Should COVID-19 vaccines be mandated in schools? - An international caregiver perspective


Shannon H. Baumer-Mouradian, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address:
Rebecca J. Hart, Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, KY, USA.
Jeffrey N. Bone, Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.Follow
Michelle Seiler, Pediatric Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland.
Prasra Olson, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
Kristina Keitel, Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital University Hospital of Bern, Bern, Switzerland.
Sergio Manzano, Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Gianluca Gualco, Pediatric Emergency Department, Pediatric Institute of Italian part of Switzerland, Ticino, Switzerland.
Danna Krupik, Pediatric Emergency Unit, Ziv Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Stephanie Schroter, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA and University of California, San Diego, La Jolla, CA, USA.
Rachel M. Weigert, Depatrment of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA.
SunHee Chung, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.Follow
Graham C. Thompson, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada.
Nina Muhammad, Advocate Aurora HealthFollow
Pareen Shah, Department of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Nathalie O. Gaucher, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Quebec, Canada.
Maren M. Lunoe, Department of Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Megan Evers, Department of Pediatrics, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Cosette Pharisa Rochat, Department of Pediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
Courtney E. Nelson, Department of Pediatrics, Nemours Children's Hospital - Delaware, Wilmington, DE, USA.
Moran Shefler Gal, Department of Pediatric Emergency Medicine, Kaplan Medical Center, Rehovot, Israel.
Adrianna Doucas, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Ran D. Goldman, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.


Advocate Children's Hospital


Objectives: Caregiver attitudes toward mandating COVID-19 vaccines for their children are poorly understood. We aimed to determine caregiver acceptability of COVID-19 vaccine mandates for schools/daycares and assess if opposition to mandates would result in removal of children from the educational system.

Study design: Perform a cross-sectional, anonymous survey of adult caregivers with children ≤ 18 years presenting to 21 pediatric emergency departments in the United States, Canada, Israel, and Switzerland, November 1st through December 31st, 2021. The primary outcome was caregiver acceptance rates for school vaccine mandates, and the secondary outcomes included factors associated with mandate acceptance and caregiver intention to remove the child from school.

Results: Of 4,393 completed surveys, 37% of caregivers were opposed to any school vaccine mandate. Caregiver acceptance was lowest for daycare settings (33%) and increased as the child's level of education increased, college (55%). 26% of caregivers report a high likelihood (score of 8-10 on 0-10 scale) to remove their child from school if the vaccine became mandatory. Child safety was caregivers' greatest concern over vaccine mandates. A multivariable model demonstrated intent to vaccinate their child for COVID-19 (OR = 8.9, 95% CI 7.3 to 10.8; P < 0.001) and prior COVID-19 vaccination for the caregiver (OR = 3.8, 95% CI 3.0 to 4.9; P < 0.001) had the greatest odds of increasing mandate acceptance for any school level.

Conclusions: Many caregivers are resistant to COVID-19 vaccine mandates for schools, and acceptance varies with school level. One-fourth of caregivers plan to remove their child from the educational system if vaccines become mandated.

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