The announcement that the Pfizer vaccine appears to work in children ages 5 to 11 is welcome news for many families across the United States. Parents who expect their children’s classrooms to soon be full of vaccinated students shouldn’t be overly optimistic, though. Many moms and dads will wait to get their kids immunized, if they do at all—and that includes those who are vaccinated themselves.
Although about two-thirds of adults and 83 percent of elderly Americans are fully vaccinated, the percentage of vaccinated adolescents is much lower. The Pfizer vaccine has been authorized for 12-to-17-year-olds since May, but only about half of kids ages 16 and 17 are fully vaccinated. Only 42 percent of those ages 12 to 15 are.
Parents tend to be skeptical of new vaccines. Whenever one is introduced, many of them are initially hesitant to adopt it. Take the varicella vaccine, for instance. Approved by the FDA in 1995, it protects against the virus that causes chickenpox, an extremely contagious, common, and unpleasant childhood infection. Even though the vaccine was highly effective and showed few side effects, uptake levels were initially low, with only 34 percent of eligible adolescents fully immunized by 2008. In my experience with my own patients, parents were concerned about the vaccine’s safety and efficacy, and weren’t convinced that chickenpox was a serious enough illness to warrant a vaccination. Immunization rates did improve over time. By 2018, about 90 percent of children had been vaccinated. But if history repeats itself, people hoping for parents’ speedy uptake of the COVID-19 vaccines may need to reset their expectations.
Most American parents of small children are between the ages of 25 and 39. Only 55 percent of them are fully vaccinated. We can expect that parents who have chosen not to vaccinate themselves are not likely to vaccinate their children quickly, if at all. We can even expect that some who did get vaccinated themselves will still be reluctant, at first, to immunize their children. This is supported by the current difference in the vaccination rates of parents and adolescents. Even parents who are enthusiastic about the vaccines may not want their children to be first in line.
Research bears this out. The C.S. Mott Children’s Hospital National Poll on Children’s Health found that across the United States, more than half of parents of children ages 3 to 11 said they were unlikely to have them vaccinated against COVID-19. A Kaiser Family Foundation national survey found that only 26 percent of parents would vaccinate their 5-to-11-year-olds right away.
Colleagues of mine at the Indiana University Fairbanks School for Public Health went further. They surveyed more than 10,000 parents across Indiana to see whether they planned to vaccinate their children and how they were thinking about it. More than 40 percent of parents of elementary- and middle-school children said they definitely would not get their children vaccinated against COVID, or would do so only if it were required by their schools or for other activities.
Ironically, more parents (60 percent) said they would not vaccinate their children if someone else in their household had already been infected with COVID-19. This could be because they assume that their children would have developed some natural immunity from the exposure, even if they did not get sick. Or perhaps the parent themselves had only a mild case, and therefore believes that COVID-19 isn’t dangerous enough to warrant vaccines for their children. This same type of thinking happens with influenza. Because most people don’t die from the flu, some adults don’t take it seriously enough and choose not to immunize their children.
The IU survey also found that roughly 15 percent of parents would “wait and see” how things went. This cohort is a good model for the “malleable middle” of parents, who might be nudged toward vaccination. Some of them said they might be motivated by more evidence of the vaccines’ safety and effectiveness as large numbers of other children get their shots. Others said they would be moved by recommendations from a trusted health-care provider, or by the vaccination of other children in their social circles.
Generally, the main reason children are vaccinated against other diseases is that schools mandate vaccines. When vaccines are required for school—as is the case with the varicella vaccine, for instance—vaccination rates increase quickly. When they are not—as is the case with the HPV shots—overall immunization rates stall at lower numbers.
I’ll be surprised if many public schools require the COVID vaccines in the near future. Given that many states are barely enforcing school mask mandates, vaccine mandates for students seem unlikely. A reasonable argument could also be made that although Pfizer’s studies have shown the vaccines to be safe so far, requiring them will be difficult until much more safety data are obtained, as was the case for adults before any mandates went into effect. Any available vaccines will also only be authorized for emergency use, not approved, which will further limit mandates in some areas.
Still, children getting vaccinated as soon as possible is important for their health and that of those they care about. I asked one of the researchers involved in the survey, Nir Menachemi, a professor and the department chair of health policy and management at the IU Fairbanks School for Public Health, what we might do to bring more parents on board. He said, “Parents, especially those on the fence, need different information than parents who already vaccinated their older children. Parents need to hear from their child’s doctor or other experts and peers from within their community that vaccinating against COVID-19 is a good thing. Up until now, most of the messages have come from media outlets, and that is not enough.”
That’s one of the key takeaways Menachemi and his team discovered through their work. Parents are used to getting their children vaccinated at their doctor’s office. If we want to persuade them to get their children the COVID vaccines, we will need to use the tools they trust. We have failed to do this again and again throughout the pandemic.
The news is full of stories about parents desperate to vaccinate their young children, some of whom have even resorted to trickery to get it done before they’re eligible. We need to be careful not to let such anecdotes convince us that it will be easier to vaccinate kids than adults. The opposite is likelier true. We need to communicate the value of vaccination to parents before the vaccines are authorized for their younger kids, because immunizing children benefits not just them, but everyone around them too.