Children’s voices are rarely included in debates about childhood vaccination [1].
This submission addresses that gap using a qualitative study conducted in 2025 with 30 adolescents aged 12–17 in England. The study was co-produced with adolescents. They helped design the study, develop the materials, and analyse the findings. As a result, it represents research conducted with adolescents rather than to or about them [2]. It provides an authentic account of post-COVID-19 adolescent perspectives on vaccination barriers, facilitators, and experiences.
A full report on the study, which is currently undergoing peer review in an academic journal, is available here: Pitt A, Amlôt R, Heffernan C, James Rubin G, Smith LE. “I didn’t even know humans could get polio … I swear that’s for dogs.” A co-produced, thematic analysis exploring adolescent attitudes to vaccines. medRxiv. 2025. https://www.medrxiv.org/content/10.1101/2025.10.29.25338465v1
Angie Pitt is a final year PhD researcher at King’s College London. Her work focuses on giving young people the opportunities and skills to shape research exploring the social, psychological, and informational factors shaping vaccine uptake among adolescents. She works as part of the NIHR Health Protection Focus Award in Outbreak Related Behaviour.
Dr Catherine Heffernan is a Director of Health Improvement at South West London Integrated Care Board, a consultant in public health and a visiting lecturer at King’s College London.
Professor G. James Rubin is a Professor of Psychology & Emerging Health Risks at King’s College London and Director of the NIHR Health Protection Research Focus Award in Outbreak Related Behaviour.
Our adolescent participants identified multiple key drivers of reducing coverage and disparities.
1. Perceived low risk and limited disease salience
Adolescents frequently assessed vaccines based on the perceived severity of the disease. Vaccines associated with conditions seen as mild for them (e.g. influenza, COVID-19) were often considered unnecessary: “There are some vaccines that you need to have, like… for your safety. But then maybe ones like, ones like the COVID vaccine and the flu vaccine, which probably aren’t that dangerous to you if you’re like my age …”. In contrast, vaccines linked to serious outcomes (e.g. cancer via HPV) were more readily accepted, but only where adolescents were aware of the association. If adolescents were unaware that, for example, the HPV vaccine protects against certain cancers, they were less likely to consider it important. Limited awareness of other vaccine-preventable diseases (e.g. diphtheria, polio) further reduced perceived relevance (“I didn’t even know humans could get polio … I swear that’s for dogs”).
2. Emotional barriers, particularly needle fear
Needle fear emerged as a dominant and often under-recognised barrier. For some adolescents, this resulted in anticipatory anxiety and, in some cases, refusal to accept vaccines. Negative experiences further reinforced hesitancy and contributed to adolescents’ intention to avoid future vaccinations both in adolescence and as adults, for example, “It was really bad. I started crying … yeah, I think after that I don't think I'd get one …”.
3. Parental influence and unequal autonomy
Parents were the primary determinant of vaccine uptake. Adolescents often had limited or no involvement in decision-making, and vaccine-hesitant parents could prevent uptake even where adolescents were willing, for example, “I was relatively on board, but I think my parents were quite unsure, so I ended up not having it”.
4. Social norms and identity
Vaccination behaviour was shaped by family norms (“we’re all pro-vaccine in this family”) and peer group alignment (“I was like, well, if they’ve decided to get it, then it should be fine”). Adolescents tended to conform to perceived group behaviour, reinforcing both acceptance and hesitancy within social clusters.
5. Spillover from COVID-19 vaccine discourse
Although adolescents reported distrusting social media, many were aware of COVID-19 vaccine misinformation. For some, this had a ‘spillover effect’, reducing confidence in other routine vaccines.
6. Inequities in information access
Information was often mediated through parents (e.g. consent forms, leaflets), limiting adolescents’ direct access. This created disparities in knowledge, informed decision-making capacity, and denied adolescents the opportunity to develop health-related critical thinking skills.
Based on the findings of this work, and suggestions from adolescent participants, we have five recommendations:
1. Strengthen vaccine education in schools
Vaccine education in schools should be strengthened by moving beyond brief, didactic sessions towards more interactive, discussion-based learning. Education should begin earlier and be revisited over time, with opportunities for adolescents to engage directly with healthcare professionals to build trust and ask questions. When asked how to improve vaccine education, one adolescent who had refused all vaccines said: “There should be a day … in school, where… someone comes in and they, like, talk to the classes and, like, people can ask questions … ‘Cause not everyone likes asking questions. So, if one person can ask, then they can all hear”.
2. Engage adolescents directly, not only via parents
Adolescents should be engaged directly in vaccination communication alongside parents, rather than relying solely on parents as intermediaries, (“The idea of someone else saying … you can or can't have it …is a bit, um, silly … it's not them being infected, it's you being infected”). This includes providing information directly to young people, supporting the development of health literacy and informed decision-making skills, and ensuring that materials are accessible, relevant, and age appropriate.
