Americans’ Largely Positive Views of Childhood Vaccines Hold Steady

Fewer than half in U.S. rate COVID-19 vaccines as having high health benefits, low risk of side effects

Americans remain steadfast in their belief in the overall value of childhood vaccines, with no change over the last four years in the large majority who say the benefits of childhood vaccines for measles, mumps and rubella (MMR) outweigh the risks, according to a new Pew Research Center survey.

Still, the survey finds that alongside broad support for childhood vaccines there are signs of some concern – especially among those closest to the decision-making process of vaccinating children. Parents see the risks of MMR vaccines as a bit higher than other Americans, and about half of those with a young child ages 0 to 4 say the statement “I worry that not all of the childhood vaccines are necessary” describes their views at least somewhat well. Concerns tend to be higher among mothers than fathers: Roughly half of mothers with a child under 18 rate the risk of side effects from MMR vaccines as medium or high – 15 percentage points higher than the share of fathers who say this.

The polarized response to the handling of the coronavirus outbreak in the United States, including the role of COVID-19 vaccines, has been a source of deep concern for medical and public health communities. It has also raised questions about whether vaccine hesitancy connected with COVID-19 vaccines would spill into Americans’ views of other vaccines. Heightened concerns follow reports of federal data that show another downtick in the share of U.S. kindergartners receiving state-required vaccines in the 2021-2022 school year.

The survey findings highlight the sizable gap between higher public confidence in childhood vaccines and lower ratings of COVID-19 vaccines. Fewer than half of U.S. adults consider the preventative health benefits of coronavirus vaccines to be high and a majority see the risk of side effects from them to be at least medium. COVID-19 vaccines were widely hailed as advances that showcased the power of scientific discovery. Yet a majority of Americans still say the statement “we don’t really know if there are serious health risks from the COVID-19 vaccines” describes their views at least somewhat well.

With the U.S. national emergency in response to the COVID-19 pandemic now at an end, Americans have sorted themselves into three groups based on their vaccination decisions. Roughly a third of U.S. adults (34%) are enthusiastic about the vaccines and up-to-date, being fully vaccinated and having gotten a recent booster shot. A similar share of the public (33%) comprises an ambivalent group that is fully vaccinated, but not recently boosted, with many who have questions about the safety and efficacy of COVID-19 vaccines. And then there are the 21% of U.S. adults who have said no to the vaccines altogether, a group that harbors deep doubts about the vaccines as well as societal efforts to encourage – or require – them.

These three groups encapsulate the range of Americans’ responses to coronavirus vaccines. They also provide a way to understand views about vaccines generally.

The Pew Research Center survey of 10,701 U.S. adults was conducted March 13-19, 2023, to explore public views of vaccines. To better understand vaccine hesitancy, the report also includes excerpts from 22 in-depth, qualitative interviews conducted with adults who hold some level of concern about vaccines.

The survey findings underscore the importance of trust in information about vaccines from a doctor or other health care provider. The survey finds that most adults have a lot (45%) or some (43%) confidence in their own health care provider to give an accurate picture of the health benefits and risks of childhood vaccines. And those with the highest level of trust in their provider also express the most confidence in the benefits of MMR vaccines.

Trust, or the lack of trust, also shapes views for the subset of Americans who have doubts about childhood vaccines and COVID-19 vaccines.

One participant in the qualitative interviews who holds concerns about vaccines expressed the following sentiment in thinking about advice from doctors about MMR vaccines:

“I again, think it’s important to interview your doctors as well as you would interview a child care provider, so that you have that trust factor with that person. Because doctors are human, and they do have their personal opinions. And if they’re going to push their personal opinion as their professional opinion, that’s not necessarily fair to you as a patient.” — Woman, age 35-44, Phoenix, Arizona

One interviewee with concerns about COVID-19 vaccines shared the following view about trust in health care providers:

“[Doctors are] not very credible because, again, that’s the personal opinion of the doctor. So if this doctor believes in it and this doctor doesn’t, and you go see this doctor and I go see this one, then we’ve got two different information. Everybody has, like I said, their formed opinions.” — Woman, age 25-34, Phoenix, Arizona

Large majority of Americans continue to say benefits of MMR vaccines outweigh risks

The Center survey finds 88% of Americans say the benefits of childhood vaccines for measles, mumps and rubella (MMR) outweigh the risks, compared with just 10% who say the risks outweigh the benefits. The share expressing confidence in the value of MMR vaccines is identical to the share who said this in 2019, before the coronavirus outbreak.

