COVID-19 vaccines for children received a good deal of scrutiny when they first became available in 2021. Chatter online and elsewhere indicated that parents were becoming less likely to vaccinate their children due to growing misinformation around the COVID-19 vaccines.
But were parents really becoming more vaccine-hesitant because of rumors about the COVID-19 vaccines? Sean O’Leary, MD, MPH, a professor of pediatrics in the Section of Pediatric Infectious Diseases at the University of Colorado School of Medicine and an investigator at the Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), wasn’t so sure.
“Throughout the pandemic, you saw a lot of headlines around COVID vaccine refusal and how that refusal was spilling over into other routine vaccines,” O’Leary says. “But a lot of that was based on stories or personal narratives, interviews with parents or pediatricians or family doctors. I work with a lot of general pediatricians, and I’m married to one, and I was hearing the other side of that coin — that some people who formerly refused vaccines were now asking to catch their kids up. It seemed a lot more complicated than simply, ‘People are refusing COVID vaccines, so now more are refusing other routine childhood vaccines.’”
A homegrown data source
O’Leary and colleagues recognized that there was no national surveillance system for vaccine confidence, so they discussed the best ways to research the issue. With colleagues at the University of Washington, his team published a study based on an ongoing clinical trial that began measuring vaccine attitudes of parents of newborns in September 2019, prior to the onset of the pandemic. That data showed that after the onset of the pandemic, after a brief improvement in vaccine confidence, levels of vaccine hesitancy returned to the pre-pandemic baseline. However, that study only reported data through December 2020.
The team then discussed how to examine the question further, and considered Health eMoms, a survey administered each year by the Colorado Department of Public Health and Environment (CDPHE). The survey randomly samples birthing parents in Colorado on a variety of health topics, including vaccine hesitancy.
“Even before the pandemic, they were asking questions about vaccine confidence and vaccine attitudes,” O’Leary says. “It’s a population-based survey that is demographically representative of Colorado in terms of urban and rural, race, and ethnicity. It’s also a validated survey, which means that it has been shown to predict future vaccination behavior. If you administer the survey to parents of young children, and they score as vaccine hesitant, that predicts that they're likely going to delay or refuse one or more vaccines for their children.”
O’Leary and his colleagues at ACCORDS had worked closely with the immunization branch at CDPHE, so they reached out and there was mutual interest in examining this question further. ACCORDS research fellow David Higgins, MD, MPH, also spent time at CDPHE as part of his preventive medicine residency.
Studying hesitancy and trust
O’Leary, Higgins, and their fellow researchers divided the data into three time periods: a pre-pandemic period spanning April 2018 to February 2020, a pandemic pre-vaccine period from April 2020 to December 2020, and a pandemic post-vaccine period from January 2021 to August 2021.
The research — published in November in the journal Pediatrics, with Higgins as lead author — showed that at least in Colorado, news and rumors about the COVID-19 vaccine didn’t result in a change in how parents felt about vaccinations for their children.
“Throughout all three of the time periods, roughly 20% of respondents scored as vaccine hesitant,” O’Leary says. “That really didn't change much during any period of the study.”
The researchers, however, did notice a couple of trends in the data indicating that parents’ trust of vaccines vacillated during the pandemic periods. To a question asking respondents to rank their hesitancy around childhood vaccinations in general, for instance, fewer parents checked the “not sure” box during the pandemic time periods, moving either to hesitant or not hesitant answer groups. Similarly, when asked if they trust the information they receive about childhood vaccinations, more parents chose the “not sure” option during the pandemic periods than during the pre-pandemic period.
“You could argue that the data show that some of the misinformation and disinformation that we saw during the pandemic has taken hold, in terms of hitting parental trust in childhood vaccines,” O’Leary says.
First step toward combatting misinformation
O’Leary knows there are more national data to be collected, but he is comfortable using the Colorado numbers as a starting point for what is happening nationwide, especially if it helps to combat potentially dangerous misinformation about vaccine hesitancy.
“One of the reasons we wanted to do this was to say, ‘Let's look at what's actually happening, as opposed to what people are saying they think is happening,’” he says. “There is a concern with normalizing vaccine hesitancy, because if it becomes a situation where a parent thinks, ‘Everyone's refusing vaccines, so I may as well refuse them too,’ that's a problem. The reality is that the vast majority of parents are still vaccinating their kids.”
The data can also be used to help create messaging around vaccination, and to give pediatric clinicians better guidelines for communicating with parents, O’Leary says.
“They might need to spend a little more time talking with families about why it’s OK to trust the information they have about shots,” he says. “We've also heard anecdotally that since the pandemic began, a lot of pediatricians are spending more time talking about shots. This might give them some information on things they might focus on.”
‘Vaccinations save lives’
In addition to the information his research provided about vaccine hesitancy, O’Leary says the process also shows how necessary it is to track attitudes about vaccines and develop ways of restoring confidence in their safety and efficacy when needed.
“We need a better understanding, on a national and ultimately a global scale, of vaccine confidence,” he says. “There's a saying in the world of vaccines that, ‘Vaccines don't save lives. Vaccinations save lives.’ We have surveillance for lots of diseases so we can understand where we need to put our health care dollars and our personnel. If vaccine confidence truly is going down, and fewer people are getting vaccinated, that will lead to outbreaks of infectious diseases. If you can understand where that's happening, so you can go into those communities and address the misinformation and rebuild the confidence in these lifesaving products, that is ultimately the goal.”