Pediatric providers deal with vaccine hesitancy and vaccine refusal for routine childhood vaccinations on a regular basis. However, the COVID-19 pandemic has brought challenges for pediatricians including COVID-19 vaccine hesitancy and refusal. Some of the issues surrounding COVID-19 vaccine hesitancy are similar to those associated with routine vaccines, however some are unique to COVID-19. Much of COVID-19 vaccine hesitancy has been because of both the fear of the known and unknown. Identifying these issues and reasons for hesitancy is important to devising strategies and approaches pediatric providers can use to address patient and parent concerns, and hopefully convince them to vaccinate against COVID-19.