Introduction
The apparent effects of COVID-19 on children are well-known, as the infection often produces moderate disease with mild or asymptomatic symptoms. Despite this, some children infected with SARS-CoV-2 can develop significant infectious diseases and require hospitalization, including critical care and post-recovery monitoring. For instance, serious consequences such as pediatric inflammatory multisystem syndrome temporally linked with SARS-CoV-2, post-COVID-19 autoimmune hemolytic anemia, and COVID toes have occurred in children in Hong Kong (Tse & Kwan, 2021).
Vaccination today is the main and proven tool that helps people cope with the consequences and impacts of the coronavirus. In this regard, it is essential that as many people as possible be vaccinated to slow the spread of the disease. In this sense, Hong Kong has implemented social distancing measures to safeguard children and adults from the transmission of infection. However, after the fifth wave of the disease, in light of the various COVID-19 variants, vaccines remain the most critical public health strategy for protecting people from infection, especially children.
However, while the United Kingdom and the United States have successfully vaccinated most of their population, only a little more than 35% of Hong Kong’s population is vaccinated (Wong et al., 2022). A slowdown in the vaccination process could have many negative repercussions on Hong Kong society. Children are important social elements and, therefore, should receive the best care at the right time. The mortality and severity of coronavirus are two of its main attributes, so it is important to prevent a critical situation in the incidence of children.
Therefore, boosting vaccination uptake among children under 18 is critical for disease prevention in Hong Kong (Zhou et al., 2022). In this regard, this essay discusses the vaccination rates among children in Hong Kong, suggests effective international and local strategies for increasing the vaccination rate, and analyzes these strategies through the Health Belief Model (HBM).
COVID-19 Vaccination Rates Worldwide
Most children infected with the SARS-CoV-2 virus show no or minor symptoms. According to Tse & Kwan (2021), 99.2% of pediatric patients suffer mild symptoms, and 26% to 38% of children have asymptomatic symptoms. Nonetheless, there have been reports of severe sickness or children developing a post-infectious multisystem hyperinflammatory condition known as a multisystem inflammatory syndrome in children (Tse & Kwan, 2021).
Vaccination decreases viral transmission and the virus’s ability to mutate into new, potentially more virulent versions. Therefore, the World Health Organization (WHO) advises that children aged five and older receive COVID-19 immunization (Zhou et al., 2022). This is critical because the virus may readily spread between uninfected children and adults, allowing new forms to arise. Thus, Children and adolescents with COVID-19 may develop a wide range of clinical symptoms, making an empiric diagnosis of COVID-19 in children difficult.
Children’s potential to become a driving force of the pandemic can be overlooked. According to Zhou et al. (2022), children have a lower mortality rate and fewer hospitalizations and critical care unit admissions after SARS-CoV-2 infection than adults. Nevertheless, COVID-19 immunization for children is critical for pandemic control. Even in nations where COVID-19 vaccines are authorized for school-aged children, uptake among this age group remains the lowest of any eligible age group (Peebles et al., 2022).
By 2022, vaccination coverage in Peru was 55% among children under 18 and 44% among 5- to 11-year-olds (Peebles et al., 2022). Meanwhile, 29% of U.S. children aged 5 to 11 were vaccinated, while the percentage of children 12 to 17 was 59. (Zhou et al., 2022). In Hong Kong, the rates are 6.5% among children aged 12-19 and 6.4% among those aged 3-11. The rate of hospitalization among children varies depending on the admission requirements in each country. However, it has been rising since the fifth wave of the COVID-19 pandemic.
School-Based Vaccination Programs
School-based vaccination programs (SBVPs) can be used to raise the children’s vaccination rates for various commonly recommended vaccinations. These programs offer substantial benefits for vaccination distribution by addressing various logistical hurdles, including reduced travel costs. This approach was implemented in Canada, and the results showed that the COVID-19 vaccination completion rates increased from 30.6% to 81.5% within twelve days (Peebles et al., 2022).
