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Up Front

What we can learn from Israel’s COVID-19 vaccination of children

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A study conducted by the Social Policy Institute at Washington University in St. Louis shows that among surveyed parents in Israel, only 37 percent intended to vaccinate their child (aged 5-11) against COVID-19 when the option became available, while 23 percent of parents were undecided and 40 percent had no intention to vaccinate their children.

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Oren Heller

Postdoctoral Researcher - Social Policy Institute at Washington University in St. Louis

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Yaniv Shlomo

Senior Fellow - Social Policy Institute at Washington University in St. Louis

The study was conducted November 3-8, 2021, among a representative sample of Israeli parents of children aged 5-11 (N = 912).

Unlike COVID-19 vaccination among adults, where the uptake rate varies among population groups, intention to vaccinate children varies much less, from 34 percent among ultra-Orthodox (Haredi) and traditional Jews to 40 percent among secular Jews. (Figure 1).

Child age, however, appears to make a difference in parents’ decision on vaccination. As children’s age increases, parents are more likely to intend to vaccinate them. Accordingly, intention to vaccinate children rises from 30 percent for children aged 5 up to 46 percent for 11-year-old children. Child gender on the other hand, does not matter (Figure 1).

Figure 1. Parents’ intention to vaccinate their child against COVID-19

The findings also suggest that parents who oppose child vaccinations against COVID-19 do not oppose vaccinations on principle. Even among parents who are vaccinated themselves against COVID-19, the majority are either still undecided or not intending to vaccinate their children against COVID-19, as only 42 percent of parents claim that they intend to vaccinate their children. Furthermore, previous vaccination of a child is also not an indicator of intention to vaccinate them against COVID-19; only 40 percent of parents who gave their children all their infant and toddler vaccinations on time intend to give them the COVID-19 vaccine as well (Figure 1).

That is, it seems that resistance to vaccinate children against COVID-19 does not exclusively stem from parent fear of child vaccinations, nor from deterrence from COVID-19 vaccines in general. Instead, the circumstance that deters parents is the combination of the two: COVID-19 vaccines in children. The aforementioned unwillingness to vaccinate younger children illustrates that the fear of COVID-19 vaccines for children is related to their young age.

What deters parents from the child COVID-19 vaccine?

In a previous study we found that the perception of lack of transparency about vaccines from the government deterred Israeli adults from getting vaccinated. Out of a desire to encourage children’s vaccination and because of the previous experience with adult vaccines, the Israeli Ministry of Health decided to increase transparency by opening one of its discussions on COVID-19 child vaccination to the public on November 4, 2021.

Our study finds that indeed this measure positively influenced parents to vaccinate their children. Nevertheless, it seems that one instance of transparency is not enough to achieve a significant effect, indicating that more effort in this direction is needed. Our findings suggest a modest impact, as 37 percent of undecided parents report that this measure encouraged them to vaccinate their children, compared to only 7 percent of parents who do not intend to vaccinate them.

According to our study, transparency is a focal issue for parents, as approximately half of them feel that it lacks in many aspects: 45 percent of parents feel there is not enough transparency on vaccine side effects, 59 percent of them feel the state’s agreement with Pfizer lacked transparency, and 55 percent feel that there is not enough transparency in the government’s decisionmaking process (Figure 2).

These perceptions made the difference in parents’ willingness to vaccinate their children: Parents who felt there’s enough transparency were approximately three times more likely to intend to vaccinate their children compared to those who felt that there is not enough transparency (Figure 2). Furthermore, parents claim that once they feel that there’s full transparency, they will vaccinate their children at higher rates. Among those who do not intend to vaccinate, 50 percent report that pro-transparency measures will encourage them to vaccinate their children, and, among undecided parents, up to 90 percent claim that they would be encouraged by these measures.

Figure 2. The association of parents’ intention to vaccinate their children with their perceptions of transparency

It seems that the Israeli government’s decision to open its discussion to the public was a move in the right direction. Scaling up the increased transparency through open governmental meetings has the potential to double vaccination takeup among children.

Why does Israel’s vaccine hesitancy matter to the US?

Since Israel was one of the first countries in the world to vaccinate its population, its pandemic experience has become a test case for the other countries to learn from. Israeli vaccination rate declines created by vaccine hesitancy have been early warning signals to other countries that having a sufficient supply of COVID-19 vaccines is just the first barrier to vaccine uptake.

Although child vaccination against COVID-19 started in Israel very recently (on November 22, 2021) and a few weeks after the U.S., uptake rates in the U.S. and Israel are quite similar, as two-thirds of American parents of children aged 5 to 11 are either reluctant or adamantly opposed to children’s vaccination against COVID-19. That is, the need for the authorities to increase the proportion of vaccinated children is common to both countries. Moreover, the public’s wish for more transparency, and the significant effect better transparency can have on COVID-19 vaccine uptake, is also common to more nations including the U.S.

In conclusion, the Israeli experience brings unequivocal findings that can be used by governments around the globe, suggesting that efforts to improve transparency and convey information to the public are an effective policy measure that encourages COVID-19 vaccinations. Our findings also show that while this is true for vaccinations of adults and adolescents, it is twice as true for vaccinations of children whose parents’ protectiveness increases hesitation. Increasing transparency is the most effective way to address vaccine hesitation among parents.

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