COVID-19 vaccine hesitancy among individuals with cancer, autoimmune diseases, and other serious comorbid conditions

AbstractBackgroundIndividuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory clinical trials with COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes.MethodsTo assess the incidence and reasons for COVID-19 vaccine hesitancy and to assess early vaccine safety, we conducted a cross-sectional online survey, fielded January 15, 2021 through February 22, 2021, with international participation (74% USA). A random sample of members of Inspire, an⍰online health⍰community⍰of over 2.2⍰million individuals⍰with comorbid conditions, completed a 55-item online survey.Results21,943 individuals completed the survey (100% with comorbidities including 27% cancer, 23% autoimmune diseases, 38% chronic lung diseases). 10% declared they would not, 4% stated they probably would not, and 5% were not sure they would agree to vaccination (hesitancy rate 19%). Factors associated with hesitancy included younger age, female gender, black-Pacific-Island-Native American heritage, less formal education, conservative political tendencies, resistance to masks or routine influenza vaccinations, and distrust of media coverage. 5501 (25%) had received at least one COVID-19 vaccine injection, including 29% of US participants. Following the first injection, 69% self-reported local and 40% systemic reactions, which increased following the second injection to 76% and 67%, respectively, with patterns mimicking clinical trials.ConclusionNearly one in five individuals with serious comorbid conditions harbor COVID-19 hesitancy. Early safety experiences among those who have been vaccinated should be reassuring.HighlightsIndividuals with serious comorbid conditions, including cancer, have been disproportionately affected by COVID-19 and therefore have been prioritized for vaccinationAn online survey of nearly 22,000 individuals with comorbid conditions revealed that nearly one in 5 expressed vaccine hesitancy.Reasons for hesitancy in this comorbid population mimicked surveys of the general population.Self-reported safety profiles among individuals with comorbid conditions were acceptable, and generally milder than reports in clinical trials among the general population.

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COVID-19 vaccine hesitancy among individuals with cancer, autoimmune diseases, and other serious comorbid conditions: A cross-sectional internet-based survey (Preprint)

10.2196/preprints.29872 ◽

2021 ◽

Author(s):

Richard Tsai ◽

John Hervey ◽

Kathleen Hoffman ◽

Jessica Wood ◽

John Novack ◽

...

Keyword(s):

Clinical Trials ◽

Native American ◽

Autoimmune Diseases ◽

Media Coverage ◽

Safety Data ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Comorbid Conditions ◽

Cross Sectional ◽

Chronic Lung Diseases

BACKGROUND Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory clinical trials with COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. OBJECTIVE To assess the incidence and reasons for COVID-19 vaccine hesitancy and to assess early vaccine safety. METHODS We conducted a cross-sectional internet-based survey, fielded January 15, 2021 through February 22, 2021, with international participation (74% USA). A random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions, completed a 55-item online survey. RESULTS 21,943 individuals completed the survey (100% with comorbidities including 27% cancer, 23% autoimmune diseases, 38% chronic lung diseases). 10% declared they would not, 4% stated they probably would not, and 5% were not sure they would agree to vaccination (hesitancy rate 19%). Factors associated with hesitancy included younger age, female gender, black-Pacific-Island-Native American heritage, less formal education, conservative political tendencies, resistance to masks or routine influenza vaccinations, and distrust of media coverage. 5501 (25%) had received at least one COVID-19 vaccine injection, including 29% of US participants. Following the first injection, 69% self-reported local and 40% systemic reactions, which increased following the second injection to 76% and 67%, respectively, with patterns mimicking clinical trials. CONCLUSIONS Nearly one in five individuals with serious comorbid conditions harbor COVID-19 hesitancy. Early safety experiences among those who have been vaccinated should be reassuring.

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Real-World Acceptance of COVID-19 Vaccines among Healthcare Workers in Perinatal Medicine in China

Vaccines ◽

10.3390/vaccines9070704 ◽

2021 ◽

Vol 9 (7) ◽

pp. 704

Author(s):

Biyun Xu ◽

Xuelian Gao ◽

Xinyue Zhang ◽

Yali Hu ◽

Huixia Yang ◽

...

