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Abstract

Background:

Vaccination is one of the most effective public health interventions, preventing millions of deaths globally. However, vaccine hesitancy persists, not only among the public, but also among healthcare professionals (HCPs), who serve as key sources of vaccine information. This study assesses HCPs’ vaccination attitudes and estimates the prevalence and determinants of vaccine hesitancy in the UAE.

Design and methods:

This cross-sectional, descriptive study surveyed HCPs across the UAE from March to October 2024 using a 57-item questionnaire adapted from previous literature. Univariate, bivariate (chi-squared test), and multivariate (logistic regression) analyses were conducted.

Results:

HCPs demonstrated generally positive attitudes towards paediatric vaccinations, with 84.29% expressing confidence in vaccine safety and efficacy. However, significant knowledge gaps were identified, particularly regarding vaccine adjuvants and long-term safety. Hesitancy was highest among mid-level professionals, including nurses, dentists, and pharmacists, with concerns about vaccine safety (47.87%) and adverse effects (57.67%) being major drivers. Additionally, 85.77% exhibited caution towards newly introduced vaccines, preferring to wait for broader community uptake. Time constraints limited vaccine discussions, and 71.9% of HCPs had never received formal training on addressing hesitancy.

Conclusion:

While HCPs generally support paediatric vaccinations, knowledge gaps and hesitancy towards new vaccines persist. Targeted professional education, particularly in vaccine safety and communication strategies, is crucial to strengthening vaccine advocacy. Addressing these gaps through tailored training programmes may enhance HCPs’ ability to effectively counter vaccine hesitancy and sustain high immunization coverage.

Keywords

vaccine hesitancy UAE HCP physician

Introduction

Vaccination is one of the most consequential public health interventions; global immunization efforts have saved an estimated 154 million lives over the past 50 years.¹ Despite its success, global immunization coverage has declined over the past decade, more so after the COVID-19 pandemic.^2,3

The 2022 WHO-UNICEF Estimates of Immunization Coverage (WUENIC) indicated that 25 million children missed out on one or more doses of DTP (Diphtheria, Tetanus, Pertussis) Vaccine through routine immunization services in 2021 alone—2 million more than in 2020 and 6 million more than in 2019.⁴ The consequences of insufficient vaccine coverage are well-documented.^5–8 A US modelling study estimated that for even a 5% reduction in MMR (Measles, Mumps, Rubella) coverage, a threefold increase in measles would be expected, costing the public sector an additional $2.1 million.⁹ This issue is only expected to grow with the 2023 UNICEF State of the World’s Children report finding that perception of the importance childhood vaccination has declined more than 10 percentage points across Europe and Central Asia, with some countries seeing drops as high as 44%.¹⁰

Vaccine hesitancy is a major driver of backslides in immunization rates globally, recently classified by the World Health Organization (WHO) as one of the 10 threats to Global Health.¹¹ WHO first defined vaccine hesitancy as the delay in acceptance or the refusal of vaccination despite availability of vaccination services.¹² In 2022, the concept has been refined as a motivational state of being conflicted about, or opposed to, getting vaccinated; this includes intentions and willingness.¹³

Understanding the underlying factors driving hesitancy is essential for addressing this public health challenge. Evidence suggests that concerns about vaccine safety, efficacy, and novelty play a central role in shaping reluctance.¹² In the United Arab Emirates (UAE), an observational cross-sectional study revealed that 14% exhibited vaccine hesitancy, despite a high degree of trust in the national healthcare system.¹⁴

Vaccine hesitancy is not confined to the general population but has also been observed among healthcare professionals (HCPs), who are conventionally regarded as the most authoritative sources of vaccine-related information. In a study conducted in the UAE, among the 45.8% healthcare workers who did not take the influenza vaccine, nearly half reported that “doubts about efficacy” was their main barrier against vaccination.¹⁵ While this is distinct from paediatric immunization, such reluctance may reflect broader vaccine scepticism, potentially influencing public perception. Despite having vaccine coverage estimates above 95% for most childhood vaccines, vaccine preventable diseases continue to persist in the UAE.¹⁶

Vaccine hesitancy among HCPs has been documented in various international contexts, further underscoring the urgency of this issue. A qualitative investigation conducted by the European Centre for Disease Prevention and Control (ECDC) in Croatia, France, Greece, and Romania identified pervasive scepticism regarding vaccine efficacy, concerns over adverse effects, and underlying distrust in pharmaceutical entities and regulatory institutions.¹⁷ A recent study also reported that 32.1% of paediatric nurses expressed some degree of vaccine hesitancy, with hesitancy rates reaching 21.9% for the HPV vaccine and 17.5% for varicella.¹⁸

Healthcare professionals serve as the primary intermediaries in vaccine advocacy, yet their own reservations regarding immunization may inadvertently contribute to public hesitancy. Previous studies in the UAE have highlighted a widespread deficiency in knowledge among physicians concerning adult vaccines, a lack of confidence in addressing patient concerns, and the influence of misinformation propagated through social media.^19,20 Although a significant proportion of physicians acknowledge vaccine hesitancy as a public health concern, some express reluctance in engaging with hesitant parents due to fears of jeopardizing the physician-patient relationship.¹⁶ The implications of this hesitancy extend beyond individual clinical encounters, as unaddressed scepticism may propagate vaccine reluctance within broader communities.

