Fear of the unknown: Parents want information and transparency when deciding to vaccinate their children

“For kids, I need the proof of success.” – Anonymous parent

Decisions to vaccinate children against COVID-19 weigh heavily on parents, especially given the evolving picture. As health-system planners seek ways of improving vaccine uptake among those five to 11 years old, it is critical to consider a broad range of perspectives to effectively support parents as they navigate the process.

Through interviews and focus groups held last fall with parents of children five to 11 years old, Health Commons Solutions Lab learned about how their experiences are shaping motivations, beliefs and questions and what resources must be available to support their needs. More than 60 parents and community ambassadors attended a series of focus groups in some of the Toronto communities most impacted by COVID-19, including individuals from Black, African, Caribbean, Arab, Hispanic, Caucasian, Indian and South Indian families.

The purpose was to identify enablers and barriers to equitable access to children’s vaccination in these communities and build on the community-driven responses led by organizations in the hardest-hit neighbourhoods. These communities have experienced the highest case rates, attributed mainly to the socio-economic conditions that made social distancing difficult and working from home impossible in many instances.

The vast majority of participants (80 per cent) reported that they chose to be vaccinated to protect their families and others, but that rationale did not extend to their children for several reasons: they did not receive information or social proof showing their own vaccines helped them; continued conflicting information on children’s needs for vaccination; and weighing benefits and risks in children is more challenging because of their lower risk of severe disease.

More than half of participants said their children bore the brunt of policy decisions, such as school closures, that impacted their communities more than others.

Many said they felt vaccinating children under 12 was exposing them to yet another set of unknowns and are seeking answers to questions about balancing the risks of long COVID against questions on the longer-term impacts of the vaccine. While health experts can provide some explanations, they described the availability of information in a timely, clear format and the opportunity for follow-up questions as limited. They also wanted reassurances that every precaution to limit the risks of exposure are also being pursued.

Here are some of the key findings from our focus groups:

Information and transparency 

• Parents want access to clear, concise information about the considerations, safety signals and implications of the vaccine for their children. This information should be updated regularly and presented in multiple formats.
• Information should be shared with their children through schools so that children can feel empowered as part of the decision-making process.
• Involving primary care in decision-making and vaccination delivery is a key support as parents indicated a high level of trust in physicians and primary care clinicians.
• Though consistency of messaging may be difficult given the evolving picture of variants, booster doses and treatments, this barrier can be addressed with a commitment to transparency. Taking parents’ questions seriously, and with significant amount of time and space to raise questions, is important. Parents strongly indicated that a realistic and honest portrayal of what is known and unknown will build trust.
• Techniques such as motivational interviewing that are focused on marshalling the individual’s own sense of agency and values in the decision-making process are an effective way of supporting parents.

Strategies to ensure access

• Parents said they want the vaccination process to be easier than it was in adult vaccination clinics. It is especially important that they are able to support and comfort their children through the process.
• The strategies that work to address barriers to access have been proven and well documented from previous vaccine rollouts (flexible hours, including evenings and weekends; hyperlocal clinics at familiar locations within walking distance; both appointment booking and walk-in options; interpretation and translation; community ambassadors welcoming people into the space, etc.).

Empowering decision-making

• Parents want to be supported in making a personalized plan for their children. Feeling like the choice is being taken away without weighing the risks makes them resentful.
• Parents are highly sensitized to the possibility of vaccination mandates and the harm they associate with these mandates. The possibility of mandates is causing a tremendous amount of distress. Many have questions about the impact of COVID-19 on their children’s health. Also, they do fear the possibility of their children losing out on social, extracurricular and developmental opportunities due to exclusion by mandate initiatives. Mandates for children were perceived as punitive and harmful and increased resentment toward governments as they affect parent’s sense of agency in decision-making.

As we roll out vaccines for children aged 5-11 in Ontario, it’s essential to incorporate the voices of communities disproportionately affected both by COVID and other long-standing barriers that determine health outcomes. Parents want to continue the dialogue about vaccination and keeping their children safe with every measure available. As we move forward during this uncertain time, health-system partners can play an important role in building trust not just in rolling out vaccines to children, but for the longer-term goals of partnering effectively with communities to improve health overall.