Hesitancy and confidence in pediatric COVID-19 vaccination among diverse caregivers of unvaccinated children

Introduction: Understanding factors associated with hesitancy about pediatric COVID-19 vaccination is important for identifying strategies to improve vaccination rates. Our objective was to describe beliefs about COVID-19 vaccination among caregivers who had not yet vaccinated their children against COVID-19. Methods: From July 2022 to February 2023, caregivers of children unvaccinated for COVID-19 across 15 states within the IDeA States Pediatrics Clinical Trial Network were recruited into a randomized, controlled trial of a COVID-19 vaccine communication phone app. Recruitment sites served high numbers of children from rural areas or of backgrounds other than non-Hispanic White. At baseline, caregivers answered questions from the SAGE Vaccine Hesitancy Scale (VHS), and questions about trusted sources of information about COVID-19. We compared responses by rurality, race, and ethnicity using chi-square tests, and used multivariable modeling of a composite outcome of summed VHS scores to identify factors associated with vaccine hesitancy. Results: A total of 725 caregivers were randomized; 512 completed the baseline survey. Many caregivers lived in a rural area (34.9 %) and nearly half were of non-White race (47.3 %). Over 80 % somewhat or strongly agreed that vaccines are important, that childhood vaccines are effective, and that vaccination is a good way to protect children from disease. Rural caregivers were more likely than non-rural caregivers to state that they generally do what their doctor recommends with regard to childhood vaccines (46.93 % vs. 37.00 %, p < .0021). In the multivariable model, the combined group of Asian, Native Hawaiian, Other Pacific Islander or multiracial caregivers, and Black or African American caregivers, had a higher vaccine hesitancy compared to White caregivers (25.25, 25.91, 22.50 respectively) (p < .0001). Conclusions: As we navigate work to build vaccine confidence, this study provides support for additional directions of study to better understand particular populations and could be further reproduced to look at intentions with other vaccines.