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In the United States, as of November 2021, nearly 2 million cases of COVID-19 had been observed in children ages 5-11, about 30% of whom had been hospitalized for the infection. “COVID-19 cases and hospitalizations among young children are increasing in the US, with the burden placed disproportionately on black and Hispanic children,” said Celia B. Fisher, PhD. “What is unknown is how far these differences will continue after the FDA’s emergency approval of COVID-19 vaccines for children ages 5-11 in October 2021.” Identifying factors associated with parental pediatric COVID-19 vaccination restraint is essential to developing effective public health programs to reduce racial/ethnic health disparities. “However, the CDC does not collect race/ethnicity data from children vaccinated against COVID-19,” said Dr. Fisher. “Currently, only seven states collect such data, and vaccine uptake across states’ racial/ethnic disparities is inconsistent.”
One-size-fits-all approach ineffective for COVID-19 vaccination messages
For a study published in Vaccines, Dr. Fisher and colleagues assessed the extent to which racial and ethnic factors predict hesitancy of pediatric COVID-19 parental vaccines for school-age children among 400 Hispanic and non-Hispanic Asian, Black and White parents. “The overarching message of our study was that a ‘one-size-fits-all’ approach to public health messages about COVID-19 vaccination will not be as effective as tailoring messages to the specific needs of parents,” said Dr. . Fisherman. Parents’ attitudes towards vaccinating their children fell into three categories: 1) those who plan to vaccinate their child, 2) those who are not yet sure, and 3) those who are strongly against vaccination. “In total, only 40% of parents planned to vaccinate their children,” says Dr. Fisher. “Our data reflect significant differences in parents from different racial/ethnic groups, with 65% of Asian, 45% of Hispanic, 31% of Black and 25% of White parents planning to vaccinate their child. “
Anti-COVID-19 vaccination decisions influenced by multiple factors
Across race/ethnicity, parents who strongly opposed vaccination had more misconceptions about the disease, believed their children were less susceptible, and believed that COVID-19 symptoms were relatively mild in young children. These parents were also suspicious of vaccines in general, did not believe the COVID-19 vaccine was safe, and reported lack of support for the vaccine from other parents, relatives, clergy and others in their communities. In addition, these parents would be less influenced by recommendations from the FDA or their physician in their vaccination decision (Figure). “An interesting finding was that parents’ decisions to vaccinate their children depended on how they valued community versus individual rights,” said Dr. Fisher. “Parents who believed vaccinating their child for COVID-19 would support the community by stopping the spread of the disease were three times more likely to plan to vaccinate their child than those who declined. Conversely, parents who believed vaccinating their child against COVID-19 would violate their family rights were twice as likely to refuse to have their child vaccinated.”
Targeted public health approaches needed to address COVID-19 vaccine hesitancy
Data from the study suggest that the pandemic has changed the extent to which parental vaccination decisions are influenced by traditional sources of expertise and community support, said Dr. Fisher. “For example, only 50% of the parents in our study who refused to vaccinate their child would respond to a school vaccination mandate,” she says. “This suggests that national or state-wide vaccination mandates in schools in certain communities may encounter strong resistance.” General mistrust of the FDA and vaccine science and a lack of trust in doctors were other important factors, says Dr. Fisher. “Most parents routinely provided their children with pediatric vaccines, but only 65% said a doctor’s recommendation would influence their decision,” she says. “This is the first time the public has been at the forefront of the vaccine development process. Thus, the COVID-19 vaccine hesitation may be a result of the barrage of conflicting information about vaccine safety and efficacy. Public health communication can increase health science literacy. In future research, we will examine to what extent parents’ experiences and attitudes toward vaccinating their children against COVID-19 will create future barriers to, or facilitate vaccination decisions for, other childhood vaccines and future pandemics.”
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