Keyword(s):

General Population ◽

Real World ◽

Healthcare Workers ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Present Survey ◽

Perinatal Medicine ◽

Vaccine Acceptance ◽

Questionnaire Online ◽

Convincing Data

Surveys showed that vaccine hesitancy may influence the acceptance of COVID-19 vaccines in healthcare workers (HCWs) and the general population. Currently, the actual acceptance of COVID-19 vaccination in HCWs has rarely been reported. In the present survey, we investigated the real-world acceptance of COVID-19 vaccination in HCWs in perinatal medicine during the first three-month period of vaccination in China and to identify the main reason for the decline of vaccination. HCWs (1087) who participated in a Chinese national symposium on perinatal medicine during 16–18 April 2021 were invited to answer a 27-question questionnaire online. A total of 1051 HCWs completed the questionnaire. Of them, 86.2% (906/1051) accepted the COVID-19 vaccination and 13.8% (145/1051) declined the vaccination. Because of the vaccine hesitancy, one-fourth of the vaccinated participants did not accept the vaccination until consulted with others or requested by employers. The main reason for the decline of vaccination in 145 unvaccinated HCWs was the concern about vaccine safety. The results indicate that vaccination request by employers may promote vaccine acceptance. More convincing data on the safety of COVID-19 vaccines appears to be important to increase the acceptance of vaccination.

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SARS-CoV-2 mass vaccination: Urgent questions on vaccine safety that demand answers from international health agencies, regulatory authorities, governments and vaccine developers

10.22541/au.162136772.22862058/v2 ◽

2021 ◽

Author(s):

Roxana Bruno ◽

Peter A Mccullough ◽

Teresa Forcades I Vila ◽

Alexandra Henrion-Caude ◽

Teresa García-Gasca ◽

...

Keyword(s):

Clinical Trials ◽

Adverse Effects ◽

Risk Mitigation ◽

Safety Data ◽

Vaccine Safety ◽

Endothelial Damage ◽

Mass Vaccination ◽

High Rate ◽

Public Confidence ◽

World Population

Since the start of the COVID-19 outbreak, the race for testing new platforms designed to confer immunity against SARS-CoV-2, has been rampant and unprecedented, leading to conditional emergency authorization of various vaccines. Despite progress on early multidrug therapy for COVID-19 patients, the current mandate is to immunize the world population as quickly as possible. The lack of thorough testing in animals prior to clinical trials, and authorization based on safety data generated during trials that lasted less than 3.5 months, raise questions regarding vaccine safety. The recently identified role of SARS-CoV-2 Spike glycoprotein for inducing endothelial damage characteristic of COVID-19, even in absence of infection, is extremely relevant given that most of the authorized vaccines induce endogenous production of Spike. Given the high rate of occurrence of adverse effects that have been reported to date, as well as the potential for vaccine-driven disease enhancement, Th2-immunopathology, autoimmunity, and immune evasion, there is a need for a better understanding of the benefits and risks of mass vaccination, particularly in groups excluded from clinical trials. Despite calls for caution, the risks of SARS-CoV-2 vaccination have been minimized or ignored by health organizations and government authorities. As for any investigational biomedical program, data safety monitoring boards (DSMB) and event adjudication committees (EAC), should be enacting risk mitigation. If DSMBs and EACs do not do so, we will call for a pause in mass vaccination. If DSMBs and EACs do not exist, then vaccination should be halted immediately, in particular for demographic groups at highest risk of vaccine-associated death or serious adverse effects, during such time as it takes to assemble these boards and commence critical and independent assessments. We urge for pluralistic dialogue in the context of health policies, emphasizing critical questions that require urgent answers, particularly if we wish to avoid a global erosion of public confidence in science and public health.

