Understanding parental perspectives on vaccines in Saudi Arabia: Lessons from the COVID-19 experience

ABSTRACT

Context:

The study focuses on Saudi parents’ perceptions regarding the newly introduced COVID-19 vaccines for children aged 9–15, amid concerns related to vaccine safety and effectiveness.

Aims:

This study aimed to explore Saudi parents’ perception of the benefits and risks associated with newly introduced COVID-19 vaccines for children aged 9-15.

Settings and Design:

A qualitative, phenomenological approach was used. Participants were recruited from two public and two private schools in Riyadh to reflect diverse socioeconomic backgrounds.

Methods and Material:

Using a qualitative phenomenological approach, semistructured one-to-one interviews were conducted with 18 Saudi parents recruited from two public and two private schools in Riyadh. Interviews were transcribed verbatim and thematically analyzed using NVivo software (version 11.4.2).

Statistical Analysis Used:

Not applicable (qualitative study using thematic analysis).

Results:

The findings revealed that Saudi parents primarily developed their understanding of vaccine safety and effectiveness through personal observations of vaccinated individuals around them. Despite a general trust in health authorities, many parents expressed hesitancy toward vaccinating their children due to the vaccine’s novelty, with future infertility cited as the most commonly reported concern.

Conclusions:

To promote uptake of newly introduced vaccines in Saudi Arabia, public health campaigns should prioritize transparent communication, particularly addressing fertility-related concerns with scientific evidence. Additionally, parents require timely and detailed information through official communication channels to address their questions and alleviate fears.

Introduction

The global rollout of COVID-19 vaccines was pivotal in pandemic control, demonstrating that rapid development and deployment can significantly reduce morbidity and mortality.[1,2] Large-scale immunization in countries such as Brazil, India, China, and the United States significantly decreases COVID-19 deaths and transmission, underscoring vaccination’s impact as a public health measure.[3] Yet vaccine hesitancy—defined as delay acceptance or refusal despite availability—emerged as a major a barrier to herd immunity,[4] reflecting the complex cultural, religious, and social factors influencing acceptance of any newly introduced vaccine.[5]

In Saudi Arabia, the Ministry of Health (MOH) implemented strict COVID-19 vaccination policies, extending eligibility to children aged 5–11 years. Despite these efforts, parental hesitancy remained substantial with 61.9% expressing reluctance due to safety concerns, potential side effects, and genetic risks.[6,7] Social media amplified these fears by spreading misinformation.[8,9] Sociodemographic factors—including gender, citizenship status, and healthcare access—also influenced acceptance, with Saudi women and citizens showing higher hesitancy than men and non-Saudi parents.[6,7,10,11] Many parents further questioned the necessity of childhood vaccination, citing children’s perceived low risk and fear of long-term side effects.[7]

While these findings offer valuable insight into vaccine attitudes, a critical gap remains in understanding the cultural narratives and social constructs shaping parental decisions about new vaccines. Addressing this gap is essential for designing effective, context-sensitive interventions to improve acceptance of COVID-19 and future rapidly introduced vaccines. To inform such strategies, this study adopted a qualitative phenomenological approach using one-to-one semi-structured interviews with Saudi parents to explore perceived risks and benefits of newly introduced vaccines. Using COVID-19 vaccination as a case example, the study aimed to uncover cultural attitudes, fears, and motivators that may inform future public health efforts.

To examine the psychological and social factors shaping parental decisions about newly introduced vaccines, this study applies the Health Belief Model (HBM). This framework is well studied to context of uncertainty and cultural influence, where limited information can hinder acceptance. The COVID-19 vaccine provides a timely case to explore how these factors affect parental attitudes toward emerging vaccination programs.

This study moves beyond measuring vaccine hesitancy by exploring why such hesitancy exists and how culturally grounded interventions can be developed to address it.[12,13,14,15] The ultimate aim is to informs healthcare practitioners by clarifying Saudi parents’ perceptions of newly introduced childhood vaccines, enabling targeted communication and trust-building. It also guides public health strategies to address misconceptions and support culturally appropriate education for parents.

