Over a third vaccinated-but-unboosted adults have reservations about vaccinating children

Reviewed by Emily Henderson, B.Sc.Mar 3 2022

While the vast majority of U.S. adults who are fully vaccinated and boosted against Covid-19 would be likely to recommend vaccinating a 5- to 11-year-old, over a third of fully vaccinated adults who have not had a booster shot have reservations about Covid-19 vaccination for a child that age, according to survey data analysis by the Annenberg Public Policy Center (APPC) of the University of Pennsylvania.

APPC's analysis of January survey data from its Annenberg Science Knowledge (ASK) national probability-based panel finds that 93% of U.S. adults who are vaccinated and boosted say they would be somewhat or very likely to recommend vaccinating a 5- to 11-year-old child if there were one in their household. But among vaccinated but not boosted adults, the percentage who would be likely to have such a child vaccinated against Covid-19 drops significantly, to 63%.

Adults who are vaccinated but unboosted are much more likely to believe misinformation about vaccination safety (for instance, that vaccines contain toxins such as antifreeze) than those who are both vaccinated and boosted, the analysis finds. And the more that one accepts these misconceptions about vaccinations, the less likely one is to recommend vaccinating a 5- to 11-year-old, APPC researchers said.

Long-lived misconceptions about vaccination are causing some vaccinated but not boosted adults to express reservations about vaccinating 5- to 11-year-olds against Covid-19. As the public health community works to increase community vaccination levels, reaching these adults with corrective content delivered by trusted individuals should be a priority."

Kathleen Hall Jamieson, Director of the Annenberg Public Policy Center

Highlights

• Vaccinating 5- to 11-year-olds: Nearly two-thirds (66%) of U.S. adults say they would be likely to recommend vaccinating a hypothetical 5- to 11-year-old in their household who is eligible for the Covid-19 vaccine.
• Belief in vaccination misinformation: An analysis of survey respondents by the extent to which they believe vaccine misinformation shows that 39% of the vaccinated-but-not-boosted hold high levels of misinformation about the effects and safety of vaccines.
• Fears of long Covid: The APPC analysis finds a relationship between fears of long Covid and intentions to get vaccinated: The more that unvaccinated adults worry about getting long Covid, the more likely they are to say they will get vaccinated.
• The persuadables: About 40% of the unvaccinated – or 9% of the total survey sample – are potentially persuadable to be vaccinated, the analysis finds.

The survey

The survey data come from the fifth wave of the Annenberg Science Knowledge (ASK) survey, a nationally representative sample of U.S. adults empaneled by the Annenberg Public Policy Center in April 2021 to track attitudes and behavior in the pandemic. APPC first began tracking beliefs about the novel coronavirus and vaccination with cross-sectional surveys in March 2020.

This survey was conducted January 11-17, 2022, among a national probability sample of 1,656 U.S. adults. The data were weighted to represent the target U.S. adult population. The margin of error for the full sample is ± 3.3 percentage points at the 95% confidence level. The panel survey, conducted for APPC by independent research firm SSRS, is a follow-up to waves in November 2021, September 2021, June 2021 and April 2021 with the same respondents.

Some data from this wave were released in January, including the findings that confidence in the Centers for Disease Control and Prevention (CDC) fell to 72% in January from 77% in November and that confidence in Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, eroded over nine months to 65% in January from 71% in April 2021.

Vaccinating children ages 5 to 11

In October 2021, the Food and Drug Administration (FDA) authorized the emergency use of the Pfizer-BioNTech Covid-19 vaccine for 5- to 11-year-olds. To date, about 26% of children 5 to 11 have received a vaccination, according to the CDC.

APPC's January survey asked respondents about vaccinating 5- to 11-year-old children. Two-thirds of those surveyed (66%) indicated that if a child between the ages of 5 and 11 in their household were eligible to get the FDA-authorized Covid vaccine, they would be somewhat or very likely to recommend that that child get vaccinated, while one-third (33%) reported it was not at all/not too likely.

When analyzed by their vaccination status, the vast majority (93%) of those who are fully vaccinated and boosted said they would be very or somewhat likely to recommend that such a 5- to 11-year-old get vaccinated with the Covid-19 vaccine (with 78% very likely). Of those who are fully vaccinated but not boosted, 63% would be likely to recommend it (with 37% very likely). Only 15% of those who are not vaccinated would be likely to recommend this.

People who are fully vaccinated against Covid-19 in this analysis have had two doses of the Pfizer-BioNTech or Moderna vaccines or one dose of the Johnson & Johnson vaccine.

Vaccination fears and background knowledge

To evaluate the influence of vaccination misinformation, APPC researchers selected four items asked in wave 1 of the survey (April 2021) that reflected consequential, baseline background vaccination misinformation. The first focused on the bogus MMR vaccine-autism link; the second on the false assumption that an increase in the number of childhood vaccinations explains the increase in the number of autism diagnoses; the third on the effects of the flu vaccine, and the fourth on the content of vaccines.

The items: 1) Vaccines given to children for diseases like measles, mumps, and rubella do not cause autism (True); 2) Increased vaccinations are why so many kids have autism these days (False); 3) Getting a flu shot increases your risk of contracting Covid-19 (False); and 4) Vaccines in general are full of toxins and harmful ingredients like "antifreeze" (False).

The respondents who embraced the misinformation in these items were much less likely to report that they had been vaccinated over the next two waves of the survey, in June and September.

