Study Examines Reluctance on Pediatric COVID-19 Vaccination

AAFP Resources Can Help Ease Parents’ Concerns

Aug. 15, 2023, News Staff — Family physicians have spent the better part of the last two years educating people about the safety and efficacy of COVID-19 vaccines for children and adolescents, and more than a year informing parents about the benefits of COVID-19 vaccinations for infants and young children.

However, the results of a study published recently in Annals of Medicine indicate FPs and other health care professionals may continue to face challenges in talking to parents about vaccination as children return to school.

The study, based on data from the U.S. Census Bureau’s Household Pulse Survey, found that COVID-19 vaccination remains low in children and adolescents. It also found that many parents are hesitant or reluctant about having their children receive the vaccine, despite large-scale efforts to fight misinformation and raise confidence.

“Because parents are the main decision-makers for child and adolescent vaccination, it is important to understand parental characteristics, intentions and reasons for non-vaccination so that targeted messages and strategies can be developed to increase vaccination coverage,” the authors wrote. “Examining disparities in child/adolescent vaccination coverage, such as by parental age and other sociodemographic characteristics, parental intent for vaccination and possible reasons for non-vaccination, is important for developing targeted strategies to increase parents’ confidence and reduce barriers to COVID-19 vaccines.”

Study Details

Researchers examined two months of 2022 data from more than 44,000 households with children. Respondents were asked about COVID-19 vaccines and boosters, intent to vaccinate children and reasons for not vaccinating. Questions about boosters were limited to households with children 5 and older, as the CDC had not yet recommended boosters for younger children.

Just over 50% of children and adolescents younger than 18 had received at least one dose of a COVID-19 vaccine and about 44% had completed a primary vaccine series. Among children ages 5 to 17, just over 50% had received a booster vaccine.

Based on age group, both receipt of at least one dose and primary series completion were highest in adolescents and lowest in infants and young children.

Parental COVID-19 vaccination status had a substantial impact on child vaccination coverage. Children and adolescents whose parents received at least one dose of COVID-19 vaccine were more than five times as likely to have some level of vaccination coverage, and more than nine times as likely to complete a primary vaccine series, as the children of parents who were not vaccinated.

Parents who had not been vaccinated against COVID-19 themselves were highly reluctant to vaccinate their children across all age groups. More than 80% of these parents who had children ages 5 to 17 were reluctant to vaccinate their children. In parents with children younger than 5, the percentage of those reluctant to vaccinate their children was even higher (90.6%).

Story Highlights

Not accounting for vaccination status, parents who were reluctant about vaccinating infants and young children tended to be between the ages of 18 and 29, white, had a high school education or less, did not report their income, were not insured, or lived in the South or Midwest.

Among reluctant parents, the main reasons for not vaccinating children against COVID-19 were

concern about possible side effects (53.3%),
lack of trust in the vaccines (48.7%) or the government (35.6%),
belief that children don’t need a COVID-19 vaccine (38.8%) and
perception that children in the household are not members of a high-risk group (32.8%).

Overall, 71% of parents with children younger than 5 were uncertain or reluctant about vaccinating their child. This decreased to 47.5% of parents with children ages 5 to 11, and almost 28% of parents with children ages 12 to 17.

The researchers noted several limitations to the survey data. For example, respondents may not fully represent the U.S. adult population. Respondents also self-reported the vaccination status of themselves and their children, which could create the potential for recall or social desirability biases. In addition, they suggested that some respondents, while adults, might not be the parents of the children they reside with, which could lead to additional biases. Finally, they noted that the Household Pulse Survey had a low response rate, although this factor was mitigated by a Census Bureau assessment.

Despite these limits, the researchers believed their findings add to the existing literature on COVID-19 vaccines by examining disparities and reasons for non-vaccination from several perspectives.

“Further efforts are needed to increase COVID-19 primary series and booster vaccination for all children and adolescents, and to reduce disparities in uptake and intention to vaccinate,” the authors concluded. “Increased vaccination would not only protect children and adolescents from severe illness or death from COVID-19, but also prevent the spread of COVID-19, particularly if new variants emerge.”

Use AAFP Tools to Raise Confidence, Increase Vaccination

The study authors discussed various ways to improve parental confidence in COVID-19 vaccines and boost coverage rates in children and adolescents. These included

motivational interviewing, which can build trust and make patients more open to vaccination;
countering myths with fact-based, easy-to-understand information;
recommending that patients get vaccinated, which has been shown to improve vaccine coverage and confidence.

The AAFP has assembled a vast collection of resources to help family physicians address vaccine hesitancy and increase childhood vaccination rates. Among the most recent is an FPM feature article that offers tips for effective conversations with vaccine-hesitant patients. Other items published in the past year include a free online CME activity on boosting COVID-19 vaccination rates in young children, a series of fact sheets and guidance documents, a conversation guide for family physicians on COVID-19 vaccinations for children 6 months and older, and an op-ed on the importance of childhood vaccinations from Anne Schneider, D.O., a 2021-2022 AAFP Vaccine Science Fellow.

All that is only a small sample of the member tools currently available. Members are invited to visit the Academy’s COVID-19 CME webpage, Immunization and Vaccines webpage and AFP by Topic collections on COVID-19 and immunizations for the latest information. Members also can direct their patients to the Academy’s companion site, familydoctor.org, which contains articles and guidance for patients on COVID-19 vaccine myths, COVID-19 vaccines for young children, the importance of vaccinations and several related topics.