In March 2020, the World Health Organization (WHO) declared COVID-19 viral disease a pandemic. It was caused by the newly identified coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), the name given by the WHO to the new coronavirus strain, discovered in 2019 in the Chinese city of Wuhan. The pandemic is in a continuous, unpredictable dynamic, due to the new mutations of the coronavirus that appear periodically, becoming dominant in a very short time.
By the time of this study, February 2022, there were 5,830,272 deaths worldwide [1
], while in Romania the death [2
] toll reached 61.520 to 2.559.348 reported cases of infection [3
Experts estimate that the COVID-19 pandemic is far from being over, and its economic and social consequences are disastrous. The fifth wave is in full swing, making many victims around the world.
Romania, during the fourth wave caused by the Delta variant, went through a very serious pandemic period [4
], with records in terms of the number of infected, hospitalized in intensive care, and deceased people [5
]. The fifth wave brought new records for the number of infected people reported daily, but the number of deaths remains low. The measures implemented by the government to limit the spread of the virus have not yielded the expected results, thus an effective vaccination campaign remains the key variable in the fight against the virus and return to normality. The public rhetoric related to the establishment of the green certificate on the Romanian territory, as well as in many European countries, generated an additional state of tension among the citizens, without, however, any substantial increase in the vaccination process.
The effects of the pandemic seriously affected the category of young people who are the subject of this study. The shifting of educational process in the online environment was likely to affect its quality, including the right of children to education. Medically, beyond the adverse consequences in terms of psychological comfort of children and their families, the COVID-19 pandemic has affected people with various comorbidities, due to the additional risks they were subject to in case of infection with the new coronavirus [6
]. This, in the case of infecting young people, raises serious problems for those who have comorbidities and are likely to develop severe forms [7
]. It should be noted that, when children and adolescents come into contact with the virus and become infected, they often remain asymptomatic or develop mild symptoms of the disease that remit within a few days, and hospitalization rates, intensive care, or deaths are extremely low.
We believe that vaccinating young people is beneficial both from a medical point of view, to prevent a potential infection, and from a psychological point of view, as it offers additional guarantees regarding the development of a normal social life. Vaccination of children is an essential policy to combat the pandemic, due to the fact that they can be serious vectors of spreading the disease [9
] within their families [12
]. On the other hand, they may be “major factors of active epidemic waves (in terms of their share in the number of documented cases), especially with the Delta variant” [13
Our study focuses on determining the degree of acceptance, refusal, or hesitation of parents/legal guardians regarding the anti-COVID-19 vaccination of children under 18 years of age.
The aim of the research is to obtain essential data to answer the questions set out in our study, as shown in Table 1
. In this way we will be able to know if there are links between these data and the reasons for accepting/rejecting COVID-19 vaccines.
2. Research Materials and Methods
The study was conducted following the application of a questionnaire in the online environment, due to the impossibility of applying it in the “face to face” variant, as national authorities of restrictions aimed at limiting the spread of coronavirus in communities. The questionnaire was applied in Romania, between 4–11 December 2021 (at the end of the fourth wave of the pandemic), to persons who are parents/legal guardians and have children under the age of 18. Any willing person could participate in filling in the questionnaire. However, the minimum conditions required for a person to be included in the target group were the following: (1) minimum age of 21 years old; (2) to be the parents or the legal guardians and the children must be under 18 years of age, so that the parents are the ones who decide on vaccination/non-vaccination; (3) permanent residence in Romania as the study was carried out in Romania.
The participation was voluntary, with no compelling elements. All respondents received information, included from the first page of the questionnaire, about the authors, their affiliation, purpose, and source of research funding.
Volunteers received a questionnaire created on the Google Forms platform. No identification data of the respondents were requested, and it was allowed to distribute the form, based on the link, on the printed from. Completion was possible only for people who ticked “Yes” to the question regarding the status of parent or legal guardian of a child under 18 years of age.
The questions in the questionnaire were in Romanian, constructed in order to obtain information (as shown in Table 1
) about parents/legal guardians and their children. This information allowed us to answer the questions set out in the introduction section. Additionally, the “fake news” was built based on the false information found on social networks.
The distribution of the questionnaire was performed on social platforms, aiming to cover, from a geographical point of view, at least 70% of Romania’s counties.
