Trends in parents' confidence in childhood vaccines during the COVID-19 pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic substantially disrupted well-child visits and vaccinations in the United States.1,2 Parent hesitancy for pediatric COVID-19 vaccines3 and widespread vaccine misinformation during the pandemic may have affected parent confidence in routine childhood vaccines. Little is known beyond 2 studies: 1 involved a convenience sample from a single medical center4; the other only evaluated adolescent vaccines.5 Using longitudinal data from a nationally representative sample, we assessed how parents’ confidence in childhood vaccines changed during the pandemic.We analyzed data from the Understanding America Study (UAS), a probability-based Internet panel of ∼9500 United States adults.6 Panel members were recruited by using address-based sampling and provided with Internet-enabled tablets if needed.Understanding Coronavirus in America surveys were administered to the UAS panel (in English and Spanish) biweekly from April 1, 2020 to February 16, 2021, then monthly through July 20, 2021, with 2 additional surveys from September 23 to October 1, 2021 and February 1 to March 30, 2022 (Supplemental Information). In every wave except for 2, respondents were asked whether they agreed with 4 statements (presented in random order) about childhood vaccines: “Childhood vaccines, such as those for measles or chicken pox: 1) provide important benefits to society; 2) may lead to illness or death; 3) have many known harmful side effects; 4) are useful and effective” (Response options: Strongly Agree/Agree/Disagree/Strongly Disagree). These questions were omitted in the June 10 to July 8, 2020 and July 8 to August 5, 2020 surveys because of cost constraints.We identified parents of children aged 0 to 17 years among UAS panel members on the basis of responses to My Household surveys, administered quarterly to all panel members to assess household characteristics (Supplemental Information). We examined trends in the percentage of parents who strongly agreed or agreed with each statement. For the “illness or death” and “harmful side effects” statements, we used linear regression models with cluster robust standard errors at the respondent level to assess characteristics associated with a change between the first (April 1–April 28, 2020) and most recent (Feb 1, 2022–March 30, 2022) waves. Analyses used SAS 9.4 (Cary, NC), were adjusted by using survey sampling weights, and used exempt data under the UAS Data Use Agreement.Across all survey waves, the weighted sample size of parent respondents ranged from 1412 to 1987. Parent response rates ranged from 96.9% to 71.5% in the first and last survey waves, respectively, and were similar to those of the overall panel (97.1% and 75.8% for the first and last waves, respectively).From April 2020 to March 2022, the percentage of parents who agreed with the “important benefits” and “useful and effective” statements remained stable and high, ranging from 89.5 to 92.5% and from 89.3 to 93.2%, respectively (Fig 1). By contrast, the percentage of parents who agreed with the illness or death and harmful side effects statements increased significantly by 13.2% (95% confidence interval [CI]: 9.4% to 16.9%) and 6.1% (95% CI: 2.2% to 9.9%), respectively (Tables 1 and 2). Statistically significant increases were observed for most parent subgroups (with overlapping CIs noted, suggesting no statistically significant differences between subgroups).In this national sample, the proportion of parents concerned about the safety and side effects of routine childhood vaccines increased significantly between April 2020 and March 2022; this trend was also observed for most parent subgroups. However, parent confidence in the benefits and effectiveness of childhood vaccines remained high. Our findings underscore the important role of pediatricians in addressing parents’ concerns about childhood vaccines, as they are highly trusted by parents about vaccinations7,8 and can address vaccine hesitancy.9,10 Pediatricians should therefore ask hesitant parents about their particular concerns and be prepared to address safety concerns.Study strengths included the use of a nationally representative sample and the ability to analyze trends using data frequently collected since the beginning of the pandemic. Limitations included: generalizability of online panel data (although UAS recruitment methods and use of survey weights in analyses should mitigate this bias), insufficient sample sizes for certain racial and ethnic groups, and inability to determine if concern was higher or lower for specific childhood vaccines or the exact factors causing the observed rise in concern.We conclude that parent concern about the safety of routine childhood vaccines has increased nationally since the start of the pandemic.