Post-Pandemic Assessment of Parental Perceptions Towards COVID-19 Vaccination and General Immunization-An Insight from Polio Endemic Country

Muhammad Abdullah¹Agha Syed Zain Haider¹Ahmad Umais Ahad²Muhammad Shoaib Alam³Shaeem Tahir⁴Hurais Malik³Talha Bin Yasin³Muhammad Hudaib³Syed Sohaib Bukhari¹Sher Afgan Ali Khan Burki¹Muneeba Mushtaq³Ayat ul Karam³Jawaria Shahzad³Rana Sajawal Joiya¹Khabab Abbasher Hussien Mohamed Ahmed^5*

• ¹CMH Lahore Medical college and IOD, Lahore, Pakistan
• ²PIMS Hospital, Islamabad, Pakistan
• ³Fazaia Ruth Pfau Medical College, Karachi, Pakistan
• ⁴Azra Naheed medical college, Lahore, Pakistan
• ⁵Faculty of Medicine, University of Khartoum, Khartoum, Sudan

Background: The COVID-19 pandemic exposed and intensified existing challenges in immunization uptake, particularly in countries like Pakistan where vaccine hesitancy persists due to historical mistrust and misinformation. This study aims to assess parental perceptions toward COVID-19 vaccination and general immunization in a post-pandemic context, using the Health Belief Model (HBM) to contextualize behavioral drivers and barriers. Methods: A cross-sectional survey was conducted from March to June 2023 at two tertiary hospitals in Pakistan—Combined Military Hospital, Lahore, and Fazaia Ruth Pfau Medical College, Karachi. Using convenience sampling, 298 parents of children aged 5–15 years completed a validated, pilot-tested questionnaire assessing demographic variables, COVID-19 vaccine perceptions, and general immunization attitudes. Data were analyzed using SPSS v26.0, employing descriptive statistics, non-parametric tests, and Spearman's correlation. Results: Of the 298 participants (64.1% male; mean age = 34.2 years), 93.6% had at least a high school education. The COVID-19 Perception Scale showed a moderate overall score (Mean = 41.3, SD = 10.1), with moderate perceived vulnerability (Mean = 13.6, S.D = 4.5), high trust in vaccine information (Mean = 17.8, SD = 6.0), but low awareness (Mean = 2.4, SD = 1.2) and willingness to vaccinate children (Mean = 3.9, SD = 1.6). The Immunization Perception Scale indicated generally positive attitudes (Mean = 1.6, SD = 0.7), though moderate hesitancy persisted (Mean = 1.7, SD = 1.2). Significant associations emerged between personal or familial COVID-19 experience and both COVID-19 perception (r = 0.269, p < 0.01) and immunization perception (r = 0.121, p < 0.05). Mapping findings to the HBM revealed gaps in cues to action and self-efficacy, despite relatively high perceived benefits. Conclusion: Parental trust in vaccine information is evident, yet awareness and pediatric vaccine uptake remain low. These findings call for context-specific, HBM-informed public health strategies that strengthen cues to action, reduce perceived barriers, and foster community trust to improve immunization outcomes in Pakistan.