Post-pandemic assessment of parental perceptions toward COVID-19 vaccination and general immunization-an insight from polio endemic country.

Background: The COVID-19 pandemic exposed and intensified existing challenges in immunization uptake, particularly in countries like Pakistan where vaccine hesitancy persists due to historical mistrust and misinformation. This study aims to assess parental perceptions toward COVID-19 vaccination and general immunization in a post-pandemic context, using the Health Belief Model (HBM) to contextualize behavioral drivers and barriers. Methods: A cross-sectional survey was conducted from March to June 2023 at two tertiary hospitals in Pakistan-Combined Military Hospital, Lahore, and Fazaia Ruth Pfau Medical College, Karachi. Using convenience sampling, 298 parents of children aged 5-15 years completed a validated, pilot-tested questionnaire assessing demographic variables, COVID-19 vaccine perceptions, and general immunization attitudes. Data were analyzed using SPSS v26.0, employing descriptive statistics, non-parametric tests, and Spearman's correlation. Results: Of the 298 participants (64.1% male; mean age = 34.2 years), 93.6% had at least a high school education. The COVID-19 Perception Scale showed a moderate overall score (Mean = 41.3, SD = 10.1), with moderate perceived vulnerability (Mean = 13.6, S.D = 4.5), high trust in vaccine information (Mean = 17.8, SD = 6.0), but low awareness (Mean = 2.4, SD = 1.2) and willingness to vaccinate children (Mean = 3.9, SD = 1.6). The Immunization Perception Scale indicated generally positive attitudes (Mean = 1.6, SD = 0.7), though moderate hesitancy persisted (Mean = 1.7, SD = 1.2). Significant associations emerged between personal or familial COVID-19 experience and both COVID-19 perception (r = 0.269, p < 0.01) and immunization perception (r = 0.121, p < 0.05). Mapping findings to the HBM revealed gaps in cues to action and self-efficacy, despite relatively high perceived benefits. Conclusion: Parental trust in vaccine information is evident, yet awareness and pediatric vaccine uptake remain low. These findings call for context-specific, HBM-informed public health strategies that strengthen cues to action, reduce perceived barriers, and foster community trust to improve immunization outcomes in Pakistan.