The Impact of the COVID-19 Pandemic on Influenza Vaccination Coverage Among Young U.S. Children: A Socioeconomic Analysis

Abstract

The COVID-19 pandemic disrupted healthcare delivery across the United States (U.S.), including childhood vaccine administration. This study analyzed data from the National Health Interview Survey (NHIS), a nationally representative survey of the U.S. population, assessing trends and predictors of influenza vaccination uptake among children ≤ 5 years before and amid the COVID-19 pandemic. Influenza vaccination coverage declined significantly, from 56% in 2019 to 46% in 2022 (p < 0.001). Age-specific declines were notable, with rates dropping among one-year-olds from 68% to 53%, two-year-olds from 63% to 49%, and infants from 31% to 24% (p < 0.001). Logistic regression revealed African American children had lower odds of vaccination compared to non-Hispanic White children (OR = 0.70, p < 0.001), while Asian children had higher odds (OR = 1.32, p = 0.018). Uninsured children were less likely to be vaccinated than insured children (OR = 0.71, p = 0.022). Regional analysis showed the Northeast had the highest vaccination rates (60% in 2019, 56% in 2022), while the South had the lowest (52% in 2019, 41% in 2022). These findings underscore the need for targeted strategies to address socioeconomic disparities and improve influenza vaccine uptake in young children in the U.S.

Keywords: COVID-19 pandemic; children; influenza vaccination; public health strategies; socioeconomic disparities.

Figure 1.

Influenza vaccination rates by educational attainment. Associations between the level of parental educational attainment and mean rates of influenza vaccination in children 5 years of age or less. Notably, parents with doctoral degrees had children with the highest mean vaccination rates, significantly outpacing those with lower educational levels. The mean vaccination rates appear to increase progressively with higher education levels, implying that educational attainment is likely a key determinant in health behavior related to the influenza vaccine. Statistical Values: The graph suggests that the mean vaccination rate for individuals with a Doctoral degree is approximately 0.8, indicating that, on average, 80% of individuals in this category received an influenza vaccine. In contrast, those who completed less than the 12th grade of high school (Grades 1–11) have a mean vaccination rate closer to 0.4, suggesting that around 40% in this group were vaccinated. These values demonstrate a doubling in vaccination rates between the lowest and highest education levels depicted.

Figure 2.

Influenza vaccination rates by parental education level and region (2019 vs. 2022). Influenza vaccination rates (%) among children aged ≤ 5 years across U.S. regions in 2019 and 2022, stratified by parental education level. Bars represent vaccination rates for children whose parents had either a bachelor’s degree or higher (blue and orange bars) or less than a bachelor’s degree (green and red bars). The Northeast consistently had the highest vaccination rates, while the South demonstrated the lowest rates. A significant decline in vaccination coverage was observed across most regions and education levels from 2019 to 2022.