Publication Date



Social Policy Institute, Washington University in St. Louis


Objective: Rates of child vaccinations declined during the COVID pandemic, which increases the risk of outbreaks of preventable diseases among children. Methods: We conducted an online survey of parents of Medicaid beneficiaries age 0-5 years old in Florida USA during January 2021 to assess barriers and strategies to increase adherence to childhood vaccinations.

Results: We surveyed 1,951 parents. Most (91%) respondents reported their child was up-to-date with childhood vaccinations, but fewer (36%) children had received a flu shot. Some (31%) parents had wanted to take their child to see a doctor but decided not to, and 22% were not comfortable with in-office visits. Not taking their child to a doctor despite wanting to was associated with lower odds of that child being up-to-date and greater odds of being uncomfortable with in-office visits. Predictors of vaccine adherence included beliefs in their safety, efficacy and being easy to get. Promising strategies for getting parents to vaccinate their children during the pandemic include advertising COVID-compliant cleaning and masking policies, reinforcing parents’ perceived importance and ease of vaccination, and reserving vaccination appointment times for healthy children.

Conclusions: Results inform future messaging and structural interventions to encourage parents to vaccinate their children, which also may be useful for encouraging vaccinations recommended for older adolescents including COVID-19 vaccinations. This study demonstrates the importance of vaccination surveillance and identifying which interventions may appeal to parents in order to maintain high adherence rates and avoid outbreaks of preventable diseases in children.

Document Type

Working Paper



immunization, prevention, public health, behavior, adherence