Subjects and Methods

Study design

This study employed a phenomenological, Primarely inductive qualitative design with semistructured telephone interviews to explore parents’ lived experiences regarding COVID-19 vaccination in children. The phenomenological approach provided deeper insight into participants’ subjective perspectives on the sensitive topic, while semistructured interviews allowed flexible and focused discussions, fostering rapport and encouraging open expression of concerns and beliefs.

Participants were recruited using a convenience sampling strategy from two public and two private schools in Riyadh. These schools were strategically selected to represent a range of socioeconomic backgrounds (upper, middle, and lower classes). In line with local cultural norms, male and female students attend separate schools; therefore, schools were contacted separately to ensure the inclusion of both mothers and fathers, allowing for gender-diverse participation. School principals were personally approached and asked to distribute an informational sheet to parents, outlining the study’s purpose and participation details to facilitate recruitment.

Sampling

The sample comprised parents of children aged 5–12 years, who had received the COVID-19 vaccine. Random selection within the convenience sample was facilitated by school principals to capture a diversity of opinions from both provaccination and vaccine-hesitant parents. This approach aimed to obtain a comparative understanding of differing attitudes toward child vaccination. To include perspectives from vaccine-hesitant individuals, participants were asked if they knew parents who had chosen not to vaccinate their children. Those who confirmed were invited to seek permission to share their contacts, leading to the recruitment of two vaccine-hesitant parents from outside the participating schools.

Data collection

Semistructured phone interviews, each lasting between 30 and 40 minutes, were conducted between February 15 and March 20, 2022. Interviews were selected as the data collection method because they enabled participants to share personal and sensitive views—particularly regarding their attitudes and emotions about their children receiving the COVID-19 vaccine. The semistructured format allowed for clarification and elaboration, encouraging richer responses.

With consent, interviews were audio-recorded. All interviews were transcribed verbatim by the researcher to allow analysis in the original language; only selected quotations were translated into English to preserve authenticity and minimize the loss of meaning through translation. The use of full recordings provided a comprehensive understanding of each participant’s perspective.

Data analysis

All interviews were audio-recorded with participant consent. Personal information was anonymized to ensure confidentiality. Transcripts were analyzed using thematic analysis, which allowed for the identification and interpretation of key themes emerging from the data. NVivo software was utilized to manage, code, and organize the data, facilitating a systematic approach to analysis.

The lead researcher, who was both the data collector and analyst, was well-versed in the data’s depth and variety. The initial coding framework was flexible to accommodate emerging codes as they appeared throughout the analysis process. A combination of pre-existing and emerging themes was identified, with representative quotations used to support the final findings. This approach ensured that the analysis was grounded in the data, offering rich insights into the lived experiences of parents regarding child vaccination.

Results

Eighteen parents were interviewed, and the enrolled participants’ demographic characteristics were displayed in Table 1. All participants were Saudi nationals from Riyadh city. Thirteen participants were female. All parents who were included in the study were vaccinated against COVID-19, while 2 children did not take the nationally recommended vaccinations and 2 had their children vaccinated against COVID-19 [Table 1].

Table 1.

Demographic characteristics of enrolled parents

Participant	Gender	Age	Occupation	Children’s uptake of nationally recommended vaccinations	School
1	Male	42	Engineer	Yes	Private
2	Male	32	Teacher	Yes	Public
3	Female	28	Teacher	yes	Private
4	Female	41	Housewife/high school graduate	Yes	Public
5	Female	28	Housewife/university graduate	Yes	Private
6	Female	34	Housewife/college graduate	Yes	Public
7	Male	38	Physician	Yes + COVID-19 Vaccine	Private
8	Female	30	Administrative work	No	Private
9	Female	30	Housewife/high school graduate	Yes	Private
10	Male	41	Teacher	Yes	Public
11	Female	26	Administrative work	Yes	Private
12	Male	36	Business owner	Yes	Private
13	Female	29	Housewife/university graduate	Yes	Private
14	Female	45	Dentist	No	Private
15	Female	32	Administrative work	Yes	Public
16	Female	38	Physician	Yes + COVID-19 Vaccine	Private
17	Female	47	Teacher	Yes	Public
18	Female	30	Housewife/high school education	Yes	Public

Two main categories emerged from the interviews: Knowledge and concerns about COVID-19 vaccine and Parents’ attitude and decision to vaccinate their children.