This study aims to comprehensively assess hesitancy towards paediatric vaccines among healthcare professionals in the UAE by exploring key factors influencing their attitudes in current times. Specifically, the research seeks to examine levels of confidence and knowledge regarding paediatric vaccines, quantify the extent of agreement with current vaccination practices, and identify prevailing concerns related to paediatric immunization. Furthermore, the study endeavours to determine predictors of vaccine hesitancy within this population, analysing how demographic, professional, and experiential factors contribute to reluctance or uncertainty. By expounding on these determinants, the study intends to provide evidence-based insights that may contribute to the development of targeted interventions to enhance vaccine confidence among healthcare professionals and, consequently, bolster vaccine uptake within the broader population.

Methodology

Questionnaire development

There is no standardized tool to measure vaccine hesitancy in healthcare professionals that has been widely used. We reviewed the Parental Attitudes towards Childhood Vaccines scale (PACV),²¹ the WHO’s Vaccine Hesitancy Scale (VHS),²² in addition to reviewing previous questionnaires from similar studies^14,23 with some adjustments to better fit our objectives. The 57-item questionnaire was split into four main sections: demographics, knowledge of vaccines, recognizing importance of vaccines, and general vaccine hesitancy. Each section utilized a mixture of yes/no questions, single and multi-select questions as well as Likert scales. The questionnaire was developed in English. Pilot testing was conducted, and all feedback was reviewed and incorporated if appropriate. The developed questionnaire was uploaded to Google Forms to facilitate distribution. The tool and research plan were reviewed and approved by the University of Sharjah Research Ethics Committee (Reference Number: REC-24-02-26-02-F) and were conducted in accordance with all relevant guidelines and regulations. The questionnaire can be found in the Supplementary Material section.

Study population and data collection

This UAE cross-sectional study gathered data from healthcare professionals from 19th March 2024 to 12th October 2024, using convenience sampling. To be included, participants had to be healthcare professionals currently working in the UAE. Recruitment occurred though various channels including WhatsApp, emails, and Instagram, as well as in person by approaching professionals at their workplaces with QR codes. Using Cochran’s sample size formula and assuming a confidence level of 95%, sampling error of 5%, and a standard error of 1.96, the minimum required sample size was found to be 385. A total of 541 responses were included after removing those not meeting inclusion criteria. Before answering the questionnaire, participants were shown a Participant Information Sheet detailing the purpose and procedures of the study; only after providing written consent can a participant begin the study. Confidentiality was maintained by not collecting any identifying information and by ensuring the data was securely stored and only accessible to the investigators.

Statistical analysis

Only the researchers had access to the raw data. Data was exported from Google Forms to CSV format and processed in python-3 using the Matplotlib-v3.3.4, pandas-v1.2.4, and statsmodels-v0.12.2 packages for analysis and interpretation. Missing values were dealt with through pairwise deletion.

All baseline and demographic characteristics were used to identify determinants of vaccine hesitancy. Chi-squared tests were used for bivariate analyses and logistic regression was used for multivariate modelling. p-Values less than 0.05 were taken to be significant.

Results

Demographic data

A total of 541 HCPs participated in the study. Most of the participants identified as Arab (63.96%, n = 346), with 88 being Emirati (16.27%). A significant proportion were physicians (69.87%, n = 378), while other HCPs included pharmacists (10.72%, n = 58), dentists (9.98%, n = 54), and nurses (6.65%, n = 36).

Affiliations varied depending on their registration with the three health regulatory authorities in the UAE - Ministry of Health and Prevention (44.36%, n = 240), Dubai Health Authority (31.98%, n = 173) and Department of Health/Health Authority - Abu Dhabi (23.66%, n = 128). The majority of participants worked in government hospitals (61.74%, n = 334). Further demographics can be seen in Table 1.

Table 1.

Demographics and baseline characteristics of participating healthcare professionals.

