Childhood and adolescent immunisation intentions post-COVID-19 in Lusaka, Zambia
A 2023 study in Lusaka, Zambia, found that while routine childhood vaccination rates remained high, caregivers' intentions to vaccinate adolescents against COVID-19 and accept future novel vaccines were lower and heavily influenced by their own vaccination status, with safety fears and knowledge gaps driving reluctance despite high trust in health authorities.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Vaccines are one of the most powerful tools in public health, acting as a shield that trains the body to fight off dangerous infections before they can cause serious harm. For decades, this system has worked quietly and effectively, protecting children from diseases like measles and polio. However, the global pandemic of the last few years tested this trust. As new vaccines were developed rapidly to fight a novel virus, some parents began to hesitate, worried about safety or unsure if the shots were necessary. This hesitation created a ripple effect; when confidence in new vaccines wavers, it can sometimes spill over to older, well-established shots, leaving children vulnerable to diseases that were once under control. Understanding why parents make these choices is critical, especially in places where health systems are already stretched thin, because the decision to vaccinate a child often rests entirely on the shoulders of a caregiver.
In Lusaka, Zambia, a team of researchers set out to understand exactly what was happening in the minds of parents and healthcare workers after the height of the pandemic. They wanted to know if the fear and uncertainty surrounding the new coronavirus vaccines had changed how people felt about vaccinating their children against other diseases, or if it had simply created a specific hesitation toward the new shots alone. To find the answer, they spoke with 277 caregivers, a group that included both ordinary community members and healthcare workers, asking them about their own vaccination history and their plans for their children, particularly those between the ages of twelve and seventeen.
The researchers found a clear divide between the old and the new. Almost all the parents, about ninety-three percent, said their children had received the standard, routine vaccines that have been used for generations. These families trusted the system that delivers shots for diseases like diphtheria and tetanus. However, when it came to the coronavirus vaccine for teenagers, the picture was much more complicated. Only about fifty-eight percent of the parents said their adolescent had received even a single dose. More telling was the attitude of those who had not yet vaccinated their teens: nearly twenty-five percent of all caregivers said they had no intention of doing so, and among those whose children were completely unvaccinated, only a quarter planned to change their minds in the near future.
A key discovery in the study was that a parent's own experience with the vaccine was the strongest predictor of whether their child would get one. If a parent had received two or more doses of the coronavirus vaccine, they were far more likely to have vaccinated their teenager. In contrast, parents who had not taken the vaccine themselves were much less likely to vaccinate their children. This pattern held true even when looking at the healthcare workers in the study. While these medical professionals were more likely to have been vaccinated themselves than the general public, they still expressed significant concerns about the new vaccines for children. In fact, healthcare workers were more likely than community members to worry about potential side effects and to question the safety of the ingredients, suggesting that even those who work in medicine are not immune to the uncertainty surrounding these newer shots.
When the researchers asked why parents wanted to vaccinate, the answers were straightforward and deeply human. The most common reason, cited by nearly eighty percent of those who planned to vaccinate, was the desire to protect their children from being hospitalized or dying. They saw the vaccine as a way to prevent severe illness from diseases like malaria, tuberculosis, and influenza, not just the coronavirus. On the other hand, the reasons for refusing or delaying vaccination were rooted in fear and a lack of information. The top concern was the fear of side effects, mentioned by nearly half of the hesitant parents. Many also felt they simply did not know enough about the benefits and risks to make a confident decision.
The study also looked at where people turned for information. Most caregivers trusted the Ministry of Health and their own doctors above all else. Television and radio were popular sources of news, but social media was a much less trusted channel. Interestingly, the parents who had not been vaccinated themselves trusted fewer sources of information overall and were less likely to trust government health officials compared to those who had been vaccinated. This suggests that the gap in vaccination rates is not just about a lack of facts, but about a lack of confidence in the messengers delivering those facts.
Ultimately, the research paints a picture of a population that still values childhood immunization but is wary of the new. The hesitation is not a blanket rejection of all vaccines; parents still trust the routine shots that have protected children for decades. Instead, the uncertainty is specific to the novel vaccines introduced during the pandemic. The findings suggest that to move forward, health officials cannot simply provide more data. They need to address the specific fears about safety and side effects, using the trusted voices of doctors and the Ministry of Health to reassure parents that these new protections are safe and necessary. By focusing on the very real fear of hospitalization and death, and by leveraging the trust that already exists in local health workers, there is a path to rebuilding the confidence needed to protect the next generation.
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