Asked to independently assess the health benefits and side effects risk of MMR vaccines for children, majorities of U.S. adults say the preventative health benefits of MMR vaccines are either very high or high (72%) and that the risk of side effects is either very low or low (64%).

There are signs that the coronavirus outbreak has influenced the public’s thinking on one important aspect of childhood vaccines: requirements for children to attend public schools.

Seven-in-ten Americans now say healthy children should be required to be vaccinated in order to attend public schools. This is a smaller majority than the 82% who supported vaccine requirements for children in 2019 and 2016. The share who say parents should be able to decide not to vaccinate their children now stands at 28%, up 12 points from four years ago. This data mirrors a December 2022 KFF update of these Pew Research Center trends.

The decline in support for vaccine requirements for children has been driven by changing views among Republicans: 57% now support requiring children to be vaccinated to attend public schools, down from 79% in 2019. By contrast, there’s been no meaningful change in the large share of Democrats (85%) who support school-based vaccine requirements.

These dynamics echo patterns seen over the past three years regarding coronavirus-related activity restrictions and COVID-19 vaccine requirements. Partisans have often been at odds over policy questions in these areas, with Republicans much more likely than Democrats to oppose activity restrictions and vaccine requirements.

White evangelical Protestants – a largely Republican group — have also become much less supportive of vaccine requirements in public schools. In the current survey, 58% say children should be required to be vaccinated to attend public schools, while 40% say parents should be able to decide not to vaccinate their children, even if that may create health risks for others. This represents a sizable shift from 2019, when White evangelicals backed vaccine requirements for public school children by a margin of 77% to 2o%.

Fewer than half of Americans rate COVID-19 vaccines’ health benefits as high, majority see risk of side effects as at least medium

Among the principal findings from the survey is the greater concern with which Americans view COVID-19 vaccines compared with childhood vaccines for MMR.

On balance, more Americans say the benefits of COVID-19 vaccines outweigh the risks (62% to 36%). But this rating falls far short of the 88% who say the same about childhood vaccines for measles, mumps and rubella.

Large differences in views extend to assessments of the respective health benefits and side effects risk.

Fewer than half of U.S. adults believe the preventative health benefits of COVID-19 vaccines are high (45%). About seven-in-ten say this about childhood MMR vaccines (72%).

Americans also see a greater risk of side effects attached to COVID-19 vaccines: A majority (58%) describe the risk from coronavirus vaccines as medium or high. By comparison, 64% describe the side effects risk from MMR vaccines as low. By comparison, 64% of U.S. adults describe the side effects risk from MMR vaccines as low, while 35% say they are medium (23%) or high (13%). (The medium and high risk categories for MMR vaccines do not sum to the 35% NET medium/high figure due to rounding.)

How COVID-19 vaccination status relates to enduring sources of vaccine hesitancy and the distinctions people make across vaccines

The survey finds that Americans make important distinctions across vaccines. In fact, among adults who have not received a COVID-19 vaccine, a clear majority (74%) believe that the benefits of childhood vaccines for measles, mumps and rubella outweigh the risks. And among parents who are not vaccinated against COVID-19, 70% say their own child has received the MMR vaccine.

Still, there is a meaningful link between COVID-19 vaccination status and MMR vaccine views. Positive evaluations of MMR vaccines are significantly higher among fully vaccinated adults than among those not vaccinated for COVID-19. Parents who have been vaccinated for COVID-19 are also more likely to report that their child has received the MMR vaccines.