Currently, this program is implemented in Argentina, Costa Rica, Panama, and Colombia, and plays a crucial role in vaccination coverage strategies (Peebles et al., 2022). Thus, expanding vaccine coverage to children is crucial for mitigating the pandemic’s impact. Following that, parents’ vaccine hesitancy can be considered the main barrier to children’s vaccination. For example, in Hong Kong, only 21.2% of parents reported that they would get their school-age children vaccinated, despite vaccines for children aged 12-17 having been approved since 2021 (Lau et al., 2022).
This rate is lower compared to other countries, indicating that Hong Kong parents are particularly reluctant to vaccinate their children during the study period. Despite this, Hong Kong implemented a “vaccine pass” program, which requires people aged 12 and older to undergo vaccination to enter public places (Lau et al., 2022). Vaccine reluctance is a significant barrier to worldwide COVID-19 immunization campaigns and pandemic control. For children aged 3 to 17, parents frequently make or substantially affect immunization decisions (Zhou et al., 2022). As a result, it is critical to evaluate parents’ COVID-19 vaccination status.
National Childhood COVID-19 Vaccination Program
In contrast to international strategies, the local National Childhood COVID-19 Vaccination Program is implemented nationwide. However, the vaccination programs for children aged 3-11 years began later than the program for teenagers between 12 and 17. Variables between parents with children under 11 years of age and those with children under 17 years of age differed and were associated with reluctance to be vaccinated (Zhou et al., 2022). Zhou et al. (2022) indicated that Chinese parents were receptive to nationwide kids’ COVID-19 vaccination programs.
Following the implementation of the immunization programs, the frequency of parents’ vaccine hesitancy in children reduced dramatically (Zhou et al., 2022; Wong et al., 2022). According to Zhou et al. (2022), compared to parents with children aged 3-11 years (22.5%), parents aged 12-17 had a more significant drop in vaccination hesitation, with 8.5%. The nationwide immunization program for children aged 12-17 years was implemented three months earlier in China than for younger children, which may explain some of the disparity (Zhou et al., 2022). Given the low vaccine hesitation among parents in China, COVID-19 immunization coverage in children aged 3-11 years is likely to increase significantly.
The Effectiveness of the Strategies Through the HBF
One of the most extensively utilized models for analyzing vaccination behavior against COVID-19 is the Health Belief Model. According to the idea, health-related behavior is influenced by various variables, including perceived vulnerability, perceived severity, perceived advantages, perceived obstacles, cues to action, and self-efficacy. Unvaccinated children are one of the threats to society during COVID-19, as they carry the disease almost asymptomatically and, accordingly, can infect other people. Based on the declining hesitancy among parents regarding vaccines, I believe the risk of children in Hong Kong not being vaccinated will decrease.
Moreover, Wong et al. (2022) state that, although children require their parents’ permission to receive a vaccine, 39% of adolescents plan to vaccinate when it becomes available. Thus, the vaccination rate among children is expected to increase with the implementation of school-based vaccination programs and the National Childhood Vaccination Program. As stated earlier, children typically experience milder symptoms, and the likelihood of hospitalization is lower compared to adults.
However, Hong Kong reported a 4-month-old baby who caught an infection from his family and another 4-year-old toddler who was infected several months before he tested positive (Tse & Kwan, 2021). These two cases add to the severity after the diagnosis, as they show children can suffer and transmit the infection the same way as adults. Thus, children’s vaccination plays a critical role in regulating the outbreak and provides a deeper understanding of the infection naturally.
In Hong Kong, various motivational and support programs ensure that as many children as possible are vaccinated and can avoid infection. One such government program is the government’s announcement that children aged 5 to 11 can receive reserved doses of the vaccine (Government of Hong Kong, n.d.). To make vaccination more convenient, the government has provided special school meetings for children and mobile vaccination centers. This initiative is free for children, which can positively affect the vaccination rate and its availability to the population.
That way, as many people as possible can get the vaccine. At the same time, children do not differ in any way by gender, religion, or ethnicity, and anyone who wants it can get vaccinated. For this program, in addition to mobile points, the Hong Kong authorities have also ordered some clinics to expand their range of services to cover elementary and secondary students. Thus, several types of vaccines were tested in the region to provide the children’s population with timely doses. Such special channels and institutions for vaccinating children are crucial steps towards achieving a society without COVID. Motivational programs are an important element in supporting the population to develop a vaccine.
