Vaccine hesitancy is a complex issue. A person’s decision around whether to accept or reject a vaccine is affected by a range of factors – from political influences to cultural beliefs to prior experiences of vaccination. The decision of whether to vaccinate a child is arguably even more complicated.
It’s perhaps unsurprising that COVID vaccination coverage in children is highly variable. Across the UK, the proportion of five to 11-year-olds who have received at least one dose ranges from roughly 3% in Northern Ireland to 9% in England, 13% in Wales and 20% in Scotland.
Many countries have achieved higher coverage. For example, in Austria, Iceland, Portugal, Spain and Denmark, more than 20% of children aged five to nine have received two doses. In the US more than one-third of children aged five to 11, and 70% of 12 to 15-year-olds, have received at least one dose, while in Australia, more than half of five to 11-year-olds have received one jab, with nearly 40% having received two.
So why aren’t vaccination rates among children higher in the UK? One reason is undoubtedly timing. For example, whereas in the US, vaccines were recommended for five to 11-year-olds in November 2021, in England, they weren’t offered to this age group until early April. But there are other likely reasons behind this slow uptake.
Safety and side effects
In our Public Views During the COVID Pandemic project, my colleagues and I have been following public attitudes to COVID vaccines. As part of this study, 24 adults took part in focus groups, where we discussed attitudes towards COVID vaccines for children.
Many participants in this study were concerned about potential unknown side effects. As one parent put it: “I still feel that [at] some point in the future they will discover something [about the vaccine] that affects children more than adults.” Another said: “I don’t want my son to be part of a giant experiment.”
Concerns around side effects are also commonly identified in large surveys looking at parents’ views on COVID vaccines for children.
It’s understandable that many people, especially parents, may have a heightened sense of hesitancy around a decision that affects children. But COVID vaccines have been demonstrated to be effective and safe in this age group.
Any side effects are generally mild and should only last one to two days. More serious side effects, such as heart inflammation (myocarditis), are very rare.
As with adults, there are significant socioeconomic inequalities in coverage. Children from some ethnic groups and more economically disadvantaged backgrounds are less likely to have been vaccinated.
For example, as of January 2022, only one in eight Black Caribbean and Gypsy/Roma 12 to 15-year-olds had received at least one dose, compared to six in ten White British and three-quarters of Chinese 12 to 15-years-olds. Meanwhile, schools with more than half of their pupils accessing free school meals had a median vaccination rate of 29%, whereas schools with fewer than 5% of pupils accessing free meals had a median vaccination rate of 73%.
Research has shown that trust in authorities and scientists is a major factor in determining vaccine acceptance or hesitancy. Mistrust is, quite understandably, much higher among historically marginalised groups, and this looks to have translated into a greater degree of distrust in, and consequentially uptake of, vaccines for five to 11-year-olds.
Sources of information
Information sources play an important role when people are deciding whether or not to get their child vaccinated. We found that local social norms heavily influenced people’s decisions. So if someone’s family or friends are having their children vaccinated, they too are more likely to seek a vaccine for their child – and vice versa.
Research from the US finds that parents of vaccinated children were much more likely to mention healthcare professionals as an important source of information. Parents of unvaccinated kids, meanwhile, were significantly more likely to say their own research was important in decision-making.
In the World Health Organization’s Vaccine Hesitancy Determinants Matrix, a framework for understanding the causes of hesitancy, one of the factors is the “strength of recommendation”. That is, how strongly that influential actors like politicians, doctors and scientists recommend or encourage a vaccine can help shape uptake.
A number of public health academics in the UK have criticised the official recommendations both for 12 to 15-year-olds and five to 11-year-olds as weak. The vaccine offer for 12 to 15-year-olds, it has been argued, was slow, confused and lacking urgency.
The subsequent vaccine offer for five to 11-year-olds was framed specifically as “non-urgent”. This is much less likely to prompt action than an official recommendation that frames vaccines as an important way to keep children “safe” and “protect” communities – as was seen for example in New Zealand and the US.
The benefits outweigh the risks
The pace of vaccinations has slowed in many countries, and it’s unlikely that we’ll see a significant uptick in vaccination coverage among children in countries like the UK any time soon. With attitudes to vaccines strongly influenced by how much risk COVID is perceived to present, we are arguably in a phase in the UK where the risk is perceived by the public to be lower than it has been previously.
But as many parents continue to weigh up the decision, it’s worth noting that a number of scientific authorities, including the UK’s Joint Committee on Vaccination and Immunisation and the US Centers for Disease Control and Prevention, advise that the health benefits of vaccination are greater than any potential risks for children aged five and older.
Simon Nicholas Williams has received funding from Swansea University, the University of Manchester, Senedd Cymru and Public Health Wales for research on COVID-19. However, this opinion article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.