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California passed Senate Bill 277 in 2015, eliminating nonmedical exemptions to school immunization requirements. California elementary school personnel who worked with parents on meeting school immunization requirements were surveyed in 2022. Of the 122 survey respondents, half (50 %) were school principals, 11 % were registrars, 9 % were health clerks, and 7 % were nurses. Only one-quarter (26 %) believed their school had authority to deny medical exemptions. Almost half supported COVID-19 vaccine mandates for children in elementary (43 %), middle (44 %), and high (49 %) schools. Almost half (42 %) were concerned that children's immune systems could be weakened by too many shots, and nearly one-third thought immunizations do more harm than good (32 %). Among our sample of California schools, many personnel working with parents on meeting immunization requirements were not clinically trained, were unaware of their responsibility to deny invalid medical exemptions, and had vaccine concerns. Vaccine education for school personnel and further involvement of school nurses in the implementation and enforcement of school immunization requirements could have a positive impact on vaccine coverage and disease prevention., Competing Interests: Declaration of competing interest Matthew Dudley has received research support from Merck. Daniel Salmon has received research support from Merck and serves on advisory boards for Merck, Janssen, Sanofi and Moderna. Matthew Dudley and Daniel Salmon have received funding from the Vaccination Confidence Fund, which is jointly funded by Facebook and Merck. Alexander Zapf received support from Merck and Johnson and Johnson. Holly Schuh served as a (paid) health advisor to the University of Roehampton that provided guidance on recovery-building and future pandemic preparedness (including views on vaccines/vaccination) and understanding citizen engagement in the G7 in 2021–22 (during the presented study). Nicola Klein has received research support from Pfizer Sanofi Pasteur, Merck, GSK, Seqirus and CDC and is a member of the International Vaccine Institute Expert Panel on Hecolin. Saad Omer has received funding from the Bill and Melinda Gates Foundation, NIH, PATH, NIAID, UNICEF, and CDC and serves on the Gavi Vaccine Alliance Board and the Board of Trustees for the Sabin Vaccine Institute. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Ltd.)

Objectives: To compare vaccine-related attitudes and values of parents of children 2-17 years old to other adults, examine intentions to vaccinate their children, and identify factors associated with intending to vaccinate children., Methods: A nationally representative survey was conducted in September 2021 (just before the EUA for children 5-11 years old) using Ipsos KnowledgePanel, a probability-based web panel. The survey measured COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities among US adults. Scale response options to survey items were dichotomized, and cross-tabulations and logistic regressions were performed., Results: Parents had lower odds of reporting being vaccinated against COVID-19 than other adults even after adjusting for associated sociodemographic characteristics such as age (aOR: 0.66; 95 %CI: 0.50-0.87). The most prevalent parental concerns about COVID-19 vaccines included the speed of their development (88 %), potential side effects (78 %), suspicion of government (77 %), and suspicion of pharmaceutical companies (72 %). Fewer than half (42 %) of parents intended to vaccinate their children 5-11 years old, while 38 % were uncertain and 20 % were unlikely to ever vaccinate their children. Vaccinated parents had higher odds than unvaccinated parents of intending to vaccinate their children (OR: 675.51; 95 %CI: 106.46-4286.12). Discussions with healthcare providers who encouraged COVID-19 vaccination were positively associated with intent to vaccinate children (OR: 11.29; 95 %CI: 2.60-49.02)., Conclusions: We found parental vaccination and conversations with providers were positively associated with intent to vaccinate children. Decisions about childhood vaccination need to be supported by healthcare providers and a public health system that makes vaccine access and related information equitable and accessible. Vaccination-related decision making should be guided by healthcare providers and provide information about safety and risk to children., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Matthew Dudley has received research support from Merck. Daniel Salmon has received research support from Merck and serves on advisory boards for Merck, Janssen, Sanofi and Moderna. Matthew Dudley, Daniel Salmon, and Rajiv Rimal have received funding from the Vaccination Confidence Fund, which is jointly funded by Facebook and Merck. Jennifer Gerber has received support from RTI International. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Vaccine hesitancy is a global health threat undermining control of many vaccine-preventable diseases. Patient-level education has largely been ineffective in reducing vaccine concerns and increasing vaccine uptake. We built and evaluated a personalized vaccine risk communication website called LetsTalkShots in English, Spanish and French (Canadian) for vaccines across the lifespan. LetsTalkShots tailors lived experiences, credible sources and informational animations to disseminate the right message from the right messenger to the right person, applying a broad range of behavioral theories., Methods: We used mixed-methods research to test our animation and some aspects of credible sources and personal narratives. We conducted 67 discussion groups ( n = 325 persons), stratified by race/ethnicity (African American, Hispanic, and White people) and population (e.g., parents, pregnant women, adolescents, younger adults, and older adults). Using a large Ipsos survey among English-speaking respondents ( n = 2,272), we tested animations aligned with vaccine concerns and specific to population (e.g., parents of children, parents of adolescents, younger adults, older adults)., Results: Discussion groups provided robust feedback specific to each animation as well as areas for improvements across animations. Most respondents indicated that the information presented was interesting (85.5%), clear (96.0%), helpful (87.0%), and trustworthy (82.2%)., Discussion: Tailored vaccine risk communication can assist decision makers as they consider vaccination for themselves, their families, and their communities. LetsTalkShots presents a model for personalized communication in other areas of medicine and public health., Competing Interests: DS has received research support from Merck and serves on advisory boards for Merck, Janssen Moderna, and Sanofi. MD has received research support from Merck. KT was employed by Bonnemaison. LB was employed by Bucci-Hepworth Health Services Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Salmon, Dudley, Brewer, Shaw, Schuh, Proveaux, Jamison, Forr, Goryn, Breiman, Orenstein, Kao, Josiah Willcock, Cantu, Decea, Mowson, Tsubata, Bucci, Lawler, Watkins, Moore, Fugett, Fugal, Tovar, Gay, Cary, Vann, Smith, Kan, Mankel, Beekun, Smith, Adams, Harvey and Orton.)