Sex—% (n)
Female	59.52 (n = 322/541)
Male	40.48 (n = 219/541)
Citizenship—% (n)
Emirati	16.27 (n = 88/541)
Non-Arab	19.78 (n = 107/541)
Other Arab	63.96 (n = 346/541)
Occupation—% (n)
Physician	69.87 (n = 378/541)
Pharmacist	10.72 (n = 58/541)
Dentist	9.98 (n = 54/541)
Nurse	6.65 (n = 36/541)
Other HCP	2.77 (n = 15/541)
Health authority—% (n)
DHA	31.98 (n = 173/541)
DOH/HAAD	23.66 (n = 128/541)
MOHAP	44.36 (n = 240/541)
Workplace—% (n)
Government hospital	61.74 (n = 334/541)
Private clinic/hospital	23.48 (n = 127/541)
Primary healthcare	9.8 (n = 53/541)
Other	4.99 (n = 27/541)
Total years of practice—% (n)
Entry level	46.03 (n = 249/541)
Mid-level	26.80 (n = 145/541)
Senior level	27.17 (n = 147/541)
Number of patients seen in a week—% (n)
1–19	27.54 (n = 149/541)
20–49	39.56 (n = 214/541)
50 and above	32.9 (n = 178/541)
Have you received the COVID-19 vaccine?—% (n)
No	2.4% (n = 13/541)
Yes, 1 dose/2 doses	34.94% (n = 189/541)
Yes, 3 doses	37.71% (n = 204/541)
Yes, 4 doses or more	24.95 (n = 135/541)
Have you received the influenza vaccine last year?—% (n)
Yes	47.87 (n = 259/541)
No	52.13 (n = 282/541)

DHA: Dubai Health Authority; DOH/HAAD/: Department of Health/Health Authority-Abu Dhabi; HCP: Healthcare professional; MOHAP: Ministry of Health and Prevention.

Confidence and knowledge about paediatric vaccines

A large proportion of participants, 84.29% (n = 456) were confident in their knowledge of vaccine usage and efficacy, with very similar confidence in their knowledge of vaccine safety. However, confidence waned when it came to understanding the role of adjuvants, with 33.27% (n = 180) feeling unconfident.

It is important to highlight that a good proportion of healthcare professionals (HCPs) reported “I don’t know” when asked about the likelihood of vaccine-associated complications, particularly in context of long-term complications of vaccines with adjuvants (31.05%, n = 168). On a positive note, 73.01% (n = 395) consider it unlikely that there is a link between the measles vaccine and autism (Table 2).

Table 2.

Knowledge of vaccine-associated complications.

Based on your knowledge, what is the likelihood of the following vaccine-associated complications:
	Very unlikely	Unlikely	I don’t know	Likely	Very likely
Influenza vaccine and Guillain-Barré syndrome	29.76% (n = 161/541)	33.09% (n = 179/541)	20.52% (n = 111/541)	12.94% (n = 70/541)	3.7% (n = 20/541)
Hepatitis B vaccine and Guillain-Barré syndrome	32.9% (n = 178/541)	32.35% (n = 175/541)	21.44% (n = 116/541)	10.91% (n = 59/541)	2.4% (n = 13/541)
Hepatitis B vaccine and multiple sclerosis	33.64% (n = 182/541)	33.46% (n = 181/541)	20.52% (n = 111/541)	9.8% (n = 53/541)	2.59% (n = 14/541)
Aluminium adjuvants and Alzheimer disease	17.74% (n = 96/541)	25.51% (n = 138/541)	38.82% (n = 210/541)	14.42% (n = 78/541)	3.51% (n = 19/541)
Vaccines with adjuvants and long-term complications	19.96% (n = 108/541)	27.91% (n = 151/541)	31.05% (n = 168/541)	18.3% (n = 99/541)	2.77% (n = 15/541)
Measles vaccine and autism disorder	48.8% (n = 264/541)	24.21% (n = 131/541)	14.05% (n = 76/541)	10.17% (n = 55/541)	2.77% (n = 15/541)

Attitudes towards current vaccination practices

The results indicate that the participants exhibit good confidence in paediatric vaccinations. Most HCPs recognize the importance of vaccines in preventive care, with 88.36% (n = 478) either agreeing or strongly agreeing with this statement. There is a high level of confidence (94.82%, n = 513) in vaccines recommended by health authorities. Yet, a substantial proportion (85.77%, n = 464) of HCPs prefer to wait for broad community experience before recommending new vaccines, demonstrating a cautious approach.

Despite this, 86.51% (n = 469) of HCPs acknowledge their responsibility in educating parents about vaccines and recognize that acceptance is significantly impacted by their recommendations (90.94%, n = 492). Unfortunately, a significant proportion of HCPs (68.77%, n = 372) reported a lack of time for advising about vaccines, highlighting a systemic challenge in providing comprehensive vaccine education.

HCPs were asked to what extent they agree that it is very useful to vaccinate children against various illnesses and results are displayed in Figure 1.

Figure 1.

