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Parental Worry: How to Combat Parental COVID-19 Vaccine Hesitancy for Their Children

April 13, 2023

Editor’s Note: Claire Castellano will be graduating from Emory University School of Medicine this spring and starting her pediatric residency at Children’s Hospital of Philadelphia. In addition to her M.D., Claire pursued a Master’s in Public Health at Emory, focusing on global epidemiology. Claire hopes to combine her interests in medical education and global health in her career as a pediatrician. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Vaccine hesitancy has been and remains to be a provocative topic within discussion of the COVID-19 pandemic. Although COVID-19 vaccines for children were approved later than for adults, vaccination rates in children are lagging behind vaccination rates in adults: in September 2022, 91% of adults over 18 years old had received at least one dose of the vaccine, while only 67% of 12-17 year olds and 38% of 5-11 year olds had at least one dose. What underlies this discrepancy? In particular, what makes parents hesitant to vaccinate their children? Ying Liu at the University of Southern California and colleagues investigated this question in their article, “Role of Parents’ Perceived Risk and Responsibility in Deciding on Children’s COVID-19 Vaccination,” being early released in Pediatrics this week (10.1542/peds.2022-058971).

They examined how likely parents were to vaccinate their child based on two factors:

  • 1) comparative long-term risk, or a parent’s concern that the COVID-19 vaccine will have long-term risks greater than the risk of remaining unvaccinated, and
  • 2) anticipated responsibility, or a parent’s feeling of responsibility if their child got sick after deciding to vaccinate versus not vaccinate their child.

They also looked at the influence of these factors in the context of parents’ individual vaccination status.

This cross-sectional study utilized data from a nationally representative database that has been collecting information since March 2020 on COVID-19 beliefs and behaviors, specifically analyzing household data from February and March of 2022, when COVID-related pediatric hospitalization rates peaked.

Analysis of 1,715 parent participants revealed the following:

  • 45% of parents felt vaccinating their child had a comparative long-term risk greater than not vaccinating their child.
  • 18% of parents felt more anticipated responsibility from their child getting sick from the vaccine than without the vaccine.
  • These feelings led to lower child vaccination rates in parents who were vaccinated, but did not alter vaccination rates among parents who were unvaccinated.
  • Perceptions translated to a lower likelihood of vaccinating one’s child:
    • 6% lower due to comparative long-term risk concerns
    • 19% lower due to anticipated responsibility

The authors use these data to move from why parents may be hesitant to vaccinate their children to how we can combat this, suggesting tangible communication strategies we can all employ:

  • Education: share data around adverse effects of vaccination, focusing on common concerns; for example, discuss how myocarditis is incredibly rare and mild due to vaccination, but can cause severe disease at much higher rates due to COVID-19 infection, to address the comparative long-term risk
  • Opt-out versus Opt-in: data suggest that fear of regret is greater when parents are asked to make an active decision instead of doing nothing; use presumptive communication to make COVID-19 vaccination the default, having parents make the active decision to not vaccinate, to address the anticipated responsibility

The authors end the article with the optimistic statistic: addressing these two main parental concerns leading to vaccine hesitancy could increase vaccination rates among children up to 8%. Every conversation counts.

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