It may also help undecided citizens clarify their positions on vaccination. Following the coronavirus pandemic, many people have become aware of the advantages of vaccination. However, despite everything, the rest continue to think that vaccines can harm their health. Such people, as a rule, did not face the threats of various diseases against which vaccinations should protect. Vaccination promotion programs are a way to support public health in Hong Kong and create a general public sentiment that encourages more people to get vaccinated.
Comparing the international and local strategies for children’s vaccination, it can be viewed that, for example, the Chinese policy is more aggressive, as the vaccination rates are higher than in the U.S. Since China implemented its zero-COVID-19 policy, the government has actively promoted vaccination among parents of children. Zhou et al. (2022) also suggest that changes in parents’ views on children’s vaccination may have led to a gradual decline in vaccination reluctance. This can have positive consequences for health promotion in the region.
The human immune system reacts to any infection with a strong opposition within the body. Gradually, the blood produces protective antibodies to effectively fight dangerous antigens, but by the time this happens, the body will already be exhausted by high temperatures and various complications. The coronavirus affects the body similarly to the usual flu; therefore, the immune system’s response to its presence in the body will be similar. In the vast majority of cases, the primary cure for viruses that enter the body is the human immune system. The virus is not a living organism; it is a small chain of RNA enclosed in a protein shell.
Entering the body from the external environment, the virus attaches to a human cell, forcing it to reproduce it. At some point, the affected cell dies, and the viruses it reproduces spread to healthy cells. The immune system is turned on when a certain number of cells are damaged. The body produces specific proteins that are sent to the affected cells to destroy the virus. Acting on the pathogen, the immune system triggers inflammation, resulting in a rise in the person’s body temperature and other unpleasant symptoms. All the symptoms are the result of the immune system fighting the virus. A sustained immune response is typically observed in most patients who have recovered from COVID-19.
Accordingly, it can be assumed that severe forms of the disease, as well as a coronavirus that has led to a fatal outcome, are most often the result of a weakened immune system. The immune system cannot always properly and effectively deal with the threat. In such cases, it needs help in the form of a virus imprint to understand how to deal with it. Such an imprint is typically a vaccine introduced into the body in advance, allowing behavior patterns to form when a real threat appears. An unfortunate outcome of the battle with such dangerous infections as whooping cough, measles, diphtheria, and tetanus, which often lead to serious consequences, disability, and death.
Therefore, it is crucial that antibodies, which act as protection, are constantly present in the body and can immediately react to a potential infection. The task of the vaccine is to mimic the development of an infectious disease, thereby stimulating the body’s immune system to form antibodies. By vaccinating children, it is possible to eliminate or significantly reduce the risk of infection. Moreover, if it does occur, the disease proceeds in a mild form without complications.
In addition to preventing disease control, vaccinations also offer some individual benefits, such as saving parents money. This is because when a child is vaccinated, it protects them from many serious diseases, such as acute viral infections or coronavirus. In such cases, parents can significantly save on the family budget, as treatment for these diseases is usually expensive and may not yield results in some instances. The vaccine acts on the child’s organism in advance, providing more reliable protection.
In Hong Kong, vaccination hesitancy among adults remained at about 40-60% in early 2021 before dropping to 20-30% in August 2021. Regarding parental vaccination for children aged 5-11 years, approximately 70-80% of parents reported being hesitant to vaccinate their children in January 2022, which is higher than in many other countries and regions worldwide (Wang et al., 2022). Parental vaccination rejection is motivated by various factors, including religious convictions, personal beliefs, philosophical reasons, safety concerns, and a desire for additional information from healthcare practitioners.
However, these reasons, as a rule, are not related to the real state of affairs and carry only the goal of preventing the child from being vaccinated. This behavior of parents can be dangerous for children and, in some cases, lead to negative consequences. Wong et al. (2022) found that by that time, 39% of adolescents with a median age of 14 years were planning to get vaccinated. This suggests that parental upbringing and anti-vaccine guidance can negatively impact a child’s future desires.
