Building trust key to overcoming vaccine hesitancy among parents

Editor’s note: With the approval of the Pfizer vaccine for children aged 5-11 just around the corner, Healthy Debate Editor-in-Chief Dr. Seema Marwaha addresses emerging parental concerns. This Q-&-A is adapted from a CBC interview broadcast on multiple CBC radio stations.


The Pfizer-BioNTech COVID vaccine has been approved for children aged 5-11 in the US. And while Health Canada is still reviewing it, for many parents here, it can’t come soon enough. Still, a recent Angus Reid poll found that while 50 per cent are ready to have their children vaccinated right away, another 23 per cent say they will not. When do we think pediatric vaccines will be available in Canada?

Some experts are hopeful we will see an approval before the end of the year for ages 5-11, maybe sooner. In Canada, Pfizer has submitted preliminary data to Health Canada and formally asked for approval of its COVID-19 vaccine for children aged 5-11, stating that study results are similar to those aged 16 to 25. Health Canada has promised its review will be thorough, and the vaccine will only be approved for children if the benefits outweigh the potential risks. Once the vaccine is approved, the National Advisory Committee on Immunization (NACI) will weigh in on safety as well. For children aged 2-5, it’s not expected to be approved until 2022.

What would you say are some of the main concerns parents have? And how would you address them?

Let’s deal with the concerns separately. Number one: the potential side effects. Public knowledge is limited to what Pfizer has highlighted in its press release. However, Health Canada has more detailed information. But from what we do know, it appears the vaccine elicits the same amount of antibody response as in adolescents or adults. So, it’s effective. And it appears to be safe. In fact, the side effect profile might be even better than for adolescents or adults. The study includes a follow-up over two months, and we know the vast majority of side effects occur within the first week. So, the study will capture most adverse reactions. There is a six-month follow-up that is ongoing.

Number two: The trials were rushed. The amount of scientific and public health scrutiny that the COVID-19 vaccines have been under is unprecedented. Anything that is going to be approved by Health Canada is going through the same process that any other medication or vaccine has gone through. It is not possible to cut corners here with respect to reviewing the evidence. If any time has been saved in this process, it’s administrative time. There was a larger global collaboration and massive public interest that cut short the study lead times and addressed funding barriers.

Number three: Kids don’t get sick from COVID, so the risk of vaccines outweighs the benefit. It really bothers me when people say that children don’t die of COVID. They can and it’s heartbreaking when it happens. With newer variants of concern, physicians are seeing more cases of children with COVID. Some of those cases are asymptomatic and some of those cases are mild. But some of those cases are children who do get severely ill. As a parent myself, even if it’s only one or two cases, you don’t know if it will be your child. There is also the multi-system inflammatory reaction to COVID, and in rare cases children have died from that.

Vaccination also helps stop the spread of other variants of concern from emerging, and we don’t know if there will be a variant of concern that does affect children. They are the largest unvaccinated group in the country.

What if two parents or caregivers disagree on whether to vaccinate their children? Any advice?

For me, I intend on getting my child vaccinated as soon as Health Canada tells me it is safe to do so. But not all households are this way. I want to recognize that this is a difficult situation for parents. Both parents are probably coming from a place of concern. It’s important to understand where each person is coming from and not dismiss concerns as being anti-vaxx. It’s good to have a trusted person, like a pediatrician or family doctor, who can help answer questions and be involved in discussions. Having someone who can help sort through the noise of what we find online is so important. It might take some time to come to common ground and a mutually agreeable decision.

I think one thing to say to parents is that while I hope you get your child vaccinated as soon as you can, you don’t have to make your decision right away. We don’t have approval yet. Seek out answers if you have questions. Just be sure to get those answers from a trusted source.

It really bothers me when people say that children don’t die of COVID. They can and it’s heartbreaking when it happens.

Why do you think there is more potential hesitancy in parents of young children? Is there anything we can learn from the experience of vaccinating those over 12?

Being a parent involves going to great lengths to protect your child from unlikely but severe things. Whether it is safe sleeping for infants, car seats or vaccines, it doesn’t matter. This is where some hesitancy stems from. I think the reports of myocarditis in relation to the vaccine is a major source of concern, both because of the side effect itself and the fact that it was recognized in surveillance after approval. People don’t like unknowns. In the case of myocarditis, it was infrequent and people who’ve developed it have typically been fine. And COVID-19 itself can also cause myocarditis.

Bottom line is nothing is risk-free. But the benefit of the vaccine will likely far outweigh the individual risk in children, just as is the case with adults.

In the time remaining before we have a vaccine, what more can be done to address hesitancy in parents of young children?

It’s important to remember that vaccinating children is a key part of ending this pandemic. Children help drive transmission. They are not staying home anymore. They are going to school, out to public places and visiting family and friends. To address the potential hesitancy in parents, I think the most important thing we can do is build trust with them. When you review the literature around addressing parental vaccine hesitancy in other pediatric vaccines, it’s obvious having conversations with people you trust makes a difference.

Family doctors have so far been underutilized in our rollout and can be really helpful in having nuanced conversations with parents to address their concerns. They can also follow up with multiple conversations. Anyone can be a trusted source though, not just doctors. Faith leaders, community leaders, family and friends can all step up.

Addressing the more complex hesitancy some parents are feeling will probably take more than campaigns or generalized messages. They need a coach to guide them to the right sources to make their decision. “No one is safe until everyone is safe” has become the mantra of the COVID-19 pandemic, with good reason.

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Seema Marwaha


Seema Marwaha is a general internal medicine physician, educator, researcher and journalist in Toronto.

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