Those who are not vaccinated for COVID-19 are among those most likely to express concern about childhood vaccines generally, even if they ultimately side with the view that MMR vaccines are worth the risks. For instance, 68% of adults who did not receive a COVID-19 vaccine say the statement “I worry that not all of the childhood vaccines are necessary” describes their own views very or somewhat well. Much smaller shares of fully vaccinated and recently boosted adults (25%) and those who are fully vaccinated but not recently boosted within the last six months (36%) say the same.

The COVID-19 vaccine decision has sorted Americans by age, educational attainment and partisan affiliation. Older Americans, those with higher levels of education and Democrats are all more likely to have gotten vaccinated against COVID-19 than other adults. As a result, the profile of Americans who have not gotten a vaccine – the group which holds the strongest concerns about the vaccines – is quite distinct from those who have pursued the highest level of protection against the coronavirus.

Those who are not vaccinated against COVID-19 are more likely to be women than men: More than half (57%) are women.

Those who did not get a COVID-19 vaccine stand out for the relatively small share (16%) who have a four-year college degree; 83% have some college or less education.

In addition, those not vaccinated for COVID-19 are more likely to be Republican than Democratic. Seven-in-ten adults who are not vaccinated identify as Republican or lean toward the Republican Party, while two-in-ten identify with or lean toward the Democratic Party (the remainder do not lean to either party or did not offer a response).

In contrast, Americans who are fully vaccinated and recently boosted against COVID-19 are much more likely to identify with or lean toward the Democratic Party (68%) than the GOP (27%). And 45% of this group has at least a four-year college degree, while 55% have some college or less education.

In addition, those fully vaccinated with a recent booster overrepresent older Americans. For instance, adults ages 65 and older – a group that’s among those most vulnerable to severe coronavirus infections – make up 34% of all fully vaccinated and boosted adults.

Those in the middle – fully vaccinated with no recent booster – are varied with a demographic profile that more closely mirrors that of the general population when it comes to gender, age, education and political identification.

Behavioral COVID-19 vaccine decisions are strongly tied to attitudinal assessments of the coronavirus vaccines, as expected. The magnitude of the opinion gaps between the three behavioral groups underscores the deep societal divides around COVID-19.

Those who are fully vaccinated but not recently boosted represent an ambivalent slice of the public. Fewer than half (43%) believe that the preventative health benefits of COVID-19 vaccines are high and 58% see at least a medium risk of side effects. But a majority (69%) ultimately conclude that the benefits of coronavirus vaccines outweigh the risks.

Adults who are not vaccinated are deeply skeptical that COVID-19 vaccines offer health benefits, and a large majority believe these vaccines come with a medium or high side effects risk. There’s also considerable frustration about some steps the country has taken to address the outbreak: 67% of this group says their views are described very well by the statement “it makes me angry when vaccination for COVID-19 is required.”

Fully vaccinated and recently boosted adults take the most positive view of COVID-19 vaccines. A large majority (92%) of this group say the benefits outweigh the risks and 74% describe the health benefits as high. Still, views aren’t entirely uniform among this group: For instance, 33% say there is a medium or high risk of side effects attached to COVID-19 vaccines.

Americans’ choices around COVID-19 vaccines are closely tied with their behavioral habits around getting an annual flu shot.

Three-quarters of those who are fully vaccinated and have had a COVID-19 booster shot in the past six months report that they typically get a flu shot every year. By contrast, 77% of those who have not been vaccinated against COVID-19 say they rarely or never get a flu vaccine. As with attitudes about the COVID-19 vaccine itself, people who are fully vaccinated with no recent COVID-19 booster fall in the middle: 44% of this group says they get a flu shot annually while 18% say they do so every few years and 37% say they rarely or never get a flu shot.

The share of U.S adults who say they typically get a flu shot every year (48%) is about the same as it was in 2020 (47%). However, the gap between the shares of Democrats and Republicans who say they get an annual flu shot is wider today (56% to 41%, respectively) than it was in 2020 (50% to 44%).