Protecting vulnerable children: parental drivers of COVID-19 vaccine uptake in children with pediatric cancers

Children with pediatric cancers are especially vulnerable to COVID-19, yet vaccination rates among this population have remained suboptimal. Understanding what shapes parental decision-making about vaccinating their immunocompromised children is critical for improving uptake. We examined the extent to which COVID-19 vaccine uptake among children with cancer is predicted by demographic characteristics, general vaccine hesitancy, and specific Health Belief Model (HBM) constructs. In early 2022, 125 parents of children with pediatric cancers in active treatment completed a survey. Measures included demographics, the Parent Attitudes about Childhood Vaccines scale, and COVID-19 specific HBM constructs. Hierarchical logistic regression identified predictors of vaccine uptake. 51.2% of children had received at least one COVID-19 vaccine dose. Mothers were less likely than fathers to have vaccinated their child. Contrary to expectations, general vaccine hesitancy did not predict uptake. However, HBM constructs higher perceived benefits, greater perceived severity of COVID-19, and greater self-efficacy were linked with increased COVID-19 vaccine uptake. Parental decisions to vaccinate their children with cancer were best explained by COVID-19 vaccine-specific beliefs, not general vaccine hesitancy. Interventions as well as future pandemic preparedness plans should emphasize vaccine benefits and disease severity, with pediatric oncology health care providers playing a key role in communication.