The APPC researchers then conducted an analysis to see whether these same inaccurate beliefs would predict individuals' decisions whether to recommend vaccinating a 5- to 11-year-old child if there were one in their household. The APPC researchers created a vaccination misinformation index and divided the survey sample in thirds by levels of belief in these misinformation items – high, medium, and low.

They found that a high level of belief in these statements that vaccinations are harmful is significantly associated with a lower likelihood to recommend the Covid-19 vaccine for those ages 5 to 11. Among those who are:

• Unvaccinated or had received just one shot of a two-shot vaccine: 73% are in the high misinformation group, 21% medium, and 6% low.
• Fully vaccinated but unboosted: 39% are in the high misinformation group, 39% medium, and 22% low.
• Vaccinated and boosted: 14% are in the high misinformation group, 36% medium, and 50% low.

"As parents consider whether to vaccinate their children and to adopt the CDC-recommended vaccination schedule, public health authorities need to continue to provide them and the public with general background knowledge about vaccination," Jamieson said. "Such parental decisions have long-term consequences for the well-being of these children as they move into adolescence and adulthood. These new data support the conclusion reached in our earlier work: background knowledge about vaccination matters."

(For a definition of background knowledge and evidence of its effects, see The role of non-COVID-specific and COVID-specific factors in predicting a willingness to vaccinate: A panel study, in Proceedings of the National Academy of Sciences.)

A closer look at vaccination misinformation

Looking at responses to the four misinformation items in our index, a worrisome number of respondents are not certain whether they are true or false:

• 46% of respondents know it is true that vaccines given to children for diseases like measles, mumps, and rubella do not cause autism, while 23% think it is probably true and 18% are not sure.
• 58% know it is false to say that getting a flu shot increases your risk of contracting Covid-19, while 25% say it is probably false and 13% are not sure.
• 64% know it is false to say that vaccines in general are full of toxins and harmful ingredients like antifreeze, while 17% say it is probably false and 13% are not sure.
• 54% know it is false to say that increased vaccinations are why so many kids have autism these days, while 22% say it is probably false and 15% are not sure.

"Those who are unsure are susceptible to persuasion," Jamieson noted. "A finding that 15% of the adult population is misinformed on an item translates into nearly 39 million people."

Public paying attention to health guidance

The survey found that much of the public is following health guidance from authorities:

• Booster shots are rising: 65% of those who say they are fully vaccinated against Covid-19 report having received a booster shot, up significantly from 25% in November 2021. Of those who are vaccinated but unboosted, 68% say they are likely to get a booster.
• However, the number who report having received two shots is plateauing: In January, 74% said they were fully vaccinated against Covid-19, significantly higher than 66% in June 2021 but statistically unchanged in recent months. In January, 3% reported that they were partially vaccinated and 23% indicated that they were unvaccinated.
• Although mask guidance by the CDC changed Feb. 25, our January data show that most reported wearing face masks indoors when with people who were not part of their household: 72% said in January that they sometimes/often/always wear a mask or face covering indoors, up from 66% in November. Those who said they always wear one was up to 24% in January from 18% in November. In late February the CDC revised its recommendations, and CDC director Dr. Rochelle Walensky noted that "with widespread population immunity, the overall risk of severe disease is now generally lower."

The persuadables

As mentioned earlier, the survey finds that 23% are not vaccinated, comprising two groups: 14% say they are unlikely to be vaccinated and that there is nothing that will change their minds. But 9%, or over 23 million adults who are 18 and older, are potentially persuadable – they either say they are likely to be vaccinated in the future, or, if they're resistant to getting vaccinated, are not firmly opposed to changing their minds.

The 9% consists of:

• 4% who say they are not vaccinated but may get vaccinated, when asked if they would be likely to be vaccinated in the future.
• 1% who say they are unlikely to get vaccinated in the future but say there is something that could change their mind to convince them.
• 4% who say they are unlikely to get vaccinated in the future but who say they are unsure if there is something that could change their minds.

Fear of long Covid

Estimates vary widely on the percentage of people infected with Covid-19 who may develop long Covid, the common name for symptoms such as fatigue and neurological problems that occur weeks or months after infection with the coronavirus. One U.K. study gives a range of 3.0% to 11.7% for long Covid symptoms at 12 weeks after infection, while another found that 37% of Covid-19 survivors had one or more long Covid features three to six months after infection. A consistent finding across studies is that patients who became severely ill with Covid-19 are more likely to develop long Covid symptoms.

In the January survey, 25% of respondents said they thought that half or more of the people infected with Covid will get long Covid, down from 30% who responded that way in November. Three-quarters of respondents said none/some of those infected will have long Covid.

A quarter of respondents (24%) said they knew of someone who experienced long Covid, and nearly half of respondents (47%) indicated being somewhat (34%) or very (13%) worried that if they get Covid-19 they will experience long Covid.

Among the unvaccinated (those who have not had a single dose of the Covid-19 vaccine), our analysis found, there is a significant positive association between being worried about getting long Covid and a reported likelihood of getting vaccinated, after controlling for party, ideology, race, gender, and education. The more worried people are, the more likely they are to say they are somewhat or very likely to take the vaccine.

"Long Covid is a real and worrisome potential consequence of being infected with Covid-19," Jamieson said. "Trusted health communicators may be able to motivate vaccination by coupling credible information about the real threat of long Covid with emerging evidence that vaccination may reduce the chance of developing it, in addition to protecting against severe disease and death."

The analyses in this news release were conducted by APPC's research director, Dan Romer, Ph.D., and managing director of survey research, Ken Winneg, Ph.D.