HCPs were asked to what extent they AGREE that it is very useful to vaccinate children against the following illness; please note that the vaccines are mentioned in the brackets.

Concerns surrounding paediatric vaccinations

Despite good confidence, participants expressed some concerns about vaccines. 37.71% (n = 204) were hesitant and 35.3% (n = 191) were unsure if new vaccines carry more risks than older vaccines. 57.67% (n = 312) expressed concerns about serious adverse effects of vaccines. When recommending vaccines, HCPs prioritized vaccine safety (47.87%, n = 259), vaccine effectiveness (45.84%, n = 248), and disease eradication potential (45.47%, n = 246). The least important factors were personal experience with the disease (13.12%, n = 71) and vaccine cost (11.46%, n = 62; Table 3).

Table 3.

Factors influencing recommendation of paediatric vaccinations.

What are the five most important factors to you personally when it comes to recommending a vaccine? % (n)
I do not directly deal with paediatric vaccines in my practice	47.5 (n = 257/541)
Vaccine safety	47.87 (n = 259/541)
Vaccine effectiveness	45.84 (n = 248/541)
Possibility to eradicate disease with vaccination	45.47 (n = 246/541)
Severity/lethality of the prevented disease	41.40 (n = 224/541)
Incidence of disease	40.48 (n = 219/541)
Inclusion of vaccine in the official immunization schedule	28.84 (n = 156/541)
Individual health-risk profile of the child	24.95 (n = 135/541)
Personal experience with the disease	13.12 (n = 71/541)
Vaccine cost	11.46 (n = 62/541)
Other	1.48 (n = 8/541)

Participants perceive that their patients’ perception of vaccination has shifted to more negative (30.5%, n = 165) to neutral (46.58%, n = 252) during the COVID-19 pandemic. When asked, how their own perceptions have changed during the pandemic, 37.52% (n = 203) concur that it has become more positive while 51.39% (n = 278) remained neutral.

Predictors of hesitancy towards paediatric vaccines

Bivariate analysis was done using Chi-Square for the demographic variables. Hesitancy towards paediatric vaccines was notably significant with certain professional roles and mid-level experience. Dentists (OR = 5.714, 95% CI = 1.846–17.690, p = 0.003), nurses (OR = 4.571, 95% CI = 1.076–19.434, p = 0.040) and pharmacists (OR = 4.229, 95% CI = 1.315–13.599, p = 0.016) demonstrated higher odds of hesitancy (Table 4).

Table 4.

The results of the logistic regression modelling general vaccine hesitancy and its determinants.

General vaccine hesitancy predictors—binary logistic regression (LR)
Model terms	-	$O R (e^{β_{i}})$	95% CI for OR	SE	z-Statistic	p-Value
Intercept ( $β_{0}$ )	-	0.014	0.005–0.037	0.486	−8.753	<0.0005
Occupation (p-value: 0.002)	Physician	-	-	-	-	-
Occupation (p-value: 0.002)	Dentist	5.714	1.846–17.690	0.577	3.022	0.003
	Nurse	4.571	1.076–19.434	0.738	2.058	0.040
	Pharmacist	4.229	1.315–13.599	0.596	2.420	0.016
	Other HCP	4.538	0.840–24.508	0.861	1.758	0.079
Total years of practice (p-value: 0.008)	Entry level	-	-	-	-	-
	Mid-level	3.183	1.188–8.534	0.503	2.302	0.021
	Senior level	0.942	0.244–3.647	0.690	−0.086	0.932
Log-likelihood: −87.283	Log-likelihood of null model: −98.228		Log-likelihood ratio p-value: 0.001

CI: confidence interval; OR: odds ratio; SE: standard error.

p-Values for the bivariate Chi-square tests are below each variable below. Rows with significant p-values are bolded.

Training needs to address vaccination concerns

Most of the HCPs (71.9%, n = 389) had not received any training to address vaccine hesitancy among parents. However, most of the HCPs were interested in receiving such training. 35.86% (n = 194) were interested, 20.33% (n = 110) were very interested, and 26.8% (n = 145) were neutral. Only 7.02% (n = 38) were not interested at all. A large majority of the HCPs (73.01%, n = 395) believed that such training should be part of university education (Table 5).

Table 5.

HCPs source of information about vaccination practices.

What is your main source of information about vaccines recommendation and their safety? % (n)
Medical experience	58.23 (n = 315/541)
International guidelines	56.56 (n = 306/541)
Local guidelines	44.73 (n = 242/541)
Journals and medical websites	36.23 (n = 196/541)
Colleagues experience and advice	34.94 (n = 189/541)
Vaccine manufacturers	13.31 (n = 72/541)
Experience of family and friends	12.94 (n = 70/541)
Social media	11.83 (n = 64/541)
Other	1.66 (n = 9/541)
I am not keen on information about vaccinations	7.58 (n = 41/541)

Discussion

This study explored the attitudes of healthcare professionals (HCPs) in the UAE towards paediatric vaccines, confidence in their safety and efficacy, and the factors influencing their recommendations.

