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Parental Intentions and Perceptions toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years — PROTECT Cohort, Four States, July 2021–May 2022

Lindsay LeClair, Kimberly Groover, Brian Sokol, Hilary McLeland-Wieser, Mark Berry, Ramona Rai, and Gabriella Newes-Adayi, Abt Global; Karen Lutrick and Patrick Rivers, Family and Community Medicine, College of Medicine, University of Arizona; Ashley Fowlkes, Tammy A. Santibanez, Julie Mayo Lamberte, Lauren Grant, and Tamara Pilishvili, Centers for Disease Control and Prevention; Katherine Herder, Ashley A. Lowe, Krystal S. Jovel, Sana Khan, Flavia Miiro Nakayima, Cynthia Porter, Zoe Baccam, Kate Ellingson, and Jeff Burgess, Mel and Enid Zuckerman College of Public Health, University of Arizona; Leah Odame-Bamfo, Claire Mathenge, and Manjusha Gaglani, Baylor Scott and White Health, Texas, A&M University College of Medicine; Maria V. Ferraris, Felipe A Pubillones, Jezahel S. Ochoa, Natasha Schaefer Solle, Lisa Gwynn, and Alberto Caban-Martinez, Leonard M. Miller School of Medicine, University of Miami; Andrew L. Phillips, Brianna Cottam, Jacob Mckell, and Sarang Yoon, Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health


September 1, 2022

More than 12 million children in the U.S. under 18 have been infected with SARS-CoV-2 since December 2019. And children under five had increased hospitalization rates during the Delta and Omicron peaks. In June 2022, the U.S. Food and Drug Administration allowed the use of the Pfizer-BioNTech COVID-19 vaccine for children 6 months through four years old.

Early reports suggested that fewer than 50% of parents would vaccinate very young children. But a new study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report shows that parents’ attitude toward vaccinating children younger than five has shifted over time, initially rising and then dropping, but their overall intent was higher than other national published rates. The study of the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) cohort in Arizona, Florida, Texas, and Utah is the first longitudinal study of parent perceptions toward the COVID-19 vaccine in those young children. This analysis was conducted using surveys from July 2021 to May 2022. Seven Abt Global staffers were among the report’s authors. 

Initially, of the 393 parents participating, 64 percent indicated they were likely to vaccinate their child younger than five, while 19 percent were unsure, and 10 percent were unlikely. Three months after enrollment, the odds of parents opting to vaccinate dropped 20 percent, while parents were 39 percent less likely to consider the vaccine effective and 35 percent less likely to consider it safe. Parents also were 51 percent less likely to trust government. That was true even though evidence shows the vaccines are both safe and effective among children.

Six months after enrollment, unadjusted models showed the intent to vaccinate and perception of safety increased, but not after adjusting for such factors as testing positive for SARS-CoV-2 before the survey’s completion, age, sex, race, ethnicity, health insurance, and site. 

Multiple factors could have produced the drop in vaccination support. They include conflicting news reports of vaccine availability for this age group; parents’ positive SARS-CoV-2 test results during the observation period, which could reduce parents’ perceived need for vaccination; and news of lower estimates of vaccine effectiveness for older children at the beginning of the omicron surge.

Enhanced efforts to address such barriers so that parents increase vaccination in children aged younger than five could include reinforcing the message of the vaccine’s effectiveness and safety among this population.