The COVID-19 vaccine was approved on June 17 by the Food and Drug Administration for children ages six months and older. The next day, the Centers for Disease Control and Prevention (CDC) recommended that children in this age group who do not have contraindications receive the vaccine.

But by September, only a small portion of children under five years had received at least one dose of the vaccine, according to the CDC—approximately 1.3 million children (8% of this age group). To compare, about 10.7 million children ages five to 11 years (38% of this age group) and 17.6 million adolescents ages 12 to 17 years (70% of this age group) had received their first dose.

A survey of parents by the Kaiser Family Foundation sought to learn why parents were hesitating to vaccinate their younger children. Called the COVID-19 Vaccine Monitor survey, it included a representative sample of 1,847 adults and was conducted from July 7 to July 17 via telephone and the internet. According to the survey, 43% of parents said they would “definitely not” get their children younger than five years vaccinated, and 13% would do so only if required for school or day care. Commonly cited concerns included the vaccine's “newness” and “not enough testing” (19%) and worries about adverse effects (14%) and the vaccine's safety (13%). Some parents (11%) said they weren't worried about COVID-19.

The survey also found that respondents' political affiliations influenced their choices, with those who said they would “definitely not” vaccinate their young child more likely to be Republicans or Republican leaning (64%) versus Democrats or Democrat leaning (21%). And nearly two-thirds of parents who themselves are unvaccinated said they would “definitely not” vaccinate their child.

Concerns also differed by racial and ethnic groups. Forty-four percent of Black parents said they were concerned about needing time off from work to get their child vaccinated or to provide care if the child experienced adverse effects. This compares with 28% of Hispanic parents and 18% of White parents. Parents' relationships with health care providers were also influential. In explaining their reluctance, 45% of Hispanic parents cited not being able to get the vaccine from a place they trust, compared with 28% of Black parents and 15% of White parents. Most survey respondents with children in this age group (70%) had not spoken to their pediatrician or other health care provider about vaccinating their children, though some said they planned to at their children's next checkup.

“This is where it is crucial to have nurses—particularly school nurses—available to answer questions and eliminate barriers to accessing the vaccine,” said Robin Cogan, a nurse in the Camden City, New Jersey, school district. Among ideas for improving vaccine uptake among the youngest eligible children, Cogan suggested school-located vaccine clinics that are timed for drop-off and pickup. Incentives for participating might also be offered.—Amy M. Collins, managing editor