COVID-19 vaccine hesitancy among caregivers of children under five years old in a pediatric emergency department

Objective: Children under five years old have a high rate of SARS-CoV-2 (COVID-19) infection, yet rates of vaccination are relatively low. Our qualitative study investigated reasons why caregivers of children ages six months to four years old may be hesitant to vaccinate their children against COVID-19.

Study design: Qualitative study.

Methods: We enrolled a convenience sample of caregivers of patients aged six months to four years who presented for care at a pediatric Emergency Department in southern California. We conducted face-to-face semi-structured interviews with caregivers to probe for themes regarding any hesitations they may have regarding vaccinating their children against COVID-19. Interviews were recorded, transcribed, translated if necessary, and coded. When thematic saturation was achieved, we applied grounded theory methodology to assess for themes and adapted the World Health Organization Strategic Advisory Group of Experts model of vaccine hesitancy determinants matrix to provide a framework for the identified themes.

Results: We conducted 20 interviews, two in Spanish, and achieved thematic saturation at 17 interviews. We categorized themes surrounding vaccine hesitancies into external, patient-centric, and vaccine-centric factors. External factors included sources of information and family/community influence. Patient-centric factors included the perceived risk versus benefit ratio, caregiver beliefs, and caregiver knowledge and awareness. Vaccine-centric factors included vaccine safety, vaccine efficacy, vaccine information, and barriers to vaccination.

Conclusions: Using qualitative methodology, we gained important insights into caregiver thoughts regarding the COVID-19 vaccine in children under five years old. We identified themes not previously published in the literature that may be specific to the COVID-19 vaccine in the young pediatric population.