# Parental Attitudes and Hesitancy Towards Childhood Influenza Vaccination in Slovakia: A Cross-Sectional Survey of 301 Parents

## TL;DR

In Slovakia, only 27.6% of parents are willing to vaccinate their children against influenza, with safety concerns and digital misinformation being major barriers, despite full insurance coverage.

## Contribution

The study reveals that vaccine hesitancy in Slovakia is widespread across all education levels and is primarily driven by fear of adverse effects, not efficacy doubts.

## Key findings

- Only 27.6% of parents in Slovakia are willing to vaccinate their children against influenza, despite full insurance coverage.
- Consulting a pediatrician increases vaccine acceptance six-fold, while reliance on the internet and social media predicts refusal.
- Fear of adverse effects is the main barrier to vaccination, reported by 70.4% of parents.

## Abstract

What are the main findings?
•Critical Vaccination Gap: Despite full health insurance coverage, only 27.6% of Slovak parents expressed willingness to vaccinate their children against influenza, highlighting a profound disconnect between public health policy and parental compliance.•The Education Paradox: Contrary to global trends, high parental education was not associated with increased vaccine acceptance (p > 0.05), suggesting that hesitancy in this region is deeply entrenched across all socioeconomic strata.

Critical Vaccination Gap: Despite full health insurance coverage, only 27.6% of Slovak parents expressed willingness to vaccinate their children against influenza, highlighting a profound disconnect between public health policy and parental compliance.

The Education Paradox: Contrary to global trends, high parental education was not associated with increased vaccine acceptance (p > 0.05), suggesting that hesitancy in this region is deeply entrenched across all socioeconomic strata.

What is the implication of the main finding?
•Protective Role of Pediatricians: Consulting a pediatrician was identified as the most robust protective factor against hesitancy, increasing the odds of vaccine acceptance six-fold (OR 6.32; 95% CI: 3.54–11.28).•Dominant Barriers: The primary driver of refusal was fear of adverse effects (70.4%) rather than doubts about efficacy, indicating a need for safety-focused risk communication.

Protective Role of Pediatricians: Consulting a pediatrician was identified as the most robust protective factor against hesitancy, increasing the odds of vaccine acceptance six-fold (OR 6.32; 95% CI: 3.54–11.28).

Dominant Barriers: The primary driver of refusal was fear of adverse effects (70.4%) rather than doubts about efficacy, indicating a need for safety-focused risk communication.

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies.