Hesitations and concerns about COVID-19 vaccines were found to be common among adolescents, with many indicating a preference for autonomy in making vaccine-related decisions and resistance toward vaccine mandates and passport policies.  These study results were published in the Journal of Adolescent Health.

Researchers conducted a study between January and March 2020 to examine perceptions and attitudes among adolescents regarding COVID-19 vaccination and vaccine mandate and passport policies. Data for this study were collected through surveys and interviews designed by youth researchers. Eligible participants were students from 2 low-income neighborhoods in Montreal, Canada. The survey was designed to capture sociodemographic-related predictors of COVID-19 vaccination status.

The study population comprised 315 participants (age range, 14-17 years), of whom 82 were not fully vaccinated. Among all participants, 56% were women, 70% were aged between 15 and 16 years, approximately 90% were non-White, and one-third were born outside of Canada. The majority of participants were fully vaccinated (~75%), whereas 8% were partially vaccinated and 18% were unvaccinated.

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Among unvaccinated participants, the most commonly reported reasons for refusing the COVID-19 vaccine included safety concerns (24%), perceived lack of effectiveness (16%), and low risk for severe illness (14%).

Participants who were fully vs not fully vaccinated were significantly more likely to view vaccination as a measure to protect the health of the community and report that the COVID-19 vaccine is safe (13% vs 44%; P <.001) and effective (33% vs 58%; P <.001). Vaccinated participants also reported higher rates of family and friends who were vaccinated (83% vs 62%), greater support for vaccine passports (47% vs 38%), and greater trust in national health authorities (29% vs 52%), health care workers (13% vs 30 %), and scientific experts (17% vs 32%).

Further analysis showed that vaccinated vs unvaccinated participants did not significantly differ in regard to the belief that only those at risk for severe illness require vaccination and that daily life constraints contribute to vaccination decisions. In addition, participants in both groups reported low trust in information about COVID-19 vaccines provided by social media, celebrities, and school guidelines or teachers.

Participants who were unvaccinated commonly described vaccine mandate and passport policies as “unfair” and cited their right to bodily autonomy in making medical decisions.

“Some adolescents remarked on the absurdity of deciding to get vaccinated to be able to eat in restaurants and play sports, rather than to protect their health,” the researchers noted.

Limitations of this study include the relatively small sample size.

According to the researchers, “Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, pro-equity recovery from COVID-19.”


McKinnon B, Abalovi K, Fortin G, et al. Perspectives on COVID-19 vaccination and vaccine passports in a diverse urban adolescent population: a youth participatory mixed-methods study. J Adolesc Health. Published online May 1, 2023. doi:10.1016/j.jadohealth.2023.04.013

This article originally appeared on Infectious Disease Advisor