3. Address emotional barriers
Emotional barriers to vaccination should be addressed more explicitly. Practical strategies to reduce needle anxiety, such as distraction techniques, increased privacy, and supportive environments, should be implemented. Needle fear should be recognised as a legitimate barrier to uptake rather than a minor concern.
4. Leverage social and family influences
Interventions should leverage social and family influences. Given the central role of parents in decision-making, approaches should actively involve families, while peer-led strategies and the use of (truthful) positive social norms in messaging, for example ‘Eight out of ten people your age have had this vaccine’ could help to normalise vaccination among adolescents.
5. Improve risk communication
Finally, risk communication should be improved by clearly emphasising disease severity and real-world consequences, particularly for less familiar conditions. Messaging should also highlight collective benefits, such as protecting others, and prioritise transparent, balanced evidence rather than dismissive or overly directive approaches, “Try and show the fact that you are telling the truth”.
Our work was initiated because of a more general finding that research on attitudes, intentions and behaviours concerning adolescent vaccines focuses on the voices of parents and caregivers as adults responsible for consent. Less attention is paid to the views of adolescents themselves [1]. Consequently, they are often underrepresented in vaccine research. Even less evidence involves adolescents as co-researchers. The UN Convention on the Rights of the Child (1989) [3] sets out children’s right to be heard, and to participate in decisions that affect them, including policy decisions. More could be done to include young voices in vaccine research and policy.
Our study findings highlight several limitations in current school-based vaccination delivery models:
1. Limited educational integration
Vaccination programmes were often delivered with minimal prior education, described as brief or tokenistic. This limits adolescents’ ability to make informed decisions.
2. Insufficient support for anxiety and comfort
Needle fear was not systematically addressed. Adolescents reported limited support from adults during vaccination, relying instead on peers for comfort (“[My friend] just came, and she sat next to me. And she held my hand. And she just talked to me”.) This indicates a gap in patient-centred delivery. Mass vaccination settings (e.g., school sports halls) were sometimes associated with anxiety. Adolescents suggested improvements such as increased privacy and use of distractions (e.g. music, videos).
3. Communication pathways bypass adolescents
Information (e.g. consent forms, leaflets) was frequently directed to parents rather than adolescents. As a result, some young people attended vaccination sessions with little understanding of the vaccine. Few adolescents recognised they could override parental decisions in school settings via Gillick consent. Most perceived parents as having ultimate control, for example “[My mum] just picked for me … she just picked no … I don't really have a say”. Current systems do not consistently support adolescent participation in decision-making.
Our study revealed a nuanced relationship between adolescents and the media environment:
1. Perceived resistance to social media influence
Adolescents generally reported that they do not trust social media for health information and view it primarily as entertainment. “When it comes to, like, real life, I wouldn’t trust TikTok”. They often claimed to “scroll past” vaccine-related content. Despite this, many participants were familiar with common vaccine rumours, particularly relating to COVID-19. They sometimes cited other people (parents, friends) as sources of rumours rather than social media, e.g., “Like parents … you know how you're not meant to believe everything you see? Well, clearly not. Because they believed everything they saw. And they were so against the Covid vaccine.” This suggests adolescent exposure to misinformation is passive and indirect.
3. Differential susceptibility
Vaccine-acceptant adolescents tended to dismiss misinformation as false or humorous. Vaccine-hesitant adolescents were more likely to experience doubt and uncertainty when exposed to rumours, and ultimately reject vaccines, “It made me think ... maybe that is true ...”.
4. Spillover effects across vaccines
Misinformation about COVID-19 vaccines was sometimes generalised to other vaccines, contributing to broader hesitancy, for example, “I think maybe people heard … these rumours about the Covid vaccine. And then they thought the same thing about like all the vaccines”.
6. Trust in institutions
Trust in government was variable, with some concerns about transparency, “Sometimes I do feel like the Government can mislead people … they wanna have more control over people …”. However, almost all participants were positively disposed toward, and trusted, health workers and the NHS.
1. Warraitch, A., et al., An umbrella review of reviews on challenges to meaningful adolescent involvement in health research. Health Expectations, 2024. 27(1): p. e13980.
2. National Institute for Health and Care Research. Briefing notes for researchers - public involvement in NHS, health and social care research. 2021 May 2024 [cited 2026 02 02]; 2.0:[Available from: https://www.nihr.ac.uk/briefing-notes-researchers-public-involvement-nhs-health-and-social-care-research#tab-briefing-note-two-what-is-public-involvement-in-research.
3. United Nations, Convention on the Rights of the Child., U. Nations, Editor. 1989, United Nations: New York.
Non-shared AI was used to condense the evidence in this submission. AI was not used in the design of the research, data collection, analysis, or interpretation of findings. All underlying evidence, conclusions, and recommendations are the research team’s own.
21 April 2026