key: cord-0813004-cqwou1r6 authors: Cioffredi, Leigh-Anne; Kohlasch, Kaelyn L.; Thomas, Elina; Potter, Alexandra S. title: Persistently Low Readiness to Vaccinate Young Children Against COVID Among Vaccine Adherent Mothers in Vermont, USA date: 2022-05-23 journal: Prev Med Rep DOI: 10.1016/j.pmedr.2022.101841 sha: fef2561270e3331dea98656f09f615ee32d20938 doc_id: 813004 cord_uid: cqwou1r6 Young children (0-4 years) represent the next population in whom the SARS-CoV-2 (COVID) vaccine will be available. Addressing parental feelings about vaccination will be important to optimize uptake. In this study, online surveys were administered in 78 perinatal women in the Northeast United States (Vermont) between January and July 2021. Women reported vaccine intention by indicating their plans to have their child vaccinated. Response choices included vaccinate as soon as possible, vaccinate but not immediately, or no intention to vaccinate. Subsequently, women rated their readiness to vaccinate children if offered the COVID vaccine tomorrow on an 11-point scale from 0 (definitely not get the vaccine) to 10 (definitely get the vaccine). Factors influencing ratings were measured categorically. General vaccine hesitancy was measured with the Parent Attitudes about Childhood Vaccinations scale. While many individual participants changed readiness to vaccinate children between baseline and follow-up; readiness in the study cohort remained unchanged. Approximately 50% of participants were likely to have their young children vaccinated. Concerns about vaccine safety was the largest driver of hesitancy. Importantly, even in a cohort highly adherent to childhood vaccines, hesitancy toward general childhood vaccines predicted decreased readiness for young children to receive the COVID vaccine. Our data provide evidence that maternal attitudes about the COVID vaccine are not fixed but overall readiness remains low, that prior adherence to childhood vaccine schedules will not predict vaccine behavior related to the COVID vaccine, and that public health messaging should emphasize messaging targeting vaccine safety in children. Young children (0-4 years) represent the next population in whom the SARS-CoV-2 (COVID) vaccine will be available. Addressing parental feelings about vaccination will be important to optimize uptake. In this study, online surveys were administered in 78 perinatal women in the Northeast United States (Vermont) between January and July 2021. was the largest driver of hesitancy. Importantly, even in a cohort highly adherent to childhood vaccines, hesitancy toward general childhood vaccines predicted decreased readiness for young children to receive the COVID vaccine. Our data provide evidence that maternal attitudes about the COVID vaccine are not fixed but overall readiness remains low, that prior adherence to childhood vaccine schedules will not predict vaccine behavior related to the COVID vaccine, and that public health messaging should emphasize messaging targeting vaccine safety in children. Keywords: COVID-19, COVID vaccine, vaccine hesitancy, childhood vaccination, COVID-19 vaccine 1 2 TEXT: Since COVID (SARS-CoV-2 ) appeared in the United States, more than 79 million cases, 63 them against COVID," "They have already had COVID," and "Other." For statistical analysis, women who rated their readiness to have their child vaccinated 65 against COVID as 7 or greater were considered "likely" to have their children vaccinated, those 66 with readiness scores between 3 and 6 were "unsure" and those with scores less than 3 67 considered "unlikely." For examination of readiness over time, those who were likely to have 68 their children vaccinated at follow-up (or both baseline and follow-up) were considered "stayed 69 high or increased" ,while "stayed low or decreased" describes participants who were persistently 70 unlikely or unsure or who decreased from likely on the follow-up survey. 103 respectively at follow-up. Though change in readiness across the study population was not 104 significantly different, many participants changed their rating between timepoints (Figure 1) . In both time periods, women who were unsure or unlikely to have their children 107 vaccinated overwhelmingly reported concern about vaccine side effects was driving their 108 decision. In contrast, most participants who were likely to have their children vaccinated 109 indicated wanting to protect their family from COVID as the driving factor ( Figure 2) . 131 transmissibility of Omicron variants means that herd immunity will require even higher rates of 132 immune individuals (Liu & Rocklov, 2022) . Therefore, current rates of intention to vaccinate are 133 lower than necessary to have a lasting impact. Our study adds longitudinal measurement to literature on parent's attitudes toward the 135 COVID vaccine. Our baseline survey was conducted prior to widespread availability of the 136 COVID vaccine in adults, while at the second timepoint all participants were eligible for 137 vaccines themselves. However, vaccine readiness overall was stable indicating improved 138 vaccine messaging and/or penetration is needed. Surprisingly 2/3 rd of those with low scores of 139 readiness were vaccinated themselves, therefore public health messaging will likely need to 140 specifically address benefits and safety of COVID vaccines in children. Similar to prior studies, concern about side effects was reported as the major factor 142 driving vaccine hesitancy. This sample of mothers were particularly compliant with childhood 143 vaccines, suggesting prior vaccine adherence does not predict readiness to accept the COVID 144 vaccine. Even among this highly adherent population, PACV scores were strongly predictive of 145 persistent or increasing readiness to have children vaccinated. It appears even low levels of 146 mistrust, or hesitation related to childhood vaccines influences feelings related to COVID 147 vaccines. Therefore, though COVID specific messaging is necessary, strategies used to improve 148 childhood vaccine adherence generally may have a role in messaging about the COVID vaccine. 149 Lastly, maternal age was the strongest predictor of vaccine readiness suggesting outreach 150 optimized for younger mothers will be important. With any study related to COVID, context is key. This study occurred in Vermont before Caption: Above, red lines represent increased readiness, blue lines represent decreased, yellow 201 are stable reediness scores. Lines represent baseline/follow-up pairs which exist in the data at 202 least once to depict the diversity of change in readiness between the timepoints. However Figure 2: Driving Factors of Readiness Rating at Baseline and Follow-up by Likelihood of 206 Having Children Vaccinated Caption: Between baseline and follow-up, concern about children getting very sick and desire to 208 protect one's family from COVID increased, particularly among those likely to vaccinate 209 children. Simultaneously, concern about the side effects decreased at follow-up, but remained 210 the most common factor driving readiness rating among those unsure or unlikely to have children The authors have no conflicts of interest relevant to this article 219 to disclose. Study sponsors were not involved in the study design, data collection, analysis or 220 interpretation of the data, nor in the writing or submitting of the manuscript. The first draft was 221 Funding Sources: This work was supported by the National Institutes of Health UG1OD024955, P20 GM103644], and The Children's Miracle The authors listed include all team members who have significantly contributed to the A review of effect sizes and their confidence 236 intervals, Part I: The Cohen'sd family. 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