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A Third of Caregivers of Kids with Cancer Have Hesitancy on COVID Vaccine

A child receives a vaccination in her arm.
A child receives a vaccination in her arm.


Sarah Avery
Sarah Avery
919-724-5343 Email

DURHAM, N.C. – A survey of parents and caregivers of children with cancer found that nearly a third of them expressed hesitancy to vaccinate their youngsters against COVID-19.

Led by researchers at Duke Cancer Institute, the survey suggests that vaccine hesitancy took hold even among those who are highly engaged with the medical community and among a population that has a high rate of participation in clinical trials.

Results are appearing online Nov. 17 in the journal Pediatric Blood & Cancer.

“Part of the reason we wanted to survey about vaccine hesitancy in this group is that they have such frequent contact with the medical system, so we were looking for anything that might be potentially unique about this patient population that might set them apart,” said Kyle Walsh, Ph.D., senior author and associate professor in the departments of Neurosurgery and Pediatrics at Duke. “And actually, the rates of hesitancy were quite high.”

Walsh and colleagues conducted the survey from February-April of 2021 as the COVID-19 vaccines were initially rolling out, and before pediatric vaccines were authorized. The 19-question survey was sent to caregivers of children with cancer who had completed treatment but could still be receiving surveillance/follow-up care; 130 families completed the survey.

The researchers were interested in determining what variables were associated with the caregivers’ willingness or hesitancy to vaccinate themselves and/or their child.

The found that 29% of caregivers expressed hesitancy to have their children with cancer receive the COVID-19 vaccine. That rate is slightly higher than the 25% reported among the general population, according to a Kaiser Family Foundation poll released in July, which was near the same time as the research survey.

While more than 40 percent of the survey respondents said their children’s cancer treatment was part of a clinical trial, that factor did not play a role in their consideration of a COVID-19 vaccine.

“We were surprised that it was not associated with vaccine acceptability,” Walsh said.

Slightly more than half of respondents reported their children with cancer would definitely receive the COVID-19 vaccine when it became available to them, and five children had already been vaccinated. An additional 18% of caregivers felt unsure if their child would receive the vaccine but were “leaning towards yes.”

An analysis of responses from survey participants found that caregivers were more inclined to have their children vaccinated if they expressed confidence in science, medicine, and vaccination in general, and in the federal response to the COVID-19 pandemic.

They were also more willing to vaccinate if they expressed concern that an infection from COVID-19 posed extra risks to their children, whose immune systems are often fragile after cancer treatments.

Those who reported they were hesitant to vaccinate expressed concerns about the swiftness of COVID-19 vaccine development and insufficient safety and efficacy data in children, particularly children with cancer.

Walsh said the results underscore the need for COVID-19 vaccination education and outreach, even among families highly engaged with the medical community, and emphasize the importance of updating families as relevant data emerge from vaccine trials and registries.

“For all parents who have children with cancer, they are trying to make the best decisions for them based on the information at hand and the potential long-term effects arising from chemotherapy, radiation and now potentially vaccinations against COVID-19,” Walsh said.

In addition to Walsh, study authors include Courtney E. Wimberly, Lisa Towry, Elizabeth Davis and Emily E. Johnston.

The study received support from Alex’s Lemonade Stand Foundation, the National Institutes of Health (R21CA242439-01) and The Children's Health and Discovery Initiative of Translating Duke Health.

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