Digging Deeper Into Why Fewer Infants Got Vaccinated During the Pandemic

A survey of women who gave birth during the pandemic linked disruptions in prenatal care, discrimination, and COVID-19-related stressors with incomplete vaccination in their infants.

Among more than 1,000 infants born from April and July 2020, 8.0% had incomplete vaccinations at ages 3 to 5 months (split between 4.6% receiving some and 3.4% not receiving any), reported Heidi Preis, MSW, PhD, of Stony Brook University in New York, and colleagues.

Likelihood of incomplete vaccination status was higher for infants born to mothers who used telehealth prenatal care (adjusted odds ratio [aOR] 2.60, 95% CI 1.59-4.24) and had shorter postpartum hospital stays (aOR 2.59, 95% CI 1.54-4.36), the group wrote in a research letter in JAMA Pediatrics.

Pandemic-related income loss (aOR 1.61, 95% CI 1.59-2.60) and mothers experiencing discrimination related to their race, gender, sexuality, or body size during pregnancy (aOR 2.32, 95% CI 1.19-4.54) were also associated with decreased vaccination uptake.

Income loss in particular — reported by over 40% of the women surveyed — may have decreased vaccination uptake due to reduced access and affordability of healthcare, according to the researchers.

“Understanding predictors of vaccination, particularly when vaccine hesitancy is increasing, is important to developing public health policies and preventive interventions to increase vaccine uptake,” Preis and colleagues wrote.

On the other hand, pregnant women with greater concern about perinatal infection (aOR 0.61, 95% CI 0.48-0.77) and greater birth satisfaction (aOR 0.70, 95% CI 0.56-0.88) were less likely to have infants with incomplete vaccination, the study found.

“The negative impact of discrimination, for any reason, during pregnancy is very troubling,” Bradley Ackerson, MD, a pediatric infectious disease physician at Harbor-UCLA Medical Center in West Carson, California, told MedPage Today. This finding may reflect increased vaccination hesitancy among Black and Hispanic people due to historical distrust of the medical community and government agencies, he added.

Addressing both vaccine hesitancy and the reluctance to attend in-person visits, which are necessary for childhood vaccinations, is crucial to improving vaccination rates in children, Ackerson said.

But Ackerson, who was not involved in the study, cautioned that the self-reported undervaccinated group in the study was small (89 infants) and may be under-reported. He also noted that the fit of the study’s statistical model was suboptimal.

“However, the results are interesting and add important points to consider in future studies and efforts aimed at reducing disparities,” Ackerson said.

Prior to the pandemic, about 1% of infants were completely unvaccinated by 2 years of age, according to the CDC.

Previous studies have reported a dip in routine vaccination in infants during the pandemic. Other groups have also found infants of lower socioeconomic background and those who are uninsured to be vaccinated at lower rates.

“Since vaccination status in early infancy is overwhelmingly predictive of future up-to-date vaccination status, strategies to address perinatal care limitations and discrimination merit serious consideration by policy makers, health care organizations, and obstetric and pediatric clinicians,” Preis and colleagues urged.

Their study included 1,107 infants and mothers from the Stony Brook COVID-19 Pregnancy Experiences Study, which recruited pregnant women via social media to take surveys at three time points from April to October 2020. Most of the women who took part in the survey were white (88%), more than three-fourths had an academic degree, and nearly all were married.

Overall, 8.5% of the women experienced discrimination in pregnancy, 57.9% had disruptions in their prenatal care, 30.3% used telehealth services, and 72.3% had postpartum hospital stays of less than 2 days.

Established risk factors for incomplete vaccination — preterm birth, number of other children, education, and mother’s age — also showed associations in the current study.

Preis’ group acknowledged that the self-selected and self-reported nature of the study severely limits its scope.