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What Determines Parental COVID-19 Vaccine Hesitancy?

What we know and don’t know about uptake of the COVID-19 vaccine among children.


For anyone who studies vaccine hesitancy, the introduction of the COVID-19 vaccines seemed like a perfect storm. These were vaccines developed on a quick timetable with heavy government involvement in response to an urgent need against a disease about which we certainly know far from everything.


At first, vaccine hesitancy was significant. According to a Kaiser Family Foundation poll in December of 2020, only 34 percent of respondents indicated plans to get vaccinated as soon as possible. At that time, 39 percent of respondents said they would wait and see, 9 percent said they would only get the vaccine if required, and 15 percent said, “definitely not.” Yet by March 2021, rates of hesitancy were down considerably. At this point, 32 percent reported having already gotten the vaccine and 30 percent indicated intent to get it as soon as possible, leaving only 30 percent with more hesitant attitudes (as opposed to 63 percent in December).


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While it is not entirely clear what helped tip the balances here, perhaps seeing other people get vaccinated and enjoy new freedoms was helpful to many Americans who were simply afraid of the unknown. This change is of course good news, but now we face a new, potentially more difficult challenge: As the vaccine becomes available to children ages 15 and younger, parental hesitancy about getting their children vaccinated has emerged as a potential roadblock to widespread vaccination. Even among parents who have received the vaccine without much thought or hesitation themselves, significant reservations about the safety of the vaccine for children may exist.


In a recent survey of 1,258 parents, the majority (53 percent) did report that they intended to vaccinate their children eventually but only 26 percent said they would do so right away. Moreover, a full third of parents surveyed said they did not plan to get their kids vaccinated at all. While it is of course possible that parents will become less hesitant as they see more and more of their peers vaccinating their children, these numbers are concerning. We do not have a wealth of information on the reasons behind these concerns, but a few bear mentioning as strong possibilities.


Parents erroneously believe that COVID-19 is not a threat to children. Anecdotally, parents have reported that they feel confident that they can protect their kids from COVID without a vaccine using masking and social distancing measures and that even if their kids get COVID, it will not be serious. They, therefore, weigh the risk of receiving the vaccine, which they perceive to have unknown long-term effects, as greater than the risk of their children getting COVID.


This is a dangerous misperception. While it is true that severe illness is less likely in children than adults, any individual child could experience a severe case that could result in hospitalization, death, or long-term health impacts. Given that there is currently no evidence that the vaccine is unsafe, parents should recognize that putting their children at risk of contracting COVID is much more dangerous and certainly unnecessary. In addition, children can be vectors of the disease and a failure to vaccinate them might result in a general inability to reach community (also known as “herd”) immunity.


Parents may also irrationally believe that adverse effects from vaccines are more likely to occur in children than in adults. Most parents have been confronted with some kind of messaging about vaccines causing disabilities in young children. The most well-known example of this is the myth that the MMR vaccine causes autism. Myths of this sort do not circulate to the same degree about adult vaccinations, which may lead parents to the misperception that vaccines are somehow more dangerous for youth than for adults.

Parents also tend to view their children as particularly vulnerable already, and thus may feel the need to “know more” about the vaccine before they will allow their child to get it. Their standard of safety evidence is thus higher for their children than for themselves. While the desire to protect children is obviously in many ways a good instinct, this particular line of thinking is based in pseudoscience that can lead parents to fail to vaccinate their children against dangerous illnesses. In fact, children do not necessarily experience more adverse side effects to medications than do adults. Vaccines are thoroughly tested in each age group before being authorized for use in that age group.


As COVID vaccines begin to receive approval for younger and younger children, it is imperative that the CDC and other local and federal health agencies and authorities thoroughly understand the nature of vaccine hesitancy among parents and that they communicate effectively to ensure that more parents get their children vaccinated. We should not be waiting until the vaccines are all approved and available to start this campaign. We already know that parents are hesitant, and we should be communicating with them early and often. Without vaccinating children, it is unlikely this pandemic will ever recede and allow us to return to complete normalcy. Public health agencies and professionals must do everything they can to ensure that parents understand that it is in everyone’s best interest to get their children vaccinated. Putting their children and those around them at risk of serious illness should not be an option when safe and effective preventive measures are available.

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