Shifting perspectives on vaccination: COVID-19 vaccine hesitancy and impacts on childhood immunizations

Abstract

The COVID-19 pandemic disrupted vaccine delivery, public trust in vaccines, and long-standing immunization norms, raising concerns about sustained declines in vaccine uptake. These disruptions occurred alongside increased skepticism towards public health institutions and politicization of vaccine discourse, creating conditions in which hesitancy toward the COVID-19 vaccine may have extended to other immunizations. This dissertation examined the individual, familial, and community-level impacts of the pandemic on vaccine intentions and behaviors, focusing on adult COVID-19 booster acceptance, caregiver-child vaccine decision-making, and trends in routine childhood vaccination coverage. Manuscript 1 presents findings from a cross-sectional survey conducted at the 2023 Minnesota State Fair to identify predictors of intention to receive the updated 2023–2024 COVID-19 vaccine. Perceived vaccine safety emerged as the strongest predictor of intention, with associations also observed for COVID-19 risk perception, public health knowledge, and political affiliation. Manuscript 2 analyzed data from families in the Environmental influences on Child Health Outcomes (ECHO) Cohort to examine caregiver-child alignment in COVID-19 vaccine hesitancy. Caregiver vaccination status was strongly associated with child vaccination status. The reasons for hesitancy, particularly regarding safety, trust in healthcare providers, and vaccine testing, were highly concordant across the reasons caregivers reported for themselves and the reasons they reported for their children. COVID-19 vaccine hesitancy among caregivers for themselves and their children was also associated with intentional delay or refusal of routine childhood vaccinations. Manuscript 3 evaluated changes in routine childhood vaccination rates in Minnesota from 2015 to 2023 using county-level data and examined whether there was an impact of political composition and COVID-19 vaccination coverage on changes in vaccination rates. Results indicated significant and sustained declines in vaccine coverage following the onset of the pandemic. Counties with a higher Republican vote share exhibited lower vaccination rates when combined with low COVID-19 vaccine uptake, suggesting a politicized spillover effect of COVID-19 vaccine skepticism on routine immunizations. Together, these studies demonstrate the enduring impact of the COVID-19 pandemic on vaccine attitudes and behaviors, particularly for childhood vaccinations. The findings underscore the influence of vaccine safety perceptions, institutional trust, and sociopolitical context on vaccine uptake, providing essential insights to guide public health efforts to rebuild trust and address low vaccination coverage in a post-pandemic public health landscape.