Study identifies biggest parental barriers to childhood influenza vaccination

A new Australia-wide survey conducted by the National Vaccination Insights project has revealed the reasons why some parents do not intend to vaccinate their children against influenza (flu) – and offers important clues about the steady and concerning decline in flu vaccination coverage since the onset of the COVID-19 pandemic.

Social science researchers from the project conducted a national survey of 2,000 parents to understand the barriers to uptake of flu vaccine among children under 5 years of age.

The researchers calculated how common access barriers (practical difficulties) and acceptance barriers (thoughts, feelings and social influences) were among parents who did not intend to vaccinate their child against flu (not intending parents) and parents who did intend to vaccinate their child against flu (intending parents). 

‘The barrier of not prioritising childhood flu vaccination over other things represented the largest difference between not intending and intending parents,’ said Dr Kasia Bolsewicz, Research Fellow, Social Science at NCIRS.

‘This can be a result of either parents choosing not to prioritise or parents being unable to prioritise due to practical challenges, such as difficulty booking flu vaccination appointments, managing competing priorities, organising transportation to the clinic and taking time off work,’ Dr Bolsewicz added.

A larger proportion of not intending parents (54.3%) than intending parents (7.5%) also reported that they would not feel guilty if their unvaccinated child got the flu, signalling the need for renewed awareness that infants and children under 5 years of age have a higher risk of flu-related complications, hospitalisation and morbidity than older children.

‘Perennial strategies are required to move this needle. Childhood flu vaccination needs to be more accessible for parents with limited time and resources. Parents also need up-to-date information about the importance of annual flu vaccinations and the risk of severe flu illness (even in healthy children), and flu vaccine safety and effectiveness data need to be shared more widely,’ noted Dr Maryke Steffens, Research Fellow, Social Science at NCIRS.

‘Healthcare workers also require support to discuss and recommend flu vaccination opportunistically, not just during scheduled vaccination appointments,’ emphasised Dr Steffens.

The percentage of not intending parents vs intending parents reporting barriers to childhood flu vaccination was as follows:

• 54.7% vs 6.1% – do not prioritise their child's flu vaccination appointment over other things
• 54.3% vs 7.5% – would not feel guilty if their unvaccinated child got flu
• 43.8% vs 3.4% – do not believe flu vaccines protect others in the community
• 41.1% vs 2.5% – do not believe flu vaccines are safe for their child
• 39.7% vs 3.0% – do not believe flu vaccines are effective for preventing flu
• 37.2% vs 4.6% – said people close to them do not support flu vaccination
• 22.7% vs 7.5% – are unable to afford costs associated with childhood flu vaccination.

Annual flu vaccination is strongly recommended for children aged 6 months to less than 5 years and is offered free for this cohort under the National Immunisation Program. Despite this, NCIRS vaccination coverage data show only about 1 in 4 children under 5 years of age were vaccinated against flu during 2024.

‘Given younger children are at higher risk of hospitalisation due to flu than other cohorts, this decline in vaccine uptake is especially concerning and highlights the urgent need to address the barriers uncovered by our research and routinely monitor any changes over time,’ concluded Dr Steffens.

A summary of key findings and the pre-print study are accessible via the links below.

View the key findings summary

View the pre-print study
 

Declaration: This study has been published as a pre-print and has not undergone academic peer review; amendments may be made before final publication. This survey was funded by the Australian Government Department of Health and Aged Care.

About the project: The National Vaccination Insights project is a collaboration between the Murdoch Children's Research Institute (MCRI) Vaccine Uptake Group, the National Centre for Immunisation Research and Surveillance (NCIRS) and the University of Sydney Social and Behavioural Insights in Immunisation (SABII) research  group. The project has been made possible by funding from the Australian Government Department of Health and Aged Care and the National Health and Medical Research Council.