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For parents, the decision to have a child vaccinated against SARS-CoV-2 is complex, and providers need to understand how and why such decisions are made to provide tailored recommendations, a qualitative study suggests.
Dr Jonathon Maguire
“Many families who are worried about vaccinating their children against the COVID-19 virus are not antivaccination, just concerned parents,” study author Jonathon Maguire, MD, of St. Michael’s Hospital and the University of Toronto, Canada, told Medscape Medical News. Therefore, clinicians need to “keep an open mind.”
Parents found the decision “challenging,” according to the study’s authors. The following four themes influenced parental attitudes toward vaccinating a child: the newness of the SARS-CoV-2 vaccines and evidence supporting their use; the perceived politicization of vaccination guidance; social pressures regarding SARS-CoV-2 vaccination; and weighing individual vs collective benefits of vaccination.
The study was published online February 21 in the Canadian Medical Association Journal.
Continuum of Concerns
Children aged 5–11 years became eligible to receive the SARS-CoV-2 vaccine in Canada in November 2021. Before regulatory approval, about two thirds of parents reported a willingness to have their child receive the vaccine, but as of October 2022, fewer than half (47%) of children in that age group had received at least one dose, according to the researchers.
To understand the factors that affect parental decision-making, the team conducted a qualitative study involving phone or video call interviews with a “purposive” sample of 20 parents in the Greater Toronto Area in Ontario.
Of the 20 participants, 18 were women. Seven were aged 31–40 years, and 13 were aged 41 years or older. Most participants (16) were White, two were Black, and two reported “other” ethnicity. Most participants (13) had a university degree, five had a college education, and two had completed elementary or high school. All had at least one child aged 5–11 years.
Parental attitudes represented a “complex continuum of concern,” according to the researchers. These concerns included the novelty of the technology (eg, mRNA vaccines) and the paucity of evidence regarding associated risks and benefits for children.
Some participants wanted to wait for further evidence of the vaccine’s potential long-term adverse effects. Others were not convinced by the evidence of efficacy to date, particularly compared with routine childhood immunizations.
One participant commented, “I am fully supportive of all other vaccines…. I believe in getting a vaccine even if you don’t need it if it will protect other people. But it doesn’t seem like this vaccine does that [for children].”
Parents expressed concern about the perceived politicization of vaccination guidance. One is quoted as saying, “I’m very uncomfortable with politicians selling vaccines on TV or on social media…. I just feel it’s a decision that should have been between my doctor and myself for my children…. Maybe if the government had stayed out of it, maybe we would have [gotten vaccinated].”
The social pressure involving SARS-CoV-2 vaccinations was also a concern. One said, “Right now, it seems like you are either pro-vaccine or anti-vax. And if you haven’t gotten a [SARS-CoV-2] vaccine, even if you’re not anti-vax, but you just don’t want that one, you’re still lumped into the [anti-vax] category.”
Weighing of individual vs collective benefits of vaccination was also a consideration. One participant noted, “We can’t look at it as a group decision. We have to look at it as an individual family decision.”
Overall, parents expressed “difficulty sourcing and evaluating evidence, determining the trustworthiness of guidance, and balancing their own conceptions of health care decisions with societal expectations and political messaging,” the authors conclude.
The demographics of the participants was the study’s main limitation: most were women who lived in households with high levels of income and education who were selected from an existing study of families willing to engage in longitudinal research. Therefore, the findings may not hold true for all parents in Canada.
Decision-Making Discussions
Commenting on the study for Medscape, Suzette Oyeku, MD, MPH, chief of academic general pediatrics at the Children’s Hospital at Montefiore in New York City, said that she agreed with the study findings on the basis of her clinical experience. She noted that certain contextual factors weren’t highlighted in the study, however, probably because of participant demographics.
Dr Suzette Oyeku
In her diverse population of patients, some parents could not take time off from work to have their children vaccinated without losing pay. “Vaccine availability has an impact in this situation,” said Oyeku. “In this population, given historical influences, issues around skepticism and potential mistrust of health systems or clinical trials also play a role.”
Furthermore, it is important to know how decisions are made in households, she said. “In some families, it’s gender-based, and even when you’re having discussions, the decider may not be in the room and needs to be brought into the conversation. As a clinician, it’s important to ask which people need to hear the information so that it can really inform the family decision.”
It’s also important to be available to address questions from families, said Oyeku. Although time is a challenge, “this is what we pediatricians do. We have conversations about vaccinations, and with the COVID vaccines, the conversations are likely to be a little long and may happen on several occasions.
“We need to use multiple strategies to get the information out, including clergy, who clinicians may not think about but who are trusted resources for up to a third of families,” said Oyeku, who served as a medical consultant with the Conference of National Black Churches on a CDC-funded project. The initiative, Trusted Voices, Trusted Content and Trusted Spaces, trained more than 3000 faith-based leaders across the US about the COVID vaccines.
She suggested that clinicians consider using short videos from The Conversation: Between Us, About Us – Greater than COVID, among other resources, to inform provider-family discussions.
The study was supported by the Canadian Institutes of Health Research and the Canadian COVID-19 Immunity Task Force. Maguire and Oyeku have disclosed no relevant financial relationships.
CMAJ. Published February 21, 2023. Full text
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