Parental Intentions and Perceptions Toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years — PROTECT Cohort, Four States, July 2021–May 2022

Approximately 12 million children and adolescents aged ≤18 years in the United States have been infected with SARS-CoV-2, the virus that causes COVID-19, since December 2019,* and COVID-19–associated hospitalization rates increased among children aged <5 years during the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variant peaks (1). In June 2022, the Food and Drug Administration amended the Emergency Use Authorization for the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine to include use of the vaccine in children aged 6 months–4 years and mRNA-1273 (Moderna) for children 6 months–5 years, which CDC recommends all children receive.^† Advance reports indicated that fewer than 50% of parents were willing to vaccinate their children aged <5 years (2,3). Using the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT)§ (4) prospective cohort, changes in parental perceptions toward COVID-19 vaccines and vaccination¶ for children aged <5 years were examined during July 2021–May 2022. Among 393 parents who participated in a baseline survey, approximately 64%, 19%, and 10% reported they were likely, were unsure, or were unlikely, respectively, to have their child aged <5 years receive the COVID-19 vaccine. The odds of parents intending to vaccinate their child was lower 3 months after the baseline survey, (adjusted odds ratio [aOR] = 0.84, 95% CI = 0.6–1.0) than at baseline. During the same period, parents also were less likely to perceive that COVID-19 vaccines were effective (aOR = 0.61, 95% CI = 0.4–0.8) and safe (aOR = 0.65, 95% CI = 0.5–0.9) compared with baseline. Intent to vaccinate and perception of safety increased 6 months after the baseline survey in unadjusted models (OR = 1.66, 95% CI = 1.1–2.5; and OR = 1.82, 95% CI = 1.3–2.6, respectively), but were no longer significant after adjusting for the child’s receipt of a positive SARS-CoV-2 test result before survey completion, age, sex, race and ethnicity, health insurance, and study site. Enhanced efforts to address parental confidence in childhood vaccination and increase vaccination coverage among children aged <5 years are needed, including reinforcing the effectiveness and safety of vaccination against COVID-19.