COVID-19 Vaccine Acceptance Among Pregnant Women and Mothers of Young Children

Graphic of world map showing surveyed regions and number of respondents

Key findings from a global survey among 17,871 pregnant women and mothers across 16 countries
Oct. 28 – Nov. 18, 2020

Human Immunomics Initiative
in collaboration with
Pregistry
COVID Collaborative


On this page, we outline key findings of a global survey conducted between Oct. 28-Nov. 18, 2020, which assessed the acceptance of COVID-19 vaccination, including potential predictors, among pregnant women and mothers of children under 18 years old.

Based on the following manuscript that is currently in press, European Journal of Epidemiology:

Malia Skjefte, Michelle Ngirbabul, Oluwasefunmi Akeju, Daniel Escudero, Sonia Hernandez-Diaz, Diego Wyszynski, Julia W Wu. COVID-19 Vaccine Acceptance Among Pregnant Women and Mothers of Young Children: Results of a Survey in 16 Countries.


Study Methodology

Online survey through Pregistry, LLC

Responses collected from 17871 pregnant women and mothers of children younger than 18-years-old 

14 Countries selected based on their high cumulative incidences of COVID-19 as of October 28, 2020

United States, United Kingdom, India, Argentina, Philippines, Mexico, Italy, Brazil, South Africa, Spain, Russia, Colombia, Chile, Peru

In addition, Australia and New Zealand were included for reference
given that they had very low incidence of COVID-19

Survey available in six languages: English, French, Italian, Portuguese, Russian, and Spanish

Respondent Groups

Global Heat Map of Respondents


Main Findings

Vaccine Acceptance Levels

  • 52% of pregnant women and 73% of non-pregnant women indicated an intention to receive the vaccine, given a 90% efficacy rate
  •  69% of women overall (pregnant and non-pregnant), indicated an intention to vaccinate their children
  • The strongest predictors of vaccine acceptance included:
    • confidence in vaccine safety + effectiveness
    • worry about COVID-19
    • belief in the importance of the vaccine to their country
    • compliance to mask guidelines
    • trust of public health agencies + health science
    • attitudes towards routine vaccines
    • monitoring of COVID-19 news

Key Demographics

  • 17,871 total respondents
  • 5,282 total pregnant respondents
  • Overall age distributions were homogenous across countries with mean age of 34.4 years
  • India, Italy, Australia and New Zealand had higher-than-overall proportions of high-income participants
  • US, South Africa, UK, India, Australia and New Zealand had higher-than-overall proportions of highly-educated participants
  • US, Russia and India had higher-than-overall proportions of marriage

Pregnancy Demographics


COVID-19 vaccine acceptance rates for self-vaccination among pregnant women and non-pregnant mothers are shown below, as well as for child-vaccination among all mothers and mothers-to-be.

Self-Vaccination Percentages in Mothers and Expectant Mothers


Vaccine Acceptance During Pregnancy
Responses among pregnant women varied substantially by country.

Covid-19Vaccine Acceptance Level in Pregnant WomenVaccination acceptance during pregnancy


Vaccine Acceptance in Non-Pregnant Mothers
Responses among non-pregnant mothers also varied substantially by 
country.

Vaccine Acceptance Level in non-pregnant mothers

Vaccine acceptance in non-pregnant mothers


Vaccine Acceptance in Mothers for their Children
Among the 17,054 women who stated likelihood to vaccinate their children, results were very similar.

Vaccine Acceptance in Mother for their Children

Vaccine Acceptance in Mother for their Children


Likelihood of Increased Vaccine Acceptance for Child or Children Six Months After Approval

Likelihood of Increased Vaccine Acceptance for Child/Children Six Months After ApprovalLikelihood of Increased Vaccine Acceptance for Child/Children Six Months After Approval


This country-variable pattern persisted after standardizing for key demographics including:

  • AgeIncomeAge

  • Income

  • Education

    Education level

  • Marital StatusMarital Status

 


 Overall, current acceptance levels of a COVID-19 vaccine among women from most of the high-income countries* included in this study are insufficient to reach the community immunity threshold of 75%. 

*High-income countries include the United States, Australia, New Zealand, Spain, Italy, Chile and the United Kingdom.  


COVID-19 Vaccine Confidence

Public confidence in COVID-19 vaccine safety and efficacy played a major role in the decision of vaccine acceptance.