Summary of results

This study provides insights into vaccine confidence and hesitancy among HCPs in the UAE. The key findings of this study highlight a generally positive attitude among HCPs towards paediatric vaccinations, coupled with high self-reported confidence in their knowledge of vaccine usage, safety, and efficacy. While confidence in paediatric vaccines was generally high (84.29%), significant knowledge gaps remained, particularly concerning vaccine adjuvants and long-term safety. A notable proportion (85.77%) exhibited caution towards newly introduced vaccines, preferring to wait for broader community uptake before recommending them.

Hesitancy was more pronounced among dentists, nurses, and pharmacists compared to physicians, with mid-level professionals displaying the highest levels of doubt. Concerns about vaccine safety (47.87%) and adverse effects (57.67%) were key drivers of hesitancy, compounded by time constraints limiting vaccine discussions. Despite their pivotal role in vaccine advocacy, 71.9% of professionals have never received formal training in addressing hesitancy, underscoring an urgent need for targeted professional education.

Vaccine hesitancy: Applying the 3C model

Vaccination, widely regarded as one of the most significant public health achievements, has paradoxically become a victim of its own success. As disease transmission declines, public awareness of the severity of these illnesses diminishes, leading some to underestimate the dangers of the disease while overestimating the risks associated with vaccination.²⁴ Strategic Advisory Group of Experts (SAGE) on Immunization, established by the World Health Organization (WHO), identifies the 3C model as factors associated with vaccine hesitancy—Confidence, Complacency, Convenience.¹²

In context of our results, there was broad agreement on the importance of vaccination, with most participants expressing confidence in vaccines recommended by health authorities. However, there was also a noticeable level of complacency, as many preferred to wait for wider community uptake before endorsing newly introduced vaccines. While a cautious approach is understandable, delays in professional endorsement can undermine confidence in immunization programmes, especially for new or rapidly developed vaccines, as the public may perceive the delay as a lack of assurance. When comparing patients’ perceptions of vaccination before and during the pandemic, a third of healthcare professionals in this study observed that their patients’ views had shifted negatively. This is most likely fuelled by the spread of misinformation, contributing to greater complacency and hesitancy among some segments of the population.

In 2018, the model was revised to become the 5C model which encompassed confidence, complacency, constraints, calculation of risk and collective responsibility.²⁵ Undertaking this research is an attempt to understand the current risk of vaccine hesitancy in our community so we can take actions to mitigate it, as a community.

Is there a need for an urgent call to action?

Vaccines are recognized as having a critical role in preventing deaths and hospitalizations due to infectious diseases; estimates suggest that vaccines could have prevented nearly one-quarter (21.7%) of the 5.3 million deaths among children under the age of 5 years in 2019.²⁶

In 2023, the WHO reported that worldwide immunization rates for key vaccines, including the diphtheria-tetanus-pertussis (DTP3) series, had dropped to 84% from pre-pandemic rates of 86%. Similarly, the global vaccine coverage of children who received a first dose of measles vaccine was 83% in 2023, compared to pre-pandemic levels of 86% in 2019.¹⁰ Measles is leading the resurgence of vaccine-preventable diseases. In 2024, the European Region saw 127,350 measles cases—double the 2023 count and the highest since 1997. Over 40% of cases were in children under 5, with more than half requiring hospitalization and 38 reported deaths as of March 2025. This highlights the urgent need for improved attitudes to vaccine preventable diseases.²⁷

Fortunately, the UAE has strong vaccination coverage, with the following rates for key vaccines: BCG at 98%, DTP third dose at 96%, Hep B third dose at 96%, Measles-containing vaccine second dose at 94%, Polio third dose at 94%, Rubella-containing vaccine first dose at 98%, and Rotavirus last dose at 91%.²⁸ These figures are close to or above the WHO-recommended 95% target for controlling vaccine-preventable diseases, though there are minor gaps in measles, polio, and rotavirus coverage.

Despite meeting WHO vaccination targets, the UAE saw an uptick in vaccine-preventable diseases like measles, mumps, and pertussis in 2024.²⁸ With expatriates making up 88.5% of the population,²⁹ global vaccine hesitancy trends could affect vaccination uptake in the UAE. As the population grows, particularly in cities like Dubai,²⁹ it’s crucial to address potential gaps in vaccine hesitancy to ensure continued public health success.

