Changes in attitudes and beliefs about childhood vaccination among parents in the United States: A repeat cross-sectional survey before and after the COVID-19 pandemic

BACKGROUND: Parental vaccine hesitancy and refusal worsened during the COVID-19 public health emergency, but little is known about parental attitudes toward vaccines in the post-emergency era. METHODS: Two internet-based cross-sectional surveys were conducted among parents of children aged <18 years in the United States (US) during the COVID-19 public health emergency (Survey 1; January-March 2022) and after the emergency ended (Survey 2; December 2023-March 2024). Participants were recruited from the National Health and Wellness Survey. Study participants completed a self-administered survey regarding access to vaccination services, the impact of COVID-19 on vaccination, beliefs about the value and safety of childhood vaccinations, vaccine information seeking, and vaccination practices. RESULTS: The sample size was 668 for Survey 1 and 676 for Survey 2; in both surveys, 57.2% of respondents were men. Survey 2 respondents were more concerned than Survey 1 respondents about serious vaccine side effects (mean 5-point scale, with 1 being very concerned and 5 being not at all concerned. Survey 2 vs 1: 2.55 vs 2.69; p = 0.0345) and childhood shots not being safe (Survey 2 vs 1: 2.62 vs 2.84; p = 0.0012). A higher proportion of Survey 2 than Survey 1 participants considered themselves to be "somewhat or very hesitant about childhood vaccines" (Survey 2 vs 1: 41.0% vs 33.8%; p = 0.0127). Compared with Survey 1 respondents, Survey 2 respondents were less supportive of vaccination requirements for school attendance (mean of 5-point scale, with 1 strongly disagreeing and 5 strongly agreeing. Survey 2 vs 1: 3.76 vs 3.93; p = 0.0082) and more supportive of vaccination exemptions for religious reasons (Survey 2 vs 1: 3.61 vs 3.43, p = 0.0115). Vaccine information seeking was significantly more common in Survey 2 than in Survey 1 for most information sources. CONCLUSIONS: Among US parents, hesitancy and refusal regarding childhood vaccination were more common in the post-COVID-19 emergency period than during COVID-19. Urgent action is needed to address growing parental distrust in routine childhood vaccinations.