Childhood vaccine-preventable diseases rates before and after COVID-19 pandemic in Saudi Arabia and the attitude of parents toward childhood vaccination

The COVID-19 pandemic and the global lockdown have affected regular immunization uptake worldwide. Saudi Arabia’s vaccination program has a historically high coverage rate. However, the impact of the pandemic on vaccine-preventable diseases (VPDs) and parental attitudes toward childhood vaccination remains insufficiently explored in Saudi Arabia. We assessed changes in childhood VPDs rates in Saudi Arabia before and after the COVID-19 pandemic and the potential change in parental attitudes toward childhood vaccination after the pandemic.
A mixed-methods design was employed. It involved analysis of epidemiological data from the Saudi Ministry of Health’s registry of childhood VPDs rates before and after the COVID-19 pandemic (from 2019 to 2023), and a cross-sectional study (between January-September 2024) via in-person interviews with parents of children aged 0-9 years in four major cities in Saudi Arabia.

Vaccination coverage rates exceeded 96% for all significant childhood VPDs from 2019 to 2023. VPDs incidence remained low. However, a slight numerical increase in the incidence/100,000-population of rubella and hepatitis B infections was observed from 0.12 and 19.9 in 2019 to 0.54 and 22.72 in 2023, respectively. Among the 385 parents surveyed, 86.4% reported fully vaccinating their children, and 64.9% received vaccine information from primary care providers. No difference in VPD rates was observed between children who received all childhood vaccines, some of them, or none of them based on parental recall. However, the reports from the parents were subject to recall and social desirability biases. Most correlations between various factors and reasons for vaccine hesitancy were weak-to-negligible, with the highest correlation being reported between a history of pertussis infection before the COVID-19 pandemic with being influenced by advice from a family member/friend against vaccination (
r
=0.22;
P
<0.0001). Most parents (83.8%) stated no change in their children’s vaccine routine since COVID-19.

The vaccination program in Saudi Arabia proved resilient during the pandemic and maintained high vaccination coverage despite unprecedented global disruptions. After the pandemic, increases in some VPDs rates indicate that vigilance is necessary. The study emphasizes the need to continue addressing parental concerns about vaccine safety and to reinforce public health strategies to curtail disease resurgence.