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Determinants of COVID-19 Vaccination Willingness among Health Care Workers: A Quick Online Survey in India

Korean Journal of Family Medicine ◽

10.4082/kjfm.21.0071 ◽

2021 ◽

Vol 42 (6) ◽

pp. 445-452

Author(s):

Rajesh Kumar ◽

Kalpana Beniwal ◽

Yogesh Bahurupi ◽

Ravi Kant ◽

Mukesh Bairwa

Keyword(s):

Health Care ◽

Health Care Workers ◽

Perceived Risk ◽

Online Survey ◽

Vaccine Safety ◽

Economic Effects ◽

Vaccine Hesitancy ◽

Multinomial Regression ◽

Chi Square ◽

Care Workers

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused a large number of deaths along with severe socio-economic effects. The vaccine is considered to be the last hope to control viral transmission. This study aimed to explore the determinants of health care workers’ (HCWs) willingness to take the COVID-19 vaccination.Methods: A structured, pre-validated, and pre-tested questionnaire was administered online to 599 HCWs including physicians, residents, and nurses from different types of healthcare set-ups across India. Information was collected regarding vaccine acceptability, attitude toward vaccination, and reasons for hesitancy. The chi-square test, followed by multinomial regression analysis, was applied to determine the factors associated with HCWs’ vaccination willingness.Results: It was found that 73 % (n=437) of HCWs were willing to accept the vaccines, while 10.85% (n=65) refused and 16.2% (n=96) needed more time to decide. Gender (P<0.001), occupation (P=0.040), working as front-line workers (P=0.008), vaccine manufacturing country preferences (P<0.001), and perceived risk of catching COVID-19 in the next 6 months (P=0.005) had a significant association with intent to receive vaccination (the response were “yes” vs. “no” and “not sure”). The reasons for vaccine hesitancy were vaccine safety and efficacy concerns, antivaccine attitude and beliefs, personal choice, and not wanting to take a vaccine before others.Conclusion: The majority of HCWs agreed to take COVID-19 vaccines once available. Nevertheless, providing support to manage evolving vaccine environments will help change the perception of HCWs who refuse or are reluctant to take the vaccines.

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SARS-CoV-2 mass vaccination: Urgent questions on vaccine safety that demand answers from international health agencies, regulatory authorities, governments and vaccine developers

10.22541/au.162136772.22862058/v1 ◽

2021 ◽

Author(s):

Karina Acevedo-Whitehouse ◽

Roxana Bruno ◽

Peter A Mccullough ◽

Teresa Forcades I Vila ◽

Alexandra Henrion-Caude ◽

...

Keyword(s):

Clinical Trials ◽

Adverse Effects ◽

Risk Mitigation ◽

Safety Data ◽

Vaccine Safety ◽

Endothelial Damage ◽

Mass Vaccination ◽

High Rate ◽

Public Confidence ◽

World Population

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Public Willingness and Determinants of COVID-19 Vaccination at the Initial Stage of Mass Vaccination in China

Vaccines ◽

10.3390/vaccines9101172 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1172

Author(s):

Yi-Miao Zhao ◽

Lin Liu ◽

Jie Sun ◽

Wei Yan ◽

Kai Yuan ◽

...

Keyword(s):

Social Media ◽

Online Survey ◽

Multinomial Logistic Regression ◽

Vaccine Safety ◽

High Income ◽

Vaccine Hesitancy ◽

Depression Symptoms ◽

Middle Aged ◽

The Government ◽

Vaccine Information

The present study assessed the willingness of the general population to receive COVID-19 vaccines and identified factors that influence vaccine hesitancy and resistance. A national online survey was conducted from 29 January 2021 to 26 April 2021 in China. Multinomial logistic regression analyses were conducted to identify factors that influence vaccine hesitancy and resistance. Of the 34,041 participants surveyed, 18,810 (55.3%) were willing to get vaccinated, 13,736 (40.3%) were hesitant, and 1495 (4.4%) were resistant. Rates of vaccine acceptance increased over time, with geographical discrepancies in vaccine hesitancy and resistance between provinces in China. Vaccine safety was the greatest concern expressed by most participants (24,461 [71.9%]), and the major reason for participants’ refusing vaccination (974 [65.2%]). Government agencies (23,131 [68.0%]) and social media (20,967 [61.6%]) were the main sources of COVID-19 vaccine information. Compared with vaccination acceptance, female, young and middle-aged, high income, and perceived low-risk of infection were associated with vaccine hesitancy. Histories of allergic reactions to other vaccines and depression symptoms were related to vaccine resistance. Common factors that influenced vaccine hesitancy and resistance were residing in cities and perceiving less protection with vaccines than with other protective measures. The results indicate that the rate of vaccine resistance is relatively low, but vaccine hesitancy is common. Individuals who are female, young and middle-aged, with a high income, and residing in cities are more likely to be hesitant for vaccination and should be the target populations for vaccination campaigns. Specific vaccine messaging from the government and social media could alleviate public concerns about vaccine safety and efficacy.

