Parental Intent and Willingness to Vaccinate Children Against COVID-19 in the Pediatric Emergency Department

Background: Limited data exist regarding parental acceptance of COVID-19 vaccines for children or likelihood of acceptance in a pediatric emergency department (PED). We sought to determine rates of COVID-19 immunization among eligible children with a minor illness or injury treated in a pediatric emergency department (PED), to ascertain parent willingness for their child to receive COVID-19 vaccine (CV) in general and during future PED visits, and to describe factors associated with vaccine acceptance.

Methods: Structured interviews were conducted with caregivers of children aged 6+ months evaluated in a large, urban PED in the summer of 2021 using questions derived from the literature and prior surveys. Exclusion criteria included temperature 103+F, communication barrier, Emergency Services Index (ESI) triage score of 1 or 2, or evaluation for non-accidental trauma or psychiatric complaints. Demographic and visit data, contact information, patient and parent vaccination history, and intent and willingness to receive CV were recorded, along with responses regarding parental concerns about COVID-19 illness or vaccination. Data were analyzed using standard descriptive statistics. Participants will be contacted by phone 6 months after vaccines become available for their age group to assess vaccination status.

Results: Of 205 families approached, 17 declined participation, 7 were ineligible, and 181 have been enrolled. The mean patient age was 6.15 (+/- 5) years; 43.6% were black. 33 (18.2%) had asthma and 16 (8.8%) had another high-risk condition. 17 (9.4%) had been previously diagnosed with COVID. Only 8/36 eligible patients (22.2%) were vaccinated. Among those previously unvaccinated, 55/173 (31.7%) definitely/probably would vaccinate their child when CV becomes available. 59/181 (32.6%) would definitely/probably accept CV in the PED at a similar future visit. Factors associated with increased overall CV acceptance included caregiver flu vaccine receipt (52.3% vs. 26.5%, p = 0.002), caregiver CV receipt (43.2% vs. 21.2%, p = 0.022), and concern that the child currently has COVID (77.8% vs. 35.6%, p = 0.012). Factors associated with acceptance in the PED included intent to vaccinate against CV (81.8% vs. 17.2%, p < 0.001), caregiver flu vaccine receipt (46.1% vs. 25.2%, p = 0.004), caregiver CV status (40.7% vs. 11.1% %, p < 0.001) and caregiver concern the child has COVID (87.5% vs. 31.9%, p = 0.001). Caregivers who were very/somewhat concerned that the child would become ill from CV were less likely to accept (overall (32.6% vs. 51.4%) and significantly less likely to accept in the PED (26.2% vs. 51.4% accepting, p < 0.001).

Conclusion: Caregiver intent to immunize children against COVID is concerningly low, but is associated with caregiver vaccination status and concern for current COVID-19 illness. Those who intend to vaccinate are willing to receive CV while in the PED, indicating potential viability for future COVID-19 vaccine programs in the PED.