COVID-19 has had an immense impact on human health worldwide, with close to 600 million confirmed infections worldwide at the time of writing in August 2022 (1). While acute infections have claimed more than 6 million lives, post-acute sequelae of SARS-CoV-2 infection has also had both health and economic impacts. On 31st December 2020, the World Health Organisation (WHO) approved the emergency use of COVID-19 vaccines for adults during the COVID-19 pandemic (2). Despite the availability of the COVID-19 vaccines, vaccine hesitancy remained prevalent in many countries, limiting the success of COVID-19 vaccination programmes worldwide (3–6). This contributed to the COVID-19 pandemic and the advent of more potential virus mutant populations. By December 2021, the Singapore Ministry of Health had also approved the use of Paediatric Dose Pfizer-BioNTech/Comirnaty vaccine for children aged 5–11 years (7). However, the uptake of paediatric COVID-19 vaccination was significantly slower compared to the adult and adolescent COVID-19 vaccination drive (8). This was a worrying trend as unvaccinated children were found to be twice as likely to get hospitalised as compared to vaccinated children (9).

This trend was also observed in the United States of America (USA), where vaccinated adults were less likely to consent to have their children vaccinated against COVID-19 (10). A Bangladeshi study showed that parental vaccine hesitancy could be as high as 42.8% (11). Other Asian countries also demonstrated that parental hesitancy relatively lower at 10.8%–11.8%, in Taiwan and Vietnam respectively (12, 13). Studies in the United Kingdom (UK) have shown that higher social media and digital device usage among parents have been associated with greater hesitancy in vaccinating their children against COVID-19 (14). Additionally, social media use could also lead to a potentially higher likelihood of exposure to COVID-19 misinformation (15). A survey on the use of social media in Singapore estimated that 79.1% the population used some form of social media, wherein the more popular choices of social media were YouTube, Facebook and Instagram (16). Hence, social media usage could have a significant influence on COVID-19 vaccine hesitancy amongst Singaporean parents (17).

In this study, we aimed to compare the social and demographic features of parents with and without hesitancy towards vaccines administration in their offspring. Secondly, we also aimed to determine the impact of social media and device usage by parents in Singapore on COVID-19 vaccine hesitancy. Using the risk factors associated with vaccine hesitancy in parents found in our study, we developed a multinomial logistic regression model to predict COVID-19 vaccine hesitancy amongst parents.

A prospective, anonymous and voluntary electronic survey modified from “Measuring vaccine hesitancy: The development of a survey tool” was used (18, 19) (Supplementary Table).

This is a multi-ethnic study done in Southeast Asia which lends a unique perspective of parental values in vaccinating their children against COVID-19. In our study, vaccine hesitancy in parents was found to be correlated with being a father, lower household income levels, parents' own unvaccinated status with a 92.4% accuracy. These associations may allow healthcare workers in identifying and tailoring their approach in making shared parental decision making with parents who may be vaccine hesitant.

A key finding by our study which could impact the rate of vaccination uptake amongst the paediatric population is the importance of parental trust in their children's primary healthcare provider. This was identified as the most significant factor contributing to the COVID-19 vaccine uptake amongst parents in our study. In fact, the COVID-19 National Preparedness Collaborators had identified that a high level of trust is not only associated with higher vaccine uptake but also lower levels of infection rates during the pandemic (20). We recommend that healthcare providers opportunistically discuss vaccine safety during routine healthcare encounters, to guide parents in making informed decisions regarding COVID-19 vaccination for their children.

Our findings suggest that parents with lower household incomes were more comfortable using social media as opposed to print material as a sole source of information. In contrast, despite the relatively high usage of social media and digital devices in Singapore, parents with a higher level of education preferred to obtain information regarding COVID-19 vaccines from newspaper and print material rather than social media. Thus, to ensure that critical information on vaccine safety is disseminated across all socioeconomic strata, the medium through which information is provided is important. Our findings suggest that a multi-pronged approach including different media forms directed at different socioeconomic groups would be necessary for a successful vaccine information campaign.

Our findings of the influence of social media and device usage contradicts that of findings reported by other studies (12, 13, 20–24). In our study, high usage of digital devices and social media use did not influence the vaccination choices made by parents in Singapore. These findings are contrary to the findings reported by the European and American adults as well as Japanese parents. One explanation for this is that supplementing social media usage with consumption of print media decreased vaccine hesitancy in the parents in our study, thus highlighting that it may not be the usage of social media but the exclusive reliance on social media for health information that leads to high vaccine hesitancy. Another explanation is that it may not be the usage of formal or informal sources of information, but rather than level of trust that an individual puts in the sources, which is more highly predictive of vaccine hesitancy (24). Hence, the availability of reliable vaccine safety information through mainstream news media could play an additive role in supplementing social media users with information that encourages parents to vaccinate their children, thus increasing COVID-19 vaccine uptake.

Due to our convenient sampling of parents from the hospital, there was an over-representation of those working in healthcare, as well as those who consult medical professionals for health issues. In addition, we expect that unvaccinated parents may be under-represented, as they may be less inclined to fill up a survey about vaccines. Taken together, our study may under-estimate vaccine hesitancy among parents in Singapore. Finally, as with self-reported surveys, there is a possibility of recall bias resulting in over- or underestimation of the events reported. A bigger study including other Asian societies with diverse socio-economic backgrounds will allow for further exploration of the problem of vaccine hesitancy, which has been identified by the World Health Organisation to be a key threat to human health.

In conclusion, newspaper and print media with reliable vaccine safety information appears to be a useful tool in educating parents about vaccine safety and efficacy, especially among highly educated parents in Singapore. Trust in the child's doctor was found to be a significant factor in childhood vaccine hesitancy.