COVID-19 and Influenza Vaccine Acceptance and Hesitancy Among Caregivers of Children With Cancer

Children with cancer are immunocompromised and at increased risk for severe outcomes from infections such as COVID-19 and influenza. Vaccination is recommended, but caregiver perceptions in this high-risk group are not well characterized.

We conducted a cross-sectional survey of English- and Spanish-speaking caregivers of pediatric oncology patients at a large urban pediatric hospital between March and June 2022, during evolving COVID-19 vaccine authorization and recommendations for children. The survey assessed vaccine-related knowledge, attitudes, and hesitancy regarding COVID-19 and influenza. Responses were linked to the child's electronic health record. COVID-19 vaccine acceptance, defined as documented or caregiver-reported receipt, or intention to vaccinate if age-ineligible, was the primary outcome. Influenza vaccine acceptance was a secondary outcome. Associations were analyzed using multivariable logistic regression.

Of 442 eligible caregivers, 100 (23%) participated. COVID-19 vaccine acceptance was 71%, influenza acceptance was 82%, and 57% of caregivers were vaccine-hesitant. Vaccine hesitancy was negatively associated with COVID-19 vaccine acceptance. In contrast, perceived vaccine safety, efficacy, prior influenza vaccination, and concern about cancer during the pandemic were positively associated.

Caregiver attitudes significantly influenced vaccine acceptance. Interventions that strengthen provider communication, address safety and efficacy concerns, and acknowledge caregiver perceptions may help reduce hesitancy in this vulnerable population.