The findings reveal a paradox in vaccine hesitancy, where parents express confidence in vaccines’ importance and effectiveness but also voice concerns about side effects and necessity. Despite these concerns, most continue to vaccinate their children, indicating a more nuanced form of hesitancy not fully captured by current surveys. For example, in a study conducted in Jordan by Barakat et al.³⁰ over 85% of participants hesitated about the MMR vaccine, but more than 90% had never refused or delayed vaccinations.30 This suggests a distinction between expressed hesitancy and behavioural hesitancy, highlighting the complexity of modelling vaccine hesitancy in public health research.

Sociodemographic predictors of hesitancy

A qualitative study in the UAE in 2020 identified several attitudes towards vaccinations, the negative ones included pressure from parents and grandparents who discourage immunization by citing their own experiences. Fear of side effects and health concerns were also prevalent. Additionally, the growing influence of social media and influencers negatively impacted vaccine perceptions, while healthcare professionals noted their own lack of engagement on social platforms due to time constraints, job restrictions, and low confidence in their communication skills.¹⁶ This is corroborated by the quantitative data from this study. Despite strong overall support for vaccination, concerns about vaccine safety and adverse effects were noted.

Additionally, hesitancy was more pronounced among non-physician healthcare professionals, including dentists, pharmacists, and nurses. This is consistent with previous research suggesting that HCPs who are less directly involved in vaccine administration may feel less confident in their knowledge, potentially contributing to greater uncertainty. This study also found that mid-level professionals were more likely to express hesitancy compared with those at entry-level or senior positions, suggesting that experience and continuous professional development play a role in shaping vaccine confidence.

Several studies have shown a strong correlation between healthcare profession or education level and vaccine hesitancy.³¹ In Finland and Croatia, nurses exhibited higher vaccine hesitancy than physicians,^32,33 while in France, hospital nurses were more hesitant than community nurses.³⁴ A European study found that medical students’ trust in vaccines grew with the duration of their studies.³⁵ Karlsson et al.³² in Finland found that doctors had the highest confidence in vaccine safety and efficacy, with nurses’ confidence increasing with their education level.³² These variations in hesitancy among healthcare professionals can also be linked to their involvement in vaccination efforts.

Ensuring that all HCPs, regardless of their professional background, have access to up-to-date immunization education may help to reduce variability in vaccine-related attitudes.

Developing tools for healthcare professionals to address vaccine hesitancy

Our study found that many HCPs rely primarily on medical experience and international guidelines as their sources of information about vaccines. A systematic review identified that vaccination-related training across medical, nursing, and pharmacy programmes is inconsistent, with only 21% of participants feeling adequately educated on the topic.³⁶ While content generally focuses on vaccination principles, a consistent gap exists in teaching communication strategies and practical skills necessary for addressing vaccine hesitancy. Additionally, there is no clear guidance on how to select and implement the most appropriate interventions to address vaccine hesitancy in different clinical contexts, as comparative studies evaluating interventions are scarce.³⁶

Given the significant influence healthcare professionals have on vaccine attitudes, enhancing both knowledge and communication skills is essential. Many HCPs expressed interest in further education, yet formal training on addressing vaccine hesitancy remains limited. Internationally, structured training programmes have demonstrated effectiveness in improving healthcare professionals’ ability to address vaccine concerns.³⁷ Tailored interventions targeting both knowledge sharing and communication skills are necessary to improve vaccine confidence. However, it remains difficult to quantify the impact of these interventions in terms of actual behavioural change in parents. Strengthening local guidelines and fostering multidisciplinary collaboration could further support vaccine advocacy practices and reduce hesitancy.

Further recommendations

This study highlights the need for healthcare professionals in the UAE to remain vigilant and avoid complacency regarding the success of current vaccination programmes. Despite positive outcomes, global trends indicate rising vaccine hesitancy, necessitating continued efforts to maintain trust in the system. Future research should focus on developing a validated scale to quantify vaccine hesitancy among healthcare professionals. Additionally, stronger tracking systems for vaccine-preventable diseases are essential to detect outbreaks and disease resurgence early, especially considering potential declines in vaccination rates. Lastly, intervention studies could be used to assess training models and evaluate their impact on healthcare professionals’ and parents’ attitudes and confidence in vaccines. By addressing these areas, future research can contribute to sustaining vaccine success and public health in the UAE and around the world.

Limitations of the study

While this study provides valuable insights, it is not without limitations. Firstly, the cross-sectional design restricts causal inferences, providing only a snapshot of attitudes at a specific point in time. Secondly, the reliance on self-reported data introduces a risk of social desirability bias, where participants might underreport hesitancy due to perceived professional expectations. The sample’s demographic composition, with most participants being physicians and those working in government hospitals, may also limit the generalizability of findings to other HCPs or private sector practitioners.

