Impact of a hypothetical COVID-19 vaccine mandate on parental likelihood to vaccinate children: Exploring school-related concerns and vaccination decision-making

Vaccine. 2023 Dec 7;41(50):7493-7497. doi: 10.1016/j.vaccine.2023.11.022. Epub 2023 Nov 14.


Objective: We assessed the impact of a hypothetical school-entry COVID-19 vaccine mandate on parental likelihood to vaccinate their child.

Methods: We collected demographics, COVID-19-related school concerns, and parental likelihood to vaccinate their child from parents of patients aged 3-16 years seen across nine pediatric Emergency Departments from 06/07/2021 to 08/13/2021. Wilcoxon signed-rank test compared pre- and post-mandate vaccination likelihood. Multivariate linear and logistic regression analyses explored associations between parental concerns with baseline and change in vaccination likelihood, respectively.

Results: Vaccination likelihood increased from 43% to 50% with a hypothetical vaccine mandate (Z = -6.69, p < 0.001), although most parents (63%) had no change, while 26% increased and 11% decreased their vaccination likelihood. Parent concerns about their child contracting COVID-19 was associated with greater baseline vaccination likelihood. No single school-related concern explained the increased vaccination likelihood with a mandate.

Conclusion: Parental school-related concerns did not drive changes in likelihood to vaccinate with a mandate.

Keywords: COVID-19; Parental concerns; School-entry based mandate; Vaccine uptake.

MeSH terms

  • COVID-19 Vaccines*
  • COVID-19* / prevention & control
  • Child
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Parents
  • Schools
  • Vaccination


  • COVID-19 Vaccines