Care Experiences and Infant Vaccination Hesitancy

In the face of the new variant, Omicron, COVID-19 has increasingly challenged our efforts in global health. The COVID-19 pandemic has led to not only millions of cases and deaths, but also highlighted the significant gaps in response and how impacting this can be in overall health.

Several times during this pandemic, access to care has been impacted. From preventative care to surgeries and fertility treatments, and even routine vaccines have been hit by this pandemic. Preventative care, like vaccines, is critical for not only personal health, but also public and global health efforts. One such piece to this is how pregnant individuals and their infants experienced prenatal disruptions in health care and postpartum hospitalization duration declines. Consider how would your health care experiences impact your choice to continue vaccinating your child? What if the experience was traumatic and impacted your access to care?

A recent research letter in JAMA Pediatrics sought to address this association. From characteristics like maternal age, relationship status, health insurance, term birth, racial and ethnic group, and more, the research team sought to understand the impact to vaccination in infants. Moreover, they studied COVID-19 related stressors and health care experiences, like facing discrimination, fear of perinatal infection, birth preparedness stress, telehealth prenatal care, disruptions to prenatal care, birth satisfaction, and duration of hospitalization.

The research team analyzed data from first and third time points via the Stony Brook COVID-19 Pregnancy Experiences (SB-COPE) study over the course of 3 weeks in 2020. There was 4388 pregnant women across the United States were recruited for this study and completed the baseline survey, and 1107 infants were 3-5 months of age at time point 3 (October 2020). The authors noted that, “A total of 89 infants (8.0%) had incomplete vaccine uptake at age 3 to 5 months (51 [4.6%] received some vaccines and 38 [3.4%] did not receive any vaccines).” Harnessing the power of bivariate analyses, the research team reported that “incomplete vaccine uptake was associated with previously established predictors (eg, parity, education, health insurance) and with COVID-19– and non–COVID-19–related stress factors (eg, income loss, discrimination, receiving telehealth prenatal care, and briefer postpartum hospitalization). Several key predictors persisted in the multivariate analysis. These included perinatal care limitations (telehealth prenatal care and brief postpartum hospitalization), COVID-19–related income loss, and experiencing discrimination owing to one’s race, gender, sexuality, or body size. Mothers with greater concern about perinatal infection and greater birth satisfaction had decreased risk of incomplete vaccine uptake.”

Not surprisingly, the impact that discrimination, perinatal care limitations, and preterm birth, all have on infant vaccination was a negative one. COVID-19 stressors, including income loss also increased the risk of incomplete vaccination. Ultimately, this emphasizes a desperate need to address the health outcomes when people struggle to get access to care or experience discrimination. Health care experiences are critical and too often overlooked, meaning that now more than ever is the time we should evaluate and invest in improving prenatal and perinatal care and access to care.