Additionally, while the study identifies significant associations between certain professions and vaccine hesitancy, it does not explore the underlying factors driving these differences, such as variations in training or exposure to vaccine-related information.

Conclusion

In conclusion, this study reveals generally positive attitudes among healthcare professionals towards paediatric vaccinations, with high confidence in vaccine safety and efficacy. However, significant knowledge gaps remain, especially regarding vaccine adjuvants and long-term safety. Additionally, a large proportion of HCPs expressed caution towards newly introduced vaccines, preferring to wait for broader community uptake. These findings highlight the need for tailored training programmes addressing knowledge gaps and communication skills.

Supplemental Material

sj-docx-1-phj-10.1177_22799036251396735 – Supplemental material for Assessing hesitancy towards paediatric vaccines among healthcare professionals: A descriptive cross-sectional study from the United Arab Emirates

Supplemental material, sj-docx-1-phj-10.1177_22799036251396735 for Assessing hesitancy towards paediatric vaccines among healthcare professionals: A descriptive cross-sectional study from the United Arab Emirates by Drishti D. Kampani, Kamel A. Samara, Mohammed Mahfouz, Ahmad Hisham Al-Anoud, Amna Basel Al-Beer, Humaid AlTaheri, Hiba Jawdat Barqawi and Eman Abu-Gharbieh in Journal of Public Health Research

Footnotes

Acknowledgements

We would like to express our sincere gratitude to all the individuals who willingly and actively participated in this study.

ORCID iDs

Drishti D. Kampani

Kamel A. Samara

Mohammed Mahfouz

Ahmad Hisham Al-Anoud

Amna Basel Al-Beer

Humaid AlTaheri

Hiba Jawdat Barqawi

Eman Abu-Gharbieh

Ethics considerations

This study was reviewed and approved by the Research Ethics Committee at the University of Sharjah (Reference Number: REC-24-02-26-02-F). It was conducted in accordance with all relevant guidelines and regulations.

Consent to participate

Informed consent was obtained from all participants. Participants were informed about the study objectives, gave informed consent, and had the freedom to withdraw. Anonymity, privacy, and participant well-being were carefully ensured during data collection and reporting.

Author contributions

KAS, HJB and EAG contributed to the conceptualization of the study. Methodology was developed by KAS, DDK, HJB, EAG. Validation was carried out by DDK and KAS. Data curation was performed by DDK, KAS, MM, AHA, ABA, HA. The original draft of the manuscript was prepared by DDK. Review and editing were conducted by DDK, KAS, MM, AHA, ABA, HA, HJB and EAG. Visualization and supervision were provided by HJB and EAG. Software and formal analysis were performed by KAS. All authors have read and agreed to the published version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding authors on reasonable request.

Supplemental material

Supplemental material for this article is available online.

References

Shattock

Johnson

Sim

, et al Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet 2024; 403: 2307–2316.

Ghaznavi

Eguchi

Suu Lwin

, et al Estimating global changes in routine childhood vaccination coverage during the COVID-19 pandemic, 2020-2021. Vaccine 2023; 41: 4151–4157.

Ackerson

Glenn

, et al Pediatric vaccination during the COVID-19 pandemic. Pediatrics 2021; 148: e2020047092.

World Health Organization. COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades, https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades, (2022, accessed 24 March 2025).

Parums

DV.

A review of the resurgence of measles, a vaccine-preventable disease, as current concerns contrast with past hopes for measles elimination. Med Sci Monit 2024; 30: e944436-1–e944436-10.

Lubanga

Bwanali

Kangoma

, et al Addressing the re-emergence and resurgence of vaccine-preventable diseases in Africa: a health equity perspective. Hum Vaccin Immunother 2024; 20: 2375081.

Agrawal

Murmu

Kanungo

, et al “Nigeria on alert: diphtheria outbreaks require urgent action” - a critical look at the current situation and potential solutions. New Microbes New Infect 2023; 52: 101100.

Bernadou

Astrugue

Méchain

, et al Measles outbreak linked to insufficient vaccination coverage in Nouvelle-Aquitaine region, France, October 2017 to July 2018. Eurosurveillance 2018; 23: 1800373.

Hotez

PJ.

Public Health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatr 2017; 171: 887–892.

10.

UNICEF. The state of the world’s children: for every child, vaccination. UNICEF Innocenti - Global Office of Research and Foresight, 2023.

11.

World Health Organization. Ten health issues WHO will tackle this year, https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019, (2019, accessed 24 March 2025).

12.

MacDonald

NE.

Vaccine hesitancy: definition, scope and determinants. Vaccine 2015; 33: 4161–4164.

13.

Brumbaugh

Kaplan

KPK

, et al Identifying emerging drivers and interventions to reduce vaccine hesitancy among long-term Care Facility Nursing Staff. Gerontologist 2025; 65: gnaf022.

