Vaccine Attitudes and COVID-19 Vaccine Intention Among Parents of Children With Kidney Disease or Primary Hypertension

Abstract

Rationale & objective: Children with kidney disease and primary hypertension may be more vulnerable to COVID-19. We examined COVID-19 vaccine hesitancy among parents of children with chronic kidney disease or hypertension.

Study design: Sequential explanatory mixed-methods design; survey followed by in-depth interviews.

Setting & participants: Parents of children aged <18 years with kidney disease or primary hypertension within a large pediatric practice.

Exposure: Parental attitudes toward general childhood and influenza vaccines assessed by the Vaccine Hesitancy Scale. Kidney disease classification, demographic and socioeconomic factors, experiences with COVID-19, COVID-19 mitigation activities and self-efficacy, and sources of vaccine information.

Outcome: Willingness to vaccinate child against COVID-19.

Analytical approach: Analysis of variance (ANOVA) test to compare parental attitudes toward general childhood and influenza vaccination with attitudes toward COVID-19 vaccination. Multinomial logistic regression to assess predictors of willingness to vaccinate against COVID-19. Thematic analysis of interview data to characterize influences on parental attitudes.

Results: Of the participants, 207 parents completed the survey (39% of approached): 75 (36%) were willing, 80 (39%) unsure, and 52 (25%) unwilling to vaccinate their child against COVID-19. Hesitancy toward general childhood and influenza vaccines was highest among the unwilling group (P < 0.001). More highly educated parents more likely to be willing to vaccinate their children, while Black race was associated with being more likely to be unwilling. Rushed COVID-19 vaccine development as well as fear of serious and unknown long-term side effects were themes that differed across the parental groups that were willing, unsure, or unwilling to vaccinate their children. Although doctors and health care teams are trusted sources of vaccine information, perceptions of benefit versus harm and experiences with doctors differed among these 3 groups. The need for additional information on COVID-19 vaccines was greatest among those unwilling or unsure about vaccinating.

Limitations: Generalizability may be limited.

Conclusions: Two-thirds of parents of children with kidney disease or hypertension were unsure or unwilling to vaccinate their child against COVID-19. Higher hesitancy toward routine childhood and influenza vaccination was associated with hesitancy toward COVID-19 vaccines. Enhanced communication of vaccine information relevant to kidney patients in an accessible manner should be examined as a means to reduce vaccine hesitancy.

Plain-language summary: Children with kidney disease or hypertension may do worse with COVID-19. As there are now effective vaccines to protect children from COVID-19, we wanted to find out what parents think about COVID-19 vaccines and what influences their attitudes. We surveyed and then interviewed parents of children who had received a kidney transplant, were receiving maintenance dialysis, had chronic kidney disease, or had hypertension. We found that two-thirds of parents were hesitant to vaccinate their children. Their reasons varied, but the key issues included the need for information pertinent to their child and a consistent message from doctors and other health care providers. These findings may inform an effective vaccine campaign to protect children with kidney disease and hypertension.

Keywords: COVID-19 vaccine hesitancy; Child; coronavirus disease 2019 (COVID-19); glomerular diseases; hypertension; immunization; influenza vaccines; kidney diseases; qualitative research; vaccination; vaccination hesitancy.

Graphical abstract

Figure 1

Survey participants on COVID-19 vaccine attitudes for children and adolescents with kidney disease or primary hypertension. ^aKidney disease due to congenital anomalies of kidney and urinary tract, glomerular disease, cystic/hereditary/congenital disease (C/H/C), or others not include those on dialysis or with a kidney transplant. Abbreviation: CKD, chronic kidney disease.

Figure 2

Responses to the Vaccine Hesitancy Scale, including questions on general childhood and influenza vaccines, of parents of children with kidney disease or primary hypertension.

Figure 3

Interview participants on COVID-19 vaccine attitudes for children and adolescents with kidney disease or primary hypertension. ^aKidney disease due to congenital anomalies of kidney and urinary tract, glomerular disease, cystic/hereditary/congenital disease (C/H/C), or others not include those on dialysis or with a kidney transplant. Abbreviation: CKD, chronic kidney disease.