Understanding Influenza and SARS-CoV-2 Vaccine Hesitancy in Racial and Ethnic Minority Caregivers

Abstract

(1) Background: We compared influenza and SARS-CoV-2 vaccine hesitancy levels in Black, Hispanic, and White parents/caregivers and identified barriers and facilitators to vaccine acceptance. (2) Methods: This was a mixed methods study. A cross-sectional survey of ED caregivers presenting with children 6mo–18yo compared vaccine hesitancy levels among diverse caregivers. Six focus groups of survey participants, stratified by caregiver race/ethnicity and caregiver intent to receive SARS-CoV-2 vaccine, assessed facilitators and barriers of vaccination, with thematic coding using the Consolidated Framework for Implementation Research (CFIR). (3) Results: Surveys (n = 589) revealed Black caregivers had significantly higher vaccine hesitancy rates than White caregivers for pediatric influenza (42% versus 21%) and SARS-CoV-2 (63% versus 36%; both p < 0.05). Hispanic caregivers were more hesitant than White caregivers (37% flu and 58% SARS-CoV-2), but this was not significant. Qualitative analysis (n = 23 caregivers) identified barriers including vaccine side effects, lack of necessity, inadequate data/science, and distrust. Facilitators included vaccine convenience, fear of illness, and desire to protect others. (4) Conclusions: Minority caregivers reported higher levels of vaccine hesitancy for influenza and SARS-CoV-2. We identified vaccine facilitators and barriers inclusive of Black and Hispanic caregivers, which may guide interventions designed to equitably improve acceptance of pediatric vaccines.

COVID-19 Vaccine Hesitancy among Economically Marginalized Hispanic Parents of Children under Five Years in the United States

“…Consistent with prior studies on parental health beliefs, resistant parents were more likely than the unsure and accepting parents to hold COVID-19 vaccine misconceptions, believe their child was not susceptible to infection, that COVID-19 symptoms would be less severe, that the vaccine would be harmful to their child and unnecessary, and hold higher levels of general vaccine mistrust [ 9 , 12 , 23 , 24 , 25 , 54 ]. COVID-19 vaccine misinformation, conspiracy theories and hoaxes have been pervasive in the general mass media as well as in social media posts specifically targeting Hispanic communities [ 55 , 56 , 57 ].…”

“…In national studies that included samples of Hispanic respondents, application of the health beliefs model (HBM) and related theories of planned health behaviors [ 17 , 18 , 19 , 20 ] indicate that the most consistent predictors of parental intentions for COVID-19 vaccine uptake for children were misinformation, underestimation of disease severity and susceptibility, distrust of vaccine safety and efficacy, a lack of community support for vaccinating children against infection [ 9 , 10 , 11 , 12 ], lower income and education, and lack of private insurance [ 17 , 18 , 21 , 22 ]. These factors have also been identified among Hispanic parents as predictive of routine and influenza pediatric vaccination intent [ 21 , 23 , 24 , 25 , 26 , 27 ].…”

Willingness to vaccinate children against COVID-19 declined during the pandemic

“…Previous reports published in our cohort [33] documented higher rates of decisions against vaccinating from maternal caregivers, as reported by others [15] , [17] , [27] . In a COVID States Project study from October 2021, mothers were found to be especially concerned about COVID-19 vaccines, compared to fathers [34] .…”

“…The lower rate of willingness to vaccinate we describe during the last phase demonstrate further decline compared to rates reported in a recent scoping review of 35 publications until July 2021 (median rate of 59.3%; IQR 48.60∼73.90%) [14] , and the five most recent studies from the US (rate of 58.5%) [15] , [16] , [17] , [18] . More recently, a Kaiser Family Foundation (KFF) study [3] from October 2021 reported that only 27% of parents of 5- to 11-year-olds are “keen” to immunize their children and 30% said they definitely are not going to vaccinate their children.…”

“…In a qualitative study of US caregivers presenting to the pediatric ED, Baumer et al found barriers to pediatric COVID-19 vaccination included a fear of vaccine side effects, lack of vaccine necessity (mild disease or vaccine ineffectiveness), vaccine novelty and lack of adequate research to support the vaccine, and distrust of the medical system/government [17] . The decline we note from almost 60% early in the pandemic to 52% in the end of 2021 is similar to what was documented in the US [20] and Germany [21] and may be linked to several factors.…”