Limited studies are available on how decisions and perceptions on SARS-CoV-2 vaccination have changed since the start of vaccination availability. We performed a qualitative study to identify factors critical to SARS-CoV-2 vaccination decision making and how perspectives evolved among African American/Black, Native American, and Hispanic communities disproportionately affected by COVID-19 and social and economic disadvantage. We conducted 16 virtual meetings, with 232 participants in wave 1 meetings (December 2020) and with 206 returning participants in wave 2 meetings (January and February 2021). Wave 1 vaccine concerns in all communities included information needs, vaccine safety, and speed of vaccine development. Lack of trust in government and the pharmaceutical industry was influential, particularly among African American/Black and Native American participants. Participants showed more willingness to get vaccinated at wave 2 than at wave 1, indicating that many of their information needs had been addressed. Hesitancy remained greater among African American/Black and Native American participants than among Hispanic participants. Participants in all groups indicated that conversations tailored to their community and with those most trustworthy to them would be helpful. To overcome vaccine hesitancy, we propose a model of fully considered SARS-CoV-2 vaccine decision making, whereby public health departments supply information, align with community values and recognize lived experiences, offer support for decision making, and make vaccination easy and convenient.

In October 2021, Emergency Use Authorization of Coronavirus Disease 2019 (COVID-19) vaccines was granted for children aged 5-11. To ensure vaccine uptake in children upon approval, California will implement a state-wide executive order mandating COVID-19 vaccination for school children following full US FDA approval. This study uses survey data collected between November 6th, 2020 and December 14th, 2020 (n = 2091) to identify how sociodemographic characteristics and attitudes towards childhood vaccines among California parents were associated with their intentions to vaccinate their child against COVID-19. About one quarter (26 %) of surveyed California parents did not intend to vaccinate their child, suggesting skepticism towards the COVID-19 vaccine for children and the potential for pushback to a COVID-19 vaccine school-entry mandate. However, 17 % were unsure of their decision, suggesting the potential for public health messaging to make a positive impact on COVID-19 vaccine confidence and uptake. This study identifies characteristics of hesitant parents in California to prioritize for research and outreach. These data also provide a baseline for parental attitudes towards vaccinating children against COVID-19 in California, which will be useful for characterizing changes in attitudes towards childhood COVID-19 vaccination over time., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nicola Klein reports financial support was provided by National Institutes of Health. Nicola Klein reports a relationship with Pfizer Inc that includes: funding grants. Nicola Klein reports a relationship with Merck Sharp & Dohme UK Ltd that includes: funding grants. Nicola Klein reports a relationship with GlaxoSmithKline USA that includes: funding grants. Nicola Klein reports a relationship with Sanofi Pasteur Inc that includes: funding grants. Nicola Klein reports a relationship with Protein Sciences Corp that includes: funding grants., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The Delta COVID-19 variant caused a resurgence in cases and deaths during the summer of 2021, particularly among the unvaccinated, highlighting the need to increase vaccine coverage. We describe a survey conducted in September 2021, in the midst of the Delta variant surge, after the FDA fully approved Pfizer-BioNTech’s vaccine for ages 16+ and issued an emergency use authorization for ages 12−15. Methods and Findings: US adults were surveyed to measure COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities. More than three-quarters (77%) reported receiving at least one dose of COVID-19 vaccination. Of the unvaccinated, 6% intended to vaccinate, 40% were unlikely to ever vaccinate, and 55% remained uncertain. Most of the unvaccinated were <45 years old (62%), without a bachelor’s degree (83%), earning less than $85,000 annually (74%), and Republican/Independent (66%). Concerns among the unvaccinated-yet-still-uncertain included the vaccines’ safety (86%), speed of development (86%), and suspicion of government (79%) and pharmaceutical companies (69%). Most (86%) of the unvaccinated reported they would not vaccinate if mandated by their employer. About one third (34%) of the unvaccinated reported facing at least one barrier to vaccination. Conclusion: More than half of unvaccinated adults remained uncertain about COVID-19 vaccination, indicating an opportunity to support their decision making. Public health must increase easy and equitable access to vaccination and renew efforts to provide unvaccinated populations access to information from trusted sources.