Knowledge and concerns about COVID-19 vaccine

It was apparent from parents’ responses that they had general awareness about the types of COVID-19 vaccines available. One parent noted:

“We have the vaccine approved here from 3 companies…they all improve your immune system to get ready to fight the virus if you get it” P18

“The vaccine enters the body and acts as a virus infection so the immunity against it would start” P4

According to the parents, all the information they have about the vaccine is from the Saudi MOH. One participant explained:

“We get these texts from the MOH and all these videos they design are circulated by WhatsApp with the information about the vaccine. I trust our MOH” P18

Some parents have already built their theories about the effectiveness and short-term effects of the vaccine from their own experiences and observations.

“I noticed that after taking the Pfizer vaccine, people are getting sick for a week or two…they complained from headache, fever.…, I have not seen the same symptoms appear in those who took AstraZeneca” P2

“Most people who got the Pfizer vaccine got infected recently. But those who got AstraZeneca are less likely to be infected?” P6

On the other hand, one physician parent declared:

“You can see the decline in ICU cases, so…to some extent, it works.” P7

A few participants expressed uncertainty about official information and voiced concerns related to the novelty and perceived safety of vaccines. As one parent noted, “They say it boosts immunity, but I’m not sure… it’s new” (P15).

Another participant described how a personal experience influenced their confidence in vaccines: “I stopped believing in vaccine safety after my child was diagnosed with autism” (P14).

In general, although a few parents expressed negative views about the vaccine, most demonstrated a reasonable level of knowledge and attempted to formulate theories about its effectiveness based on personal observation and experiences. However, this “knowledge” was often incomplete and often shaped by anecdote rather than evidence. Trust in the MOH existed but did not guarantee unquestioned acceptance, as some parents substituted personal or social observations for scientific data.

Views about the safety of the vaccine

Although two of the interviewed parents who were healthcare workers had already gotten their children vaccinated, most parents were concerned about the safety of the vaccine:

“I worried my daughters would be infertile…or have deformities” P16

It was apparent from the interviews that almost all parents were afraid of the unknown. A parent noted:

“…I can’t put something I don’t know about into my son’s body” P5

“We still do not know what this vaccine does and will do to our children’s bodies. It was something made up in labs!” P6

Long-term fertility risk dominated among the participants:

“I took the vaccine, I have already completed my family, but I don’t think I want to give it to my son” P5

“What if they become infertile in the future?” P18

Safety concerns centered on hypothetical long-term harms, especially infertility. Even healthcare professionals described parental anxiety, suggesting that professional knowledge alone did not overcome fear. These concerns reflected perceived rather than evidence-based risk and revealed a gap between public messaging and parental safety priorities.

Views about the effectiveness of the vaccine

Parents were uncertain about effectiveness, including those who vaccinated their children:

“We do see a big number of people got vaccinated and then got COVID…we do our best” P16

“I got the vaccine and then I got infected again, most people do. So why would I put my child through taking a mysterious vaccine if he is most probably going to get the infection naturally” P7

Breakthrough infections shaped beliefs that benefit was limited. Effectiveness judgments were often based on social observation, weakening trust in official recommendations. Even accepting parents described vaccination as precautionary rather than fully convincing.

