Top 5 Takeaways

  1. Decline in Vaccination Intent and Confidence Over 3 Months: Parental intent to vaccinate children under 5 against COVID-19 and confidence in vaccine safety and effectiveness decreased within 3 months of the study.
  2. Return to Baseline Intent After 6 Months: Although there was a decline in vaccination intent and confidence initially, these returned to baseline levels after 6 months.
  3. Statistical Significance of Findings: The changes in parental intent and perception were statistically significant. However, after adjusting for various factors like the child’s SARS-CoV-2 infection status, these changes were not significant.
  4. Higher Initial Intent Compared to National Rates: The study revealed a higher initial intent to vaccinate among parents in the cohort compared to earlier surveys and national rates.
  5. Need for Enhanced Efforts: The study underscores the need for enhanced efforts to build parental confidence and increase vaccination coverage among children under 5.

Original Article Author and Citation

Corresponding Author

Karen Lutrick,

Suggested Citation

Lutrick K, Fowlkes A, Rivers P, et al. Parental Intentions and Perceptions Toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years — PROTECT Cohort, Four States, July 2021–May 2022. MMWR Morb Mortal Wkly Rep 2022;71:1109–1114. DOI:


The study examined changes in parental perceptions towards COVID-19 vaccines for children aged under 5 years, from July 2021 to May 2022, in a longitudinal cohort of 393 children in four states. The study observed a decline in parental intent to vaccinate and in their perception of vaccine safety and effectiveness over a 3-month period. However, after 6 months, the intent to vaccinate and perceptions of vaccine safety returned to baseline levels.


Participants were surveyed every 3 months as part of the PROTECT study. The study utilized a generalized estimating equation model to evaluate changes in parental responses regarding vaccine intention and perceptions. Both unadjusted and adjusted models were analyzed, including factors like the child’s SARS-CoV-2 infection status, demographics, and study site.


The study suggests that parents initially had a high intent to vaccinate their children, but this declined over time, potentially due to factors like pandemic-related events and news about vaccine effectiveness in older children. The recovery of intent and perception of safety to baseline levels after 6 months highlights the dynamic nature of parental decision-making regarding vaccination.


This longitudinal study emphasizes the importance of addressing parental barriers and building confidence in COVID-19 vaccination for children aged under 5 years. It underscores the need for public health efforts to educate parents about the vaccine’s effectiveness and safety in young children.

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