In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.

Senate Bill 277 (SB277) eliminated nonmedical exemptions for school-entry vaccines in California, but the impact of parental vaccine knowledge, attitudes, and beliefs on vaccine decision-making has not been extensively examined within the post-SB277 context. This study generates preliminary understanding and discussion of the vaccination knowledge, attitudes, and beliefs among a pilot population of parents of kindergarten students in California after the implementation of SB277. School officials administered a cross-sectional survey to parents of kindergarten children in California from April to July 2019. Parents reported their perceptions of diseases and vaccines, key immunization beliefs, and confidence in different sources of vaccine information. Most parents (92%) had fully vaccinated their children post-SB277 and generally perceived vaccines to be safe and effective, but about 44% reported they were hesitant about childhood vaccines. The majority of parents (87%) rated vaccine information from their doctor as highly credible. This pilot group of kindergarten parents was generally supportive of vaccination and had fully vaccinated their children, but most parents still harbored concerns and misconceptions about vaccines and about public health authorities. This indicates a disconnect between parental vaccine compliance and confidence, and suggests that educational interventions could impact parental vaccine behavior and decision-making.

Introduction: Safe and effective vaccines against Coronavirus Disease 2019 (COVID-19) provide the best opportunity to control the pandemic. Having safe and efficacious vaccines available is only half the equation; people must also take them. We describe a study to identify COVID-19 vaccine attitudes, values and intentions immediately preceding authorization of COVID-19 vaccines in the US., Methods: A national panel survey was conducted to measure intent to receive COVID-19 vaccines as well as disease and vaccine attitudes, values and trust in local, state and federal public health authorities., Results: Greater than 80% of respondents reported confidence they could adhere to COVID recommendations such as mask wearing, social distancing and hand washing. The majority of respondents (70%) reported believing that current drugs were somewhat or very good at treating COVID-19 infection. Vaccine intent fell into three groups: Intenders (50%), Wait and Learn (40%), and Unlikelys (10%). Intent to get vaccinated was substantially lower among African American (32%), and higher among men (56%), those over 60 years of age (61%), those with a Bachelor's degree or higher (63%), and Democrats (63%). The Wait and Learn group, compared to the Intenders, were less likely to report being diagnosed with a high risk condition for COVID-19, receiving an influenza vaccine in the past 12 months, discussing COVID-19 vaccine with their healthcare provider, perceiving COVID-19 as severe, considering a COVID-19 vaccine important to stop the spread of infection, and wering a mask usually or almost always., Conclusion: Only half of US adults intend to accept COVID-19 vaccines; most others (40%) are uncertain. Levels of immunity associated with community protection will not be achieved without reaching those who are currently uncertain. Characterizing COVID-19 vaccine attitudes and intentions and ascertaining values and trust in local, state, and federal public health authorities that impact vaccine decision-making are essential., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Physician recommendation is a key predictor of human papillomavirus (HPV) vaccine uptake. Understanding factors associated with recommendation is important for efforts to increase current suboptimal vaccine uptake., Purpose: This study aimed to examine physician recommendations to vaccinate female patients aged 11-26 years, in 2009 and 2011, at 3 and 5 years postvaccine licensure, respectively. A second aim was to identify trends in factors associated with vaccine recommendation for ages 11 and 12 years., Methods: Nationally representative samples of physicians practicing family medicine, pediatrics, and obstetrics and gynecology were randomly selected from the American Medical Association Physician Masterfile (n=1538 in 2009, n=1541 in 2011). A mailed survey asked physicians about patient and clinical practice characteristics; immunization support; and frequency of HPV vaccine recommendation ("always" ≥75% of the time vs other). Analyses were conducted in 2012., Results: Completed surveys were received from 1013 eligible physicians (68% response rate) in 2009 and 928 (63%) in 2011. The proportion of physicians who reported always recommending HPV vaccine increased significantly from 2009 to 2011 for patients aged 11 or 12 years (35% vs 40%, respectively; p=0.03), but not for patients aged 13-17 years (53% vs 55%; p=0.28) or 18-26 years (50% vs 52%; p=0.52). Physician specialty, age, and perceived issues/barriers to vaccination were associated with vaccine recommendation for patients aged 11 or 12 in both years., Conclusions: Results suggest a modest increase in recommendations for HPV vaccination of girls aged 11 or 12 years over a 2-year period; however, recommendations remain suboptimal for all age groups despite national recommendations for universal immunization., (Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)