Collecting the data allowed us to establish the behavioral attitude of parents/legal guardians regarding the acceptance, non-acceptance, or hesitation of vaccinating their own children. The aim was to obtain: socio-demographic data (age, place of residence, educational background, county of residence); data on the respondents’ opinions on the acceptance/non-acceptance of vaccines included in the mandatory vaccination schedule in Romania (hepatitis B vaccine, hexavalent vaccine, tuberculosis vaccine, etc.) and optional vaccines for children (like rotavirus vaccine, hepatitis A and B, meningococcal vaccine etc.); data on the confidence in COVID-19 vaccines available to minors; data regarding the acceptance/non-acceptance of the administration of the child/children vaccine; motivation for accepting/not accepting the administration of the vaccine.
We also aimed to establish the participants’ behavior regarding the “fake news” statements related to the COVID-19 vaccination process [14
2.4. Statistical Analysis of Data
The analysis and processing of the extracted data, after questionnaire filling, was performed using the Excel program, part of Microsoft Office Professional Plus 2019, and IBM SPSS Statistics 26. These were installed on a computer with an operation system Microsoft Windows 11 Professional. The data collected through the questionnaire was automatically centralized in an excel file and followed by the processes of visualization, extraction, and statistical analysis.
The variables used for the analysis of data regarding the respondents are the following: (1) age group; (2) acceptance/non-acceptance of mandatory and optional vaccines; (3) acceptance of COVID-19 vaccination of parents/legal guardians; (4) trust/mistrust of parents/legal guardians in “fake news”. Following the statistical analysis, we proceeded to compare the results to observe the behavior of parents/legal guardians according to the four variables mentioned above, presenting the data where we observed a significant difference.
The processing and extraction of data from the answers given to the open-ended question was performed by hand, as the analyses extracted using AI-based programs were not conclusive enough. We reviewed all the answers provided, together with the centralization of the reasons provided by the parents, in order to determine the final percentages for our study.
The answers in the last part of the questionnaire helped us to understand the level of trust given to the information found in the “fake news” [14
Various statistical analysis tests were applied to determine the dependence between the selected variables. Thus, we applied statistical tests that helped us to understand whether there is a link between vaccination of children with vaccines included in the national vaccination schedule, optional vaccines and parents’ decision to vaccinate/not vaccinate their children against COVID-19; participants who rated 1–2 (disagree) and 4–5 (agree) on the “fake news” statements were selected and correlated with their decisions to vaccinate/not vaccinate their children against COVID-19 to understand if there is a relationship between these variables.
Global studies addressing the issue of vaccination in children [18
] show an increase in situations of rejection or hesitation to administer vaccines for various reasons, without being able to identify a valid universal pattern [22
] that could lead to a review of such behavior [23
], thus inherently ensuring a high degree of immunization against new strains of coronavirus. In this study, we wanted to determine the rejection rates of COVID-19 [24
] vaccines and the reasons behind them [25
In Romania, during the fourth wave, from October to November 2021, a decision for students in pre-academic education was taken to have a two-week vacation in order to limit the spread of the virus. Such measures were also adopted by other states during the pandemic [26
]. Children can be a very serious vector of spreading the disease in their own families and in the communities they belong to. Such preventive measures showed a decrease in the number of cases.
From the participants in the study, we observed that 183 (31.5%) adults and 140 (24.1%) children got infected with COVID-19, but regarding vaccination against COVID-19, out of the total respondents only 411 (70.7%) adults and 185 (31.8%) children were vaccinated.
The age groups most reluctant to vaccinate their children are 26–30, 31–35, 36–40, and 41–45 years old (Table 6
). A comparative analysis regarding the agreement of the parents/legal guardians concerning the vaccination of the children, in the case of the vaccinated parents/legal guardians vs. unvaccinated parents/guardians, pointed out that the acceptance rate of the latter is extremely low. We should mention that, in the case of vaccinated parents/legal guardians, 43.8% of the children were also vaccinated. However, after applying the Kendall and Spearman statistical tests, we observed that there was no significant correlation between parental vaccination against COVID-19 and vaccination of children. However, in the case of parents not vaccinated against COVID-19 and unvaccinated children, the correlation is strong and significant, as shown in Figure 1
For children who have not reached the minimum age to be vaccinated or the vaccine is not yet available for their age, 77.8% of vaccinated parents/guardians responded that they will vaccinate their children when possible. In the case of unvaccinated parents/guardians, only 3.5% stated that they would vaccinate their children against COVID-19 when possible.