14.

Barqawi

Samara

Kannas

, et al Vaccine practices, literacy, and hesitancy among parents in the United Arab Emirates. PLoS One 2024; 19: e0307020.

15.

Barqawi

Saddik

Adra

, et al Evaluating the knowledge, attitudes, and uptake of the influenza vaccine in healthcare professionals: a cross-sectional study from the United Arab Emirates. Pharm Pract 2021; 19: 2587.

16.

Elbarazi

Al-Hamad

Alfalasi

, et al Exploring vaccine hesitancy among healthcare providers in the United Arab Emirates: a qualitative study. Hum Vaccin Immunother 2021; 17: 2018–2025.

17.

Karafillakis

Dinca

Apfel

, et al Vaccine hesitancy among healthcare workers in Europe: a qualitative study. Vaccine 2016; 34: 5013–5020.

18.

Elizondo-Alzola

Carrasco

Pinós

, et al Vaccine hesitancy among paediatric nurses: prevalence and associated factors. PLoS One 2021; 16: e0251735.

19.

Barqawi

Samara

Hassan

, et al Adult vaccination in the United Arab Emirates—a physicians’ knowledge and knowledge sources study. Front Public Health 2022; 10: 865759. DOI: 10.3389/fpubh.2022.865759.

20.

Barqawi

Samara

Haddad

, et al Attitudes and practices to adult vaccination among physicians before and after COVID-19 pandemic in the United Arab Emirates. Vaccine: X 2024; 17: 100455.

21.

Opel

Mangione-Smith

Taylor

, et al Development of a survey to identify vaccine-hesitant parents: the parent attitudes about childhood vaccines survey. Hum Vaccin 2011; 7: 419–425.

22.

Larson

Jarrett

Schulz

, et al Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015; 33: 4165–4175.

23.

Alamer

Alamir

AlJohani

, et al Childhood vaccination hesitancy in Saudi Arabia: a time for action. J Infect Public Health 2022; 15: 94–99.

24.

Wagner

Prentice

Saad-Roy

, et al Economic and behavioral influencers of vaccination and antimicrobial use. Front Public Health 2020; 8: 614113. DOI: 10.3389/fpubh.2020.614113.

25.

Nuwarda

Ramzan

Weekes

, et al Vaccine hesitancy: contemporary issues and historical background. Vaccines 2022; 10: 1595.

26.

Perin

Mulick

Yeung

, et al Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022; 6: 106–115.

27.

UNICEF, WHO/Europe. European Region reports highest number of measles cases in more than 25 years, https://www.who.int/europe/news/item/13-03-2025-european-region-reports-highest-number-of-measles-cases-in-more-than-25-years—unicef–who-europe, (2025, accessed 24 March 2025).

28.

World Health Organization. WHO immunization data portal - Eastern Mediterranean Region. Immunization Data, https://immunizationdata.who.int/dashboard/regions/eastern-mediterranean-region, (2024, accessed 24 March 2025).

29.

GMI Research Team. United Arab Emirates (UAE) Population Statistics 2025 | GMI. Official GMI Blog, https://www.globalmediainsight.com/blog/uae-population-statistics/ (2025, accessed 24 March 2025).

30.

Barakat

Abdaljaleel

Atawneh

, et al Pervasive parental hesitancy and resistance towards measles rubella vaccination in Jordan. Vaccines (Basel). 2023; 11(11): 1672.

31.

Verger

Botelho-Nevers

Garrison

, et al Vaccine hesitancy in health-care providers in Western countries: a narrative review. Expert Rev Vaccines 2022; 21: 909–927.

32.

Karlsson

Lewandowsky

Antfolk

, et al The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PLoS One 2019; 14(10): e0224330.

33.

Tomljenovic

Petrovic

Antoljak

, et al Vaccination attitudes, beliefs and behaviours among primary health care workers in northern Croatia. Vaccine 2021; 39: 738–745.

34.

Wilson

Zaytseva

Bocquier

, et al Vaccine hesitancy and self-vaccination behaviors among nurses in southeastern France. Vaccine 2020; 38: 1144–1151.

35.

Rostkowska

Peters

Montvidas

, et al Attitudes and knowledge of European Medical Students and early graduates about vaccination and self-reported vaccination coverage-multinational cross-sectional survey. Int J Environ Res Public Health. 2021; 18(7): 3595.

36.

Lip

Pateman

Fullerton

, et al Vaccine hesitancy educational tools for healthcare providers and trainees: a scoping review. Vaccine 2023; 41: 23–35.

37.

Lo Moro

Ferrara

Langiano

, et al Countering vaccine hesitancy: a systematic review of interventions to strengthen healthcare professionals’ action. Eur J Public Health 2023; 33: 905–915.

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