Parents’ attitude and decision to vaccinate their children

Attitudes and cues to vaccination

The two parents who had their children vaccinated had overcome their fears by focusing on positive justifications:

“Because I trust the way the Ministry of Health takes their decisions,” P16

All parents, except P8, P14, and P15, explained that they would get the vaccine when it became necessary. They explained the word “necessary” as follows:

“If they make traveling and entering facilities conditioned by getting the vaccine” P4

Actions parents take to delay/not give the vaccine

Parents who had a strong attitude against COVID-19 vaccination often sought ways to avoid vaccinating their children.

One parent visited her son’s doctor to convince him that her 11-year-old had a skin allergy that prevented him from taking the vaccine. P15

When asked about the doctor’s opinion, she replied:

“He said he is fine now and it’s better not to exempt him, but I explained my concerns to him” P15

Another parent was not willing to vaccinate her children as one of them was diagnosed with autism. P14

Some parents tried to find ways to delay their children’s vaccination. A few avoided relying on home tests when their children tested positive for COVID-19, seeking official documentation to change their health status to “recuperated” in Tawakkalna (an application presents medical status).

“I do not want him to be vaccinated that’s why I want the status to be ‘recuperative’ in Tawakkalna.”

Many parents perceived vaccination as a response to policy mandates rather than a decision based on personal conviction. Some actively pursued medical exemptions or delays, reflecting how fear and uncertainty outweighed perceived benefit. Policy incentives alone may not sustain uptake without stronger safety reassurance and tailored risk communication.

Discussion

This study explored the perceptions of Saudi parents in Riyadh regarding the benefits and risks associated with the newly introduced COVID-19 vaccines for children. The findings revealed that while parents possessed a high level of theoretical knowledge about the COVID-19 vaccine, many were reluctant to vaccinate their children due to concerns related to the vaccine’s novelty. A predominant concern among parents of both sexes was the fear of future infertility. This apprehension aligns with previous studies indicating that 53.7% of parents agreed to vaccinate their child, whereas 27% declined due to a lack of robust safety data.[15]

Applying the Health Belief Model (HBM),[10,16] parents’ concerns about long-term safety, particularly potential effects on fertility, constitute major perceived barriers, while trust in the Ministry of Health (MOH) communications functions as an important cue to action. Most participants demonstrated good knowledge of available COVID-19 vaccines, primarily obtained from the MOH aligns with evidence that information from credible health authorities enhances parental vaccine confidence.[17] However, personal observations of side effects also influenced perceptions, consistent with studies showing that individual experiences strongly shape vaccine attitudes.[13,14]

Despite some parents expressing doubts about vaccine effectiveness, citing instances of COVID-19 infection postvaccination, others supported vaccination, noting a reduction in severe cases. This dichotomy reflects broader research findings where parental views on vaccine efficacy vary based on personal experiences and observed outcomes.[18,19,20,21]

Notably, while some parents were hesitant, they indicated a willingness to vaccinate their children if mandated by authorities or required for access to certain facilities. This conditional acceptance aligns with evidence suggesting that external requirements and perceived social pressures significantly influence vaccination intentions.[20] Conversely, a minority actively sought to avoid or delay vaccination due to fears of side effects and personal convictions, behaviors consistent with patterns observed in vaccine hesitancy studies.[21]

Demographic factors such as age, education, and occupation were pertinent in contextualizing vaccine perceptions both nationally and internationally. Recent literature highlights that parental age, educational attainment, and occupation are key determinants of vaccination decisions. For instance, studies have shown that younger parents and those with lower educational levels exhibit higher vaccine hesitancy, underscoring the need for targeted interventions.[22,23,24]

The persistent concern among parents regarding long-term vaccine implications, particularly fertility-related issues, is corroborated by studies in various regions of Saudi Arabia.[25,26,27,28,29] In Aseer region, 30.6% of parents perceived COVID-19 vaccination as potentially more dangerous for children than adults, with 15.4% expressing concerns about genetic impacts.[25] Similarly, in Riyadh, 65% of parents cited vaccine safety and side effects as primary reasons for hesitancy, indicating a widespread apprehension that transcends regional boundaries.[26]