We observe a vaccine reluctance only in the case of anti-COVID-19 vaccines, because when we discuss vaccination (Table 4
) and acceptability (Table 5
) of vaccines included in the national mandatory scheme or optional vaccines, the percentages are considerably increased, and similar statistics are also found in other states [27
]. In this situation, we have 98.4% adults and 97.2% children vaccinated with the vaccines included in the mandatory national vaccination scheme. In the case of optional vaccines, 51.1% of children are vaccinated with one of them, the percentage being 19.2% higher than in the case of vaccination with one of the COVID-19 vaccines.
Statistical analysis carried out to determine a potential link between vaccination of children with vaccines included in the mandatory national schedule, optional vaccines, and acceptance of COVID-19 vaccines shows that this hypothesis is rejected, as there is no strong correlation between variables, as shown in Figure 2
Comparative analyses among vaccines included in the national scheme, optional vaccines (like rotavirus vaccine, hepatitis A and B, meningococcal vaccine etc.), and anti-COVID-19 vaccines, show a fear about the last category of vaccines. This occurs due to the element of novelty and/or distrust developed against the background of the lack of a minimum education in the medical field. In addition to these arguments, the fake information present in the online environment (sites and social platforms) induces a state of insecurity for people who do not distinguish between “fake news” and scientific data, leading to various situations in which anti-vaccine arguments come from such sources and have no scientific basis.
To the open question “What is the reason why you did/did not vaccinate your child?”, the centralization of the answers reveals that the people who chose to vaccinate their children, or who will vaccinate them when possible, have motivated, as a first argument, the need to be healthy and to avoid complications in the event of a potential infection. The confidence of those who chose the vaccine is validated on the data obtained from doctors, as they declare, also based on the confidence in the vaccines on the market, other than those against COVID-19. The second argument is mobility limitation due to restrictions imposed by the authorities and not necessarily out of a desire to be protected from infection. The third argument is about returning to a normal life, as it was before the pandemic began.
On the contrary, those who have refused to vaccinate their children consider, as a first argument, that vaccines available for children are experimental and no one, pharmaceutical manufacturers or doctors, assumes any potentially dangerous side effects. In addition, parents/guardians, as a second argument, also claim that a very short time has elapsed since the appearance of the vaccines, so all the possible side effects in the medium and long term are not known and there is no research to confirm or negate these potential side effects.
Regarding the section dedicated to “fake news” statements, we notice a high percentage of respondents show confidence in them, so that 22.5% believe that there is a global society wanting to control the world and 20.3% believe that this society wants to reduce the world population. A percentage of 12.3% believe that doctors receive money to inoculate the COVID-19 vaccine to reduce the population.
When questioning “fake news” statements about COVID-19 vaccines, 17.3% of respondents believe that vaccines based on mRNA technology produce dangerous genetic changes, 14.6% believe that vaccination against COVID-19 aims to reduce the number of elderly people, 7.9% believe that the vaccine causes infertility and 7.7% believe that vaccinated people will die in the coming years due to it. Regarding the statement concerning the implantation of a chip in the body by means of the vaccine, 3.6% of the respondents share such an opinion. People who believe such fake news are likely to refuse vaccination, backing up their decisions with false information obtained from such sources.
Thus, in order to determine the connection between the trust in ”fake news” and the decision not to vaccinate their children, we chose to perform a statistical analysis, having as variables the individuals who graded with 4–5 (agree), 1–2 (disagree), and their decision to vaccinate/not vaccinate their children against COVID-19. The results are presented in Figure 3
Based on the statistical tests conducted, we consider the hypothesis valid that the level of confidence in “fake news” claims determines the level of vaccination among children. The more parents trust official data and reject “fake news” claims, the greater the acceptance of the COVID-19 vaccine for children.
In Romania, the decision to vaccinate minor children against COVID-19 raises a serious problem among parents/legal guardians, divided into two categories: pros and cons of the vaccine. However, vaccination of minors is an important advantage when the vector of the spread of the COVID-19 pandemic by young people is under discussion. In fact, minors, in the case of a potential infection, develop quite mild forms of the disease or remain asymptomatic. Even those with comorbidities rarely develop severe forms or die.
From the analysis of the data obtained through the questionnaire, following the application of the Kendall and Spearman statistical analysis tests, it is found that there is a strong link between participants’ trust/distrust in “fake news” information and their decision to vaccinate their children. Most likely, the lack of minimal medical knowledge among participants and their reliance on malicious or scientifically unsubstantiated information, to the detriment of official information presented by doctors, leads to decisions to reject vaccination.
In addition, we believe that social platforms and some news sites are easy ways of disseminating “fake news” information. More and more authorized voices among medical scientists claim that these platforms are responsible, up to a large extent, for the high degree of rejection of COVID-19 vaccines [14