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Attitudes and Intentions toward COVID-19 Vaccination among Health Professions Students and Faculty in Qatar

Vaccines ◽

10.3390/vaccines9111275 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1275

Author(s):

Amine Zaidi ◽

Amal Elmasaad ◽

Hend Alobaidli ◽

Rana Sayed ◽

Dana Al-Ali ◽

...

Keyword(s):

Online Survey ◽

Health Professions ◽

Vaccine Safety ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Natural Immunity ◽

Cross Sectional ◽

The Impact ◽

To Receive

A population’s desire to take the COVID-19 vaccine is an important predictor of a country’s future pandemic management. This cross-sectional study examines the impact of psychological and sociodemographic factors on attitudes toward and intentions to take the COVID-19 vaccine among students and faculty at four colleges of health professions and sciences at Qatar University. The data were collected through an online survey using Google Forms. The survey was distributed through various online platforms. Data analysis was conducted using Stata 16. Of the 364 participants, 9.89% expressed a high mistrust of vaccine safety, and 21.7% were uncertain about their levels of trust; 28% expressed strong worries about unforeseen side effects, whereas 54.95% expressed moderate worries. Furthermore, 7.69% expressed strong concerns and 39.84% showed moderate concerns about commercial profiteering. Approximately 13% of the participants expressed a strong preference towards natural immunity, whilst 45.33% appeared to believe that natural immunity might be better than a vaccine. Importantly, 68.13% of the participants intended to receive the COVID-19 vaccine once it became available, compared to 17.03% who were uncertain and 14.83% who were unwilling to be vaccinated. Our findings differ from the data on vaccine hesitancy among the general population of Qatar. We argue that this gap is due to scientific knowledge and domain of education. Furthermore, although knowledge and awareness may affect vaccine attitudes, mental health and sociodemographic factors play a role in shaping attitudes towards vaccines.

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Estimating vaccine confidence levels among future healthcare workers and their trainers: A quantitative study protocol

10.1101/2021.02.03.21251068 ◽

2021 ◽

Author(s):

Elizabeth O. Oduwole ◽

Hassan Mahomed ◽

Birhanu T. Ayele ◽

Charles S. Wiysonge

Keyword(s):

Healthcare Workers ◽

Online Survey ◽

Multinomial Logistic Regression ◽

Statistical Significance ◽

Vaccine Hesitancy ◽

P Value ◽

List Type ◽

Confidence Levels ◽

Vaccine Confidence ◽

To Receive

ABSTRACTIntroductionThe outbreak of novel coronavirus disease 2019 (COVID-19) caught the world off guard in the first quarter of the year 2020. To stem the tide of this pandemic, the development, testing, and pre-licensure approval for emergency use of some COVID 19 vaccine candidates were accelerated. This led to raised public concern about their safety and efficacy, compounding the challenges of vaccine hesitancy which was already declared one of the top ten threats to global health in the year 2019. The onus of managing and administering these vaccines to a skeptical populace when they do become available rests mostly on the shoulders of healthcare workers (HCWs). Therefore, the vaccine confidence levels of HCWs becomes critical to the success of vaccination endeavors, especially COVID 19 vaccination. This proposed study aims to estimate the level of vaccine confidence and the intention to receive a COVID 19 vaccine among future HCWs and their trainers at a specific university in Cape Town, South Africa, and to identify any vaccination concerns early for targeted intervention.Methods and analysisAn online survey will be distributed to current staff and students of an academic institution for HCWs. The survey questionnaire will consist of a demographic questions section consisting of six items and a vaccine confidence section comprising six items in Likert scale format.A multinomial logistic regression model will be employed to identify factors associated with vaccine confidence and intention. The strength of association will be assessed using odds ratio and its 95% confidence interval. Statistical significance will be defined at a p-value <0.05.Ethics and disseminationEthics approval has been obtained for the study from Stellenbosch University (HREC Reference # S19/01/014 (PhD)). The results will be shared with relevant health authorities, presented at conferences, and published in a peer-reviewed journal.ARTICLE SUMMARYStrengths and limitations of this study▸The proposed study will generate baseline knowledge of the vaccine confidence among future healthcare workers and their trainers in its specific context.▸It will contribute to addressing the knowledge gap about the intention to receive a COVID 19 vaccine among health care workers in Africa.▸It will enable the early identification of vaccine concerns of healthcare workers while they are still in training and assist in informing tailored measures to address them.▸A limitation of the study is the possibility of a low response rate which is an inherent challenge of online surveys.