National policies in Saudi Arabia, such as mandating vaccinations for office attendance, have been implemented to address vaccine resistance. Surveys indicate that safety concerns and side effect apprehensions are critical barriers to vaccine uptake, suggesting that enforcement measures may enhance vaccination rates.[30]

Our findings are broadly consistent with Saudi studies reporting safety concerns, fertility-related fears, and the influence of social media misinformation on parental decisions.[25,26,27,28,29] However, our work extends this evidence by showing that, despite high trust in the Ministry of Health (MOH), parents’ acceptance of newly introduced vaccines often depends on external mandates rather than intrinsic confidence in vaccine safety. This contrasts with reports from other countries where lower levels of confidence in health authorities were a stronger driver of hesitancy.[13,24,31,32] By focusing on childhood COVID-19 vaccination within the Saudi cultural and policy context, our study adds new insight into how emotional concerns and perceived long-term risks persist even when institutional trust is strong, underscoring the need for targeted, culturally sensitive communication strategies.

Parental beliefs ranged from skepticism to acceptance, reflecting the complexity of vaccine hesitancy. Fears of long-term effects and perceived lack of safety evidence shaped reluctance, while some parents were reassured by the absence of proven harm.[30] Personal experiences, including concerns about adverse effects in children with chronic conditions, further influenced decisions. These varied factors underscore the need for tailored communication to address safety and efficacy concerns and support effective public health interventions.

Study implications

This research provides valuable insights into Saudi parents’ attitudes toward COVID-19 vaccination for children, with broader implications for public health strategies concerning newly introduced vaccines, especially during emergencies. The COVID-19 pandemic serves as a case study illustrating how individuals assess medical interventions amidst uncertainty, limited data, and widespread public discourse.

Parents’ decisions were influenced not only by scientific evidence but also by social dynamics, emotional responses, and cultural beliefs. These factors underscore the importance of integrating strategic health communication and marketing approaches that address both rational concerns and emotional barriers.

Effective vaccine campaigns should move beyond information dissemination to deliver culturally sensitive, psychologically informed messages that build trust and addresses public fears. This study underscores the importance of integrating social and behavioral science into public health communication and leveraging marketing strategies to counter misinformation and promote protective behaviors during future health crises.

Study limitations and future directions

While this study offers valuable insights into parental attitudes toward COVID-19 vaccination, certain limitations must be acknowledged. The reliance on a convenience sample from two public and two private schools in Riyadh may not fully represent the perspectives of parents in other regions of Saudi Arabia or those with different cultural or educational backgrounds. Additionally, the sample size of 18 participants, although adequate for a phenomenological study, may not capture the full spectrum of parental opinions.

Self-reported data may be influenced by social desirability and personal experiences biases, and the limited number of parents with unvaccinated children further restricts the depth of analysis for this subgroup.

Future research should include larger, more representative samples from diverse Saudi regions to examine cultural and socioeconomic influences on vaccine decisions. Investigating the impact of social media and other information sources is recommended, given widespread vaccine misinformation. Longitudinal studies could track how parental opinions change with emerging evidence or policy shifts, informing targeted communication strategies and public health interventions to enhance vaccine uptake.

Conclusion

In conclusion, this study highlights the complex perceptions of Riyadh parents toward vaccinating their children with newly introduced vaccines, using COVID-19 as a case example. Although parents generally trust the Saudi MOH and possess strong educational backgrounds, persistent safety concerns—particularly about long-term effects—continue to drive hesitancy. These fears, along with doubts about efficacy, lead some to delay or avoid vaccination. Addressing them requires not only accurate information but also culturally sensitive, transparent, and dialogic public health communication. Future research should include more demographically and geographically diverse parents and examine the influence of social media and peer networks on decision-making. Such insights are essential for designing effective interventions during future vaccine rollouts.

Ethical policy and institutional review board statement

The study protocol was approved by the institutional review board at King Saud University Ref. No. 22/0124/IRB. Informed consent was waived by the IRB.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.