Trust in Vaccine Safety and Efficacy


Confidence that the COVID-19 vaccine approved will be safe (n=17790)

Confidence in Vaccine Safety


Confidence that the COVID-19 vaccine approved will be effective (n=17780)

Confidence in Vaccine Effectiveness


Perceptions on the COVID-19 Pandemic

Worries about COVID-19 (n=17844)

COVID-19 worry

Mask-wearing compliance (n=17803)

Mask wearing compliance

Trust that public health agencies would provide accurate vaccine safety information (n=17839)

Trust in public health agencies

 

Respondents’ general trust in health science (n=17837)

General trust in health science

 

Respondents’ general increased trust in health science during the COVID-19 pandemic (n=17837)

Increased trust in health science during the pandemic

 

Satisfaction on responsiveness of government policies to participants concerns during the COVID-19 pandemic (n= 17838)

Trust in local government pandemic policies

 

Satisfaction with health authorities for their performance in controlling COVID-19 in their countries (n= 17837)

Satisfaction with authority response to and control of the pandemic

 

Satisfaction with medical scientists for their performance in controlling COVID-19 in their countries (n= 17837)

Satisfaction with medical scientists in their response to the pandemic


Attitudes towards Vaccines

Overall participant responses showed a positive attitude towards COVID-19 vaccination in general.

belief in overall importance of covid-19 vaccine and vaccination


Importance for the country where respondents currently live to have a COVID-19 vaccine (n=17769)

Importance of a vaccine in ones own country

Importance for a majority of people in the country where respondents currently live to get vaccinated for COVID-19 (n=17761)

Importance of vaccination in ones own country

Respondents’ feelings of how informed they are about COVID-19 and vaccines being developed (n=17747)

Feelings of being informed regarding COVID-19 vaccine development


Attitudes Toward Routine Vaccinations

Overall attitudes towards routine vaccination

Perceptions on safety of childhood vaccines (n=17840)

Safety of childhood vaccines

 

Perceptions on effectiveness of childhood vaccines (n=17839)

Effectiveness of childhood vaccines


Reasons for COVID-19 Vaccine Reluctance

COVID-19 Vaccine Reluctance During Pregnancy

The top three reasons for pregnant women to decline COVID-19 vaccination during pregnancy even if the vaccine were safe and free were that:

  1. Do not want to expose their developing baby to any possible harmful side effect

  2. Would like to see more safety and effectiveness data among pregnant women

  3. Were concerned that approval of the vaccine would be rushed for political reasons


    COVID-19 Vaccine Reluctance in Mothers of Children

    The top three reasons for mothers to be unwilling to have their child/children vaccinated for COVID-19 were that:

    1. Concern that approval of the vaccine would be rushed for political reasons

    2. Would like to see more safety and effectiveness data among pregnant women

    3. Belief that the COVID vaccine is not safe, and could have potentially harmful side effects


Predictors of COVID-19 Vaccine Acceptance

Confidence in COVID-19 vaccine safety and efficacy

Confidence

  • Out of non-pregnant women who were confident in the safety of the COVID-19 vaccine, 97% were likely to accept the COVID-19 vaccine. 
  • Non-pregnant women who were confident in the safety of the COVID-19 vaccine were 5.12 times more likely to accept the COVID-19 vaccine after adjusting for all variables, in comparison to non-pregnant women who were not confident. 
  • Out of non-pregnant women who were confident in the efficacy of the COVID-19 vaccine, 95% were likely to accept the COVID-19 vaccine
  • Mothers who were confident in the efficacy of the COVID-19 vaccine were 2.03 times more likely to get their child/children vaccinated, after adjusting for all variables, compared to mothers who were not confident.Vaccine safetyvaccine efficacy

Belief in the importance of vaccines + mass vaccination in their own country

Mass vaccination

  • Out of non-pregnant women who believed in the importance for their country to have a COVID-19 vaccine, 84% were likely to accept the COVID-19 vaccine. 
  • Pregnant mothers who believed in the importance for their country to have a vaccine were 1.74 times more likely to accept the vaccine for themselves, after adjusting for all variables, compared to pregnant mothers who disbelieved in the importance.
  • Out of non-pregnant women who believed the importance for the majority of people in their country to receive the COVID-19 vaccine, 87% were likely to accept the COVID-19 vaccine. 
  • Non-pregnant women who believed that the majority of people in their country should get vaccinated for COVID-19 were 4.46  times more likely to accept the COVID-19 vaccine for themselves, after adjusting for all variables, compared to non-pregnant women who did not believe.

    covid-19 vaccine in own country

    covid-19 vaccination in own country


Confidence in routine childhood vaccines

Routine childhood vaccines

  • Out of non-pregnant women who were confident in safety of routine childhood vaccines, 81% were likely to accept the COVID-19 vaccine.
  • Pregnant women who  had confidence in childhood vaccines safety were 2.09 times more likely to accept the vaccine for themselves, after adjusting for all variables, compared to pregnant mothers who did not think childhood vaccines were safe.
  • Out of non-pregnant women who were confident in the efficacy of routine childhood vaccines, 79% were likely to accept the COVID-19 vaccine.
  • Mothers who thought childhood vaccines were effective were 1.39 times more likely to get their child/children vaccinated, compared to mothers who did not think childhood vaccines were effective.