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Predictors of COVID-19 Vaccine Acceptance, Intention, and Hesitancy: A Scoping Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.698111 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ashish Joshi ◽

Mahima Kaur ◽

Ritika Kaur ◽

Ashoo Grover ◽

Denis Nash ◽

...

Keyword(s):

Risk Perception ◽

General Population ◽

Vaccine Coverage ◽

Average Rate ◽

Vaccine Safety ◽

Demographic Variables ◽

Vaccine Hesitancy ◽

Vaccine Acceptance ◽

Large Variability ◽

Tailored Interventions

COVID-19 vaccine is regarded as the most promising means of limiting the spread of or eliminating the pandemic. The success of this strategy will rely on the rate of vaccine acceptance globally. The study aims to examine the factors that influence COVID-19 vaccine acceptance, intention, and hesitancy. PubMed was searched comprehensively for articles using the keyword “COVID-19 vaccine surveys.” Of the 192 records, 22 studies were eligible for the review. Eighty-two percent of these studies were conducted among the general population. Gender, age, education, and occupation were some of the socio-demographic variables associated with vaccine acceptance. Variables such as trust in authorities, risk perception of COVID-19 infection, vaccine efficacy, current or previous influenza vaccination, and vaccine safety affected vaccine acceptance. Globally, in March 2020, the average vaccine acceptance observed was 86% which dropped to 54% in July 2020 which later increased to 72% in September 2020. Globally, the average rate of vaccine hesitancy in April 2020 was 21%, which increased to 36% in July 2020 and later declined to 16% in October 2020. Large variability in vaccine acceptance and high vaccine hesitancy can influence the efforts to eliminate the COVID-19. Addressing the barriers and facilitators of vaccines will be crucial in implementing effective and tailored interventions to attain maximum vaccine coverage.

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COVID-19 vaccine hesitancy and vaccine passports: Vaccination or restriction?

10.1101/2021.09.15.21263559 ◽

2021 ◽

Author(s):

Shohei Okamoto ◽

Kazuki Kamimura ◽

Kohei Komamura

Keyword(s):

Public Health ◽

Side Effects ◽

Online Survey ◽

Ethical Issues ◽

Herd Immunity ◽

Vaccine Safety ◽

Careful Consideration ◽

Vaccine Hesitancy ◽

Global Pandemic ◽

Novel Coronavirus

Objectives: While the development of vaccines against the novel coronavirus (COVID-19) brought the hope of establishing herd immunity, which might help end the global pandemic, vaccine hesitancy can hinder the progress towards herd immunity. In this study, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of vaccine passports in relaxing public health restrictions. Methods: Through an online survey that includes a conjoint experiment of a demographically representative sample of 5,000 Japanese adults aged 20-74, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of hypothetical vaccine passports. Results: We found that about 30% of respondents did not intend to vaccinate or have not yet decided, with major reasons for vaccine hesitancy being related to concerns about the safety and side effects of the vaccine. In line with previous findings, younger age, lower socioeconomic status, and psychological factors such as weaker COVID-19 fear were associated with vaccine hesitancy. The easing of public health restrictions such as travel, wearing face masks, and dining out at night was associated with an increase in vaccine acceptance by 4-10%. Conclusion: Vaccine hesitancy can be reduced by mitigating the concerns about vaccine safety and side effects, as well as by relaxing public health restrictions. However, the feasibility of vaccine passports needs to be sufficiently assessed, taking the ethical issues of passports and the public health impacts of the relaxation of restrictions into careful consideration.

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