Therefore, since March 2021, the Hong Kong government has also implemented a free COVID-19 immunization program for all Hong Kong citizens (Lau et al., 2022). This can significantly impact the growth rate of the vaccinated population, affecting not only adults but also children. Most often, parents are the reason their child is not vaccinated. As shown above, later, such children, when they grow up, have no desire to be vaccinated. This is due to the strong influence of their parents in childhood.
Concerns about vaccination safety among parents contribute to low COVID-19 vaccine uptake among young people. The SBVPs can make vaccinations more widely available and increase vaccine acceptance by normalizing vaccination and providing access to trustworthy sources of information through school nurses or other officials, allowing parents to be meaningfully engaged and concerns to be addressed (Peebles et al., 2022). School-based immunization programs can significantly enhance vaccine uptake among kids, minimizing the pandemic’s catastrophic consequences on children and their families.
These programs are also critical for addressing disparities experienced by underprivileged populations. Lessons learned from previous childhood vaccination campaigns should be applied to COVID-19 immunization as soon as possible to ensure schools are prepared and equipped to lead vaccination initiatives. It is important to note that after the children are vaccinated, the community has several tangible benefits. First, they protect everyone from diseases and stop the rapid transmission of infection among vulnerable groups of people. Moreover, children’s vaccination can be a significant contribution to medicine and a better understanding of infectious diseases.
When discussing the effectiveness of the National Childhood COVID-19 Vaccination Program, it is essential to mention that this program, like other vaccination programs, depends on parents’ attitudes toward vaccines. Wong et al. (2022) suggest that it is influenced by three main factors: a lack of trust in a vaccine’s safety, a poor perception of disease risk, and a lack of affordability. However, Zhou et al. (2022) state that after the national vaccination campaign was implemented in China, the overall hesitancy rates fell considerably.
Negative and positive attitudes, support from important people, and behavioral control related to vaccination in children, as well as discussion on social networks, have increased significantly (Zhou et al., 2022). Various circumstances impacted parents’ vaccine hesitation both before and after the implementation of the immunization program. Regular vaccination hesitancy and its related variables should be monitored among parents to inform health promotion and policymaking.
In this sense, increasing vaccination coverage among children by implementing school-based COVID-19 vaccination programs in line with the National Childhood COVID-19 Vaccination Program may help decrease parents’ anxieties about not having free opportunities to vaccinate their children. This program can help increase the vaccination rate of children by obliging parents to vaccinate their children so that they can attend school. This is a radical method, but it works and is one of the most effective in cases where it was not possible to convince parents.
Conclusion
To conclude, COVID-19 can pose a significant danger to children and young people. Thus, vaccinating children can protect them from contracting COVID-19 and reduce the risk of severe illness, hospitalization, and long-term complications. However, at a time when vaccines are already available to all people, timely vaccination is extremely important. After all, if a child contracts a coronavirus at a young age and remains relatively asymptomatic, the consequences of the disease may still appear later.
Delays in initiating vaccination clinical trials in children would prolong our recovery from COVID-19 and, as a result, impact children’s health, emotional well-being, education, and fair access to opportunities for growth and social achievement in the country’s economy. It is vital to understand the safety, immunogenicity, and effectiveness of COVID-19 vaccinations in children to protect children and adults. Vaccination has the added benefit of allowing children to return to school and extracurricular activities safely, allowing them to participate in their environment face-to-face once more. This will have a positive impact on the pace of socialization, allowing schoolchildren to lead a full life again, as they did before the quarantine.
It has been noted that parents have a significant impact on children’s vaccination rates. This means that if the parents are anti-vaccine in some way, then the children will not be vaccinated either. Such a detrimental effect can lead to consequences in the form of illness for the whole family, which in the long term poses a threat to the rest.
Therefore, several programs have been implemented nationwide and worldwide, particularly the School-Based Vaccination Programs and the National Childhood COVID-19 Vaccination Program. The effectiveness of these programs has been examined using the HBF. As a result, individual perceptions, as well as modifying factors such as age, socio-economic status, education, and perceived benefits and behavioral changes in children’s vaccination, were identified.
References
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The Government of the Hong Kong. (n. d.). Arrangements for children aged 5 to 11 to receive COVID-19 vaccines.
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