Nearly 2 million cases of COVID-19 have been seen in children aged 5-11 in the United States, and about 30% of these patients have been hospitalized for the infection. “COVID-19 cases and hospitalizations among young children are increasing across the US, with the burden disproportionately falling on Black and Hispanic children,” says Celia B. Fisher, PhD. “What is unknown is the extent to which these disparities will continue following the FDA’s emergency approval of COVID-19 vaccines for children aged 5 to 11 years in October 2021.”

Identifying factors associated with parental pediatric COVID-19 vaccine hesitancy is essential for developing effective public health programs to reduce racial/ethnic health disparities. “However, the CDC does not collect data on the race/ethnicity of children vaccinated against COVID-19,” Dr. Fisher says. “At present, only seven states collect such data, and vaccine uptake across states’ racial/ethnic differences is inconsistent.”

‘One-Size-Fits-All’ Approach Ineffective for COVID-19 Vaccination Messaging

For a study published in Vaccines, Dr. Fisher and colleagues looked at the extent to which racial and ethnic factors predict pediatric COVID-19 parental vaccine hesitancy for school-age children among 400 Hispanic and non-Hispanic Asian, Black, and White parents. “The overarching take-home message from our study was that a ‘one-size fits-all’ approach to public health messaging about COVID-19 vaccination will not be as effective as tailoring messages to the specific needs of parents,” says Dr. Fisher.

Parents’ attitudes toward vaccinating their children fell into three categories: 1) those who plan to vaccinate their child, 2) those who remain unsure, and 3) those who are strongly against vaccination. “Overall, only 40% of parents were planning to vaccinate their children,” says Dr. Fisher. “Our data reflected wide 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/ethnicities, parents strongly against vaccination held more misconceptions about the disease, thought their children were less susceptible, and believed COVID-19 symptoms were relatively mild in young children. These parents were also distrustful of vaccines in general, did not believe the COVID-19 vaccine was safe, and reported lack of support for the vaccine from other parents, family members, clergy, and others in their community. In addition, these parents would be less influenced in their vaccination decision by recommendations from the FDA or their doctor (Figure).

“An interesting finding was that parents’ decisions to vaccinate their children depended on how they valued community versus individual rights,” Dr. Fisher says. “Parents who believed getting their child vaccinated for COVID-19 supports the community by stopping spread of the disease were 3 times more likely to plan to vaccinate their child than those who refused. Conversely, parents who believed vaccinating their child for 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 the pandemic has changed the extent to which parents’ decisions on vaccination are influenced by traditional sources of expertise and community support, according to Dr. Fisher. “For example, only 50% of parents in our study who refused to vaccinate their child would be responsive to a school vaccination mandate,” she says. “This suggests national or state-wide school vaccination mandates may be met with strong resistance in certain communities.”

General distrust of the FDA and vaccine science and a lack of confidence in physicians were other important factors, says Dr. Fisher. “Most parents provided their children with routine pediatric vaccines, but only 65% said a physician’s recommendation would influence their decision,” she says. “This is the first time the public has had a ringside seat to the process of vaccine development. Thus, COVID-19 vaccine hesitancy may be a consequence of the barrage of conflicting information on vaccine safety and efficacy. Public health communication may increase health science literacy. In future research, we will examine the extent to which parents’ experiences with and attitudes toward vaccinating their children against COVID-19 will raise future barriers to, or facilitate, vaccination decisions for other childhood vaccines and future pandemics.”