routine childhood vaccination safetyroutine childhood vaccination efficacy


Worry regarding COVID-19

worry

  • Out of non-pregnant women who were worried about COVID-19, 86% were likely to accept the COVID-19 vaccine.
  • Pregnant mothers who were worried about COVID-19 were 1.79 times more likely to accept the vaccine for themselves, after adjusting for all variables, compared to pregnant mothers who were not worried.

worry regarding covid-19


Trust of public health agencies + health science

trust

  • Out of non-pregnant women who trusted public health agencies in providing accurate information on vaccine safety, 92% were likely to accept the COVID-19 vaccine.
  • Non-pregnant women who trusted their public health agencies were 1.62 times more likely to accept the COVID-19 vaccine for themselves, after adjusting for all variables, compared to non-pregnant women who did not trust these agencies.
  • Out of non-pregnant women who trusted health science in general, 84% were likely to accept the COVID-19 vaccine.
  • Mothers who trusted health science were 1.24 times more likely to accept the COVID-19 vaccine for themselves, after adjusting for all variables, compared to mothers who did not trust health science.

trust in health sciencetrust in public health agencies


Compliance to mask guidelines

mask compliance

  • Out of non-pregnant women who complied with COVID-19  mask wearing guidelines, 78% were likely to accept the COVID-19 vaccine.
  • Non-pregnant women who complied with COVID-19 mask wearing guidelines were 2.69 times more likely to accept the COVID-19 vaccine for themselves, after adjusting for all variables, compared to non-pregnant women who did not comply with mask guidelines.

compliance to federal mask guidelines


Monitoring of COVID-19 news and media

news

  • Out of non-pregnant women who monitored COVID-19 news and media, 77% were likely to accept the COVID-19 vaccine.
  • Mothers who monitored COVID-19 news were 1.21 times more likely to get their child/children vaccinated, compared to mothers who did not monitor COVID-19 news.

monitoring of covid-19 news and media


COVID-19 Denial and Doubt 

A high burden of disease alone may not provide sufficient motivation for pregnant women and mothers of young children to seek vaccination for themselves or their children.

 

  • Women’s risk perception of COVID-19 in the US and Russia, was comparable to that in low incidence countries (ie. Australia and New Zealand), potentially suggesting a phenomenon of COVID-19 denial.

     

Our findings suggest that there is room for governments, especially those of countries currently experiencing COVID-19 denial and public distrust, to rebuild confidence in the coming months as vaccine roll-out continues.


Study Strengths and Limitations

Strengths

Limitations

  • Survey sampled from countries that were highly affected by COVID-19 during time frame

  • Included two reference countries (Australia and New Zealand) with low COVID-19 incidence for comparison

  • Consistency among key predictors of COVID-19 vaccine acceptance

  • Survey is snapshot of time

  • Generalizability to other countries or regions

  • Survey only available in six languages

  • Possible selection bias, as whites and those with higher education levels in the USA and Europe were the main respondents


Key Recommendations 

The key message is clear: denial of the disease, skepticism of the vaccine, distrust of the system, along with pre-existing vaccine attitudes, all shaped the COVID-19 vaccine hesitancy we observed.

This is consistent across all countries, for acceptance of both self-vaccination among pregnant and non-pregnant women, and for acceptance of child-vaccination among mothers.


Recommendations for Improving COVID-19 Vaccine Acceptance, Confidence, and Public Trust

  • Due to geographic variation in vaccine acceptance, locally-specific vaccine programs are needed in this population.

  • Vaccine education campaigns should emphasize the pandemic as a whole and its impact on communities, rather than limiting to vaccine safety and effectiveness.

  • Significant portions of pregnant women and mothers expressed additional safety concerns due to insufficient pregnancy- and children- related clinical evidence.

  • As more such data become available for these two groups, there will be more opportunities for pregnant women and mothers to build trust on the scientific approval of these vaccines.

  • Rebuild vaccine confidence through transparent communication and effective community engagement, especially in countries experiencing widespread distrust exacerbated by the pandemic.

  • Vaccination campaigns for women and children should be specified for each country in order to attain the largest impact.

  • Policymakers must address public denial, doubt, fears and misconceptions of the disease, using clear and unified communication.

  • Previous roll-outs of new vaccines (such as HPV and Ebola) show the importance of community work with sensitivity toward country-, local- and subgroup- specific culture contexts.


    Contact

    Thank you for your interest in our findings!

    Please send all correspondence to:

    Julia W Wu, ScD
    Human Immunomics Initiative Department of Epidemiology
    Harvard TH Chan School of Public Health Boston, MA 02459, USA
    wwu@hsph.harvard.edu


    Citation

    Malia Skjefte, Michelle Ngirbabul, Oluwasefunmi Akeju, Daniel Escudero, Sonia Hernandez-Diaz, Diego Wyszynski, Julia W Wu. 

    COVID-19 Vaccine Acceptance Among Pregnant Women and Mothers of Young Children: Results of a Survey in 16 Countries. European Journal of Epidemiology. 2021