered to their children than older ones.”  Sentence structure could be improved.  Consider “… young parents, rather than older parents, were more likely to accept a COVID-19 vaccine to be administered to their children.” 

Reply: Corrected according to the reviewer's comment.

35- Line 288 delete the word “Finally”.

Reply: Word deleted

36- Lines 321-322 check for typographic or formatting errors.

Reply: Corrected according to the reviewer's comment.

37- Lies 323-324 “…the main reasons to refuse a COVID-19 to be administered…”  There is a word missing “vaccine” or “vaccination”.

Reply: Corrected according to the reviewer's comment.

38- Lines 350-352 “Finally, data were collected during the second COVID-19 wave and parents' willingness might change over time and the strategies of the health authorities could impact parents' attitudes towards their vaccination intentions for their children.”  Suggest deletion of ”Finally” and consider replacement with the word “Last,”.  Please add clarification to “the second COVID-19 wave” by adding a date or time span, even if approximate.

Reply: Corrected according to the reviewer's comment.

Thank you.

Sincerely,

Mohammed AL-Mohaithef, PhD

Vice Dean

Department of Public Health

College of Health Sciences

Saudi Electronic University

Riyadh-

Saudi Arabia

 

 

 

Round 2

Reviewer 1 Report

The authors overall have decently addressed prior comments. I just have a few minor comments/suggested edits:

• In the "study design and participants" section, please add a sentence or two that states how people were initially contacted to be in the study. Was a mass message sent through the authors' facebook and other social media accounts, for instance?
• The title for Table 1 appears to be incorrect. Isn't this information for all parents in the study, not just those willing to vaccinate?
• Since the study was meant to only provide information about parental willingness to vaccinate children, I do not think it is a limitation of the study (lines 483-485) that it only included parents (since that was the point). Also, the authors would have no idea what the "participation rate" is since they don't know how many people saw the invite. I would rephrase this part of the manuscript to simply indicate that the results cannot represent all Saudi Arabia residents (because it was limited to parents of children under 18) and because it was a convenience sample, it also cannot be said to represent even Saudi Arabia residents who are parents of children  under 18.

 

 

Author Response

Date: January 13, 2022

Dear Editor-in-Chief

 

We have submitted a manuscript entitled" Parents' willingness to vaccinate children against COVID-19 in Saudi Arabia: A cross-sectional study" for publication in your journal: Vaccines (ID:-1494114). We thank you for your interest to our work and for the valuable remarks and comments you have made during the 1st round of the reviewing process to ameliorate our paper.

Enclosed please find the details of the responses to the minor comments/suggested of the referees.

1-In the "study design and participants" section, please add a sentence or two that states how people were initially contacted to be in the study. Was a mass message sent through the authors' facebook and other social media accounts, for instance?

Reply: The requested information were added in the "study design and participants" section.

2- The title for Table 1 appears to be incorrect. Isn't this information for all parents in the study, not just those willing to vaccinate?

Reply: The title of the Table 1 was corrected.

3- Since the study was meant to only provide information about parental willingness to vaccinate children, I do not think it is a limitation of the study (lines 483-485) that it only included parents (since that was the point). Also, the authors would have no idea what the "participation rate" is since they don't know how many people saw the invite. I would rephrase this part of the manuscript to simply indicate that the results cannot represent all Saudi Arabia residents (because it was limited to parents of children under 18) and because it was a convenience sample, it also cannot be said to represent even Saudi Arabia residents who are parents of children under 18.

Reply: Yes I agree, corrections were done according to the reviewer's comment.

Thank you.

Sincerely,

Mohammed AL-Mohaithef, PhD

Vice Dean

Department of Public Health

College of Health Sciences

Saudi Electronic University

Riyadh-

Saudi Arabia

T: 00966504111933

Email: [email protected]