Hesitancy towards routine childhood vaccinations before and after the COVID-19 pandemic in Arkansas

Prior to the COVID-19 pandemic, vaccine-preventable diseases increased nationally, associated with low childhood vaccination coverage. Studies on parental vaccine hesitancy in southern U.S. states is limited, and childhood vaccine uptake has decreased since early 2020. Our study purpose was to examine parental vaccine hesitancy before and after the COVID-19 pandemic among Arkansas residents.

A repeated cross-sectional design using telephone surveys was conducted among Arkansas parental guardians of children aged ≤6 years in 2019 (n = 407) and 2023 (n = 402). Parental hesitancy towards routine childhood vaccines and vaccine confidence was assessed. Weighted multiple logistic regression models examined associations between sociodemographic factors and parental hesitancy.

Parental hesitancy increased 15-percentage points from 2019 to 2023 (35.7 % [38.6% - 43.0 %] to 50.3 % [40.7 % - 60.0 %]), while those expressing no hesitancy declined (64.3 % [56.7 % - 71.0 %] to 49.7 % [40.2 % - 59.0 %]). The association between parental age and vaccine hesitancy differed by region, with older parents in the Southwest region (and similarly in the Northeast and Northwest) showing greater hesitancy compared to those in the Central region (OR 1.21 [1.07-1.35]). Compared to parents of public-school children, those with privately schooled (OR 2.60 [1.22-5.51]) or homeschooled children (OR 2.65 [1.24-5.67]) had higher odds of hesitancy.

Despite low annual response rates, findings suggest an increase in parental vaccine hesitancy following the COVID-19 pandemic in Arkansas. Vaccine hesitancy remains a concern in our largely rural population. Repeat analyses with similar survey tools is needed to understand if these trends are maintained in the Arkansas population or similar southern rural populations.