COVID: How many parents will actually vaccinate their kids?

The early data makes a clear case for vaccinating adolescents. But it's also true that humans have an extremely difficult time making a medical choice on another person's behalf — and sometimes default to doing nothing.

"My child is not a lab rat."

The words are from a 25-yearold woman, Susan, and they're in reference to her three-year-old twin girls.

While she speaks to DW, her eyes flicker between them as they begin to meander away — first together, then in different directions — in a large, open park in Bonn, Germany.

"It just hasn't been tested enough," Susan insists. "A few months [of testing]? That isn't safe."

So no, she says. Her kids are not getting vaccinated against COVID-19. And she isn't, either. Her husband had to, and she didn't like that.

At a nearby playground, another mother, who does not want to share her name, feels very differently. "I'd vaccinate them. If it were allowed, or doable, then definitely."

Her 12-year-old daughter, she says, has had two different kids in her classroom get COVID-19. That led to a two-week quarantine — each time. "That's where you realize it affects them too."

At some point in the coming weeks, the European Medicines Agency is expected to approve the Pfizer/BioNTech vaccine for use in 12- to 15-year-olds.

Then, if further trials are successful, children younger than 12 may be approved for immunization as early as the end of summer.

But the question remains: Will their parents actually vaccinate them?

A big decision

The most current data available comes from ongoing research on COVID-19 measures and vaccine hesitancy conducted by various German public health agencies, the University of Erfurt and the Yale Institute for Global Health in the US.

Sarah Eitze, a researcher at the University of Erfurt, told DW that, at the time their latest data on parents was collected (late February), 50% would have decided in favor of a vaccination. Interestingly, when they appealed to ideas of herd immunity (as opposed to the strict selfinterest of protecting their children), they saw a big increase in acceptance.

"The decision depends strongly on the possibility of protecting others through the vaccine," Eitze said. "The acceptance increased to over 70% if the participants were told to imagine the vaccine protecting against the spread of the virus."

These percentages may actually be higher now, since these surveys were done before Pfizer released its jubilant results (which have yet to be peer reviewed) from a phase-III trial on 12- to 15-year-olds. In that trial, not a single one of the roughly 1,000 young adolescents who received the Pfizer/BioNTech vaccine developed COVID-19 symptoms. Not one.

Though the sample size was small, it was also large enough to make an early comparison to the non-vaccinated group, where 18 of the 1,000+ participants got COVID-19.

General vaccine willingness high in Germany

But a few other insights come from the research of Heidi Larson, who's the director of The Vaccine Confidence Project and a professor at the London School of Hygiene & Tropical Medicine.

Every two years, Larson's team collects data for the EU — and in it, there's information about parents' willingness to immunize their children with the MMR vaccine (measles, mumps, rubella, given between ages one and six) and the HPV vaccine (human papillomavirus, usually given at age 11 or 12).

That data, she told DW, "[W] ould capture willingness for child and adolescent vaccines." And, by extension, it may serve as a proxy survey on parents' willingness to administer COVID-19 vaccines to their kids.

What those surveys showed is that roughly 91% of Germans feels the MMR vaccine is either safe or important for their children. Another 77% said the same for the HPV vaccine. All in all, good news.

Not all vaccines are created equal

Or is it? The clear percentage gap between those two vaccines suggests that, when we're talking about a "willingness to vaccinate children," that discussion is dependent on which vaccine you're talking about — or rather, on the "risk" parents are trying to avoid by vaccinating their kids, versus the risk (perceived or real) of the vaccination itself. (Note: At the time of publication, there have been no unexpected side effects in adolescents vaccinated with Pfizer/BioNTech, according to the company and, independently, statements by Israel's health ministry.)

Second, a survey like the one above that includes both men's and women's willingneess may not actually capture the truth, or the reality, of how a parent decides to vaccinate (or not vaccinate) a child.

That's because when it comes to vaccinating children, mothers tend make the call more often than fathers do, as researchers have found.

And in the case of COVID-19, that could present a problem.

A survey conducted in December by the US magazine National Geographic showed a pretty staggering gender gap when it comes to taking a COVID-19 vaccine.

At that time, 69% of American men said they were prepared to get a COVID-19 jab, compared just 51% of women. That's a big difference. In Germany, a similar gender gap — though not quite as pronounced — has been recorded.

In an interview with DW in December, Heidi Larson chalked it up to two factors: women accurately perceiving that this virus was less risky to them (compared to men), and the prevalence of online misinformation.

Larson said that in general, women do more research into vaccines then men, because mothers are more likely to look up information about vaccines for their children than fathers are. "And in their searching for more information, they've likely been sent down different social media strands that have taken them to some pretty negative information. So I think that they're probably more aware of some of these anxiety-provoking images, and sentiments, that are circulating online."

Default to nothing

Then, there's a final psychological hindrance that Sarah Eitze says has been known about for decades.

"What I can say is that health decision-making for others is, in general, more risk averse," she told DW. "So every time we make decisions for other persons, we weigh benefits and risks and try to reduce risk as much as possible. Furthermore, with preventive behaviors ( such as vaccinations) we also tend to be more risk averse (compared to treatment decisions)."

In other words, if I choose to vaccinate my child, and it directly causes discomfort or even harm? Then it's my fault. But if I do nothing, and they get infected? Then maybe it's just… fate?

(Full disclosure: I'm a father of two and will vaccinate both of my kids based on the data we know. But I'd be lying if I said I didn't have a fear, somewhere inside me, of making the wrong decision.)

This "default" setting in human psychology implies that, despite declaring a "willingness" to do something in a survey, things may turn out differently when it comes time to actually schedule an appointment.

Numbers in constant flux

So, how many Germans will actually vaccinate their kids? Your author's best guess is between 50% and 60%. That number assumes some of the roughly 50% of German parents who've said they're "willing" to vaccinate will not actually follow through — either because of "default to nothing" tendencies or the fact that mothers tend to make more childcare health decisions and have lower COVID-19 vaccine acceptance rates than men.

But it also assumes that some of the roughly 18% of parents who've said they're "undecided" (or who were undecided as of late February) will make up a part of that gap and may even overshoot it.

Obviously, these numbers would most likely go down if there was negative vaccine data on adolescents and children in the future — or up if there are new requirements regarding reentry into German kindergartens, elementary schools or high schools, as well as airlines, restaurants and other businesses.

What about kids and teens themselves?

Back at the playground in Bonn, the mother of a very vocal 1-year-old boy cites those final points as her primary incentive for vaccinating.

"We wouldn't be afraid to go out," she tells DW. "We wouldn’t be afraid to visit his grandparents anymore. If he's vaccinated, we would have a normal life again."

When the boy's scream interrupt her train of thought, she jokingly says that yes, it is lunchtime, but that... you know, maybe he's also voicing his support? Maybe he's "pro-vaccination?"

Would he be, though? It's an interesting question. With all this discussion about parents, how do children and adolescents feel about all of this?

On the way out of the park, I ask a 13-year-old who's on his way to the basketball court to be honest with me. Does he actuallywant to get vaccinated? If he could make the choice himself?

"Yeah," he says. "Because of course, I want to help contain the whole coronavirus pandemic."

The v erb h e u s e s is "eindämmen," meaning "to contain." It's a big word for a 13year-old. Or maybe we all just have new vocabularies now.

And is he scared of the vaccine? Of the stuff inside it?

"Nah. ' Cause they're doing lots of tests on it."

For now, German schools have implemented antigen tests for in-person lessons in areas with high incidence levels

Parents are likely facing a big choice soon: To vaccinate or not to vaccinate