COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey

Abstract

Background Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of 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 We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively. Conclusions In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual’s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care–related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role.

Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron

“…The vaccination rate documented in TriNetX is only about 2%, whereas the reported vaccination rates during this time period 12 indicate that most patients in the study population were likely to have been vaccinated. However, the cohorts were propensity-score matched for EHR-documented vaccination status including vaccine types and booster along with demographics, adverse socioeconomic determinants of health and comorbidities, some of which are associated with vaccination acceptance 13,14 . Finally, the findings apply only to infections that occurred in the US between 12/15/2021-12/24/2021.…”

Sociodemographic and psychological correlates of COVID-19 vaccine hesitancy and resistance in the young adult population in Italy

“…COVID-19 vaccine hesitancy was measured via the following questions: “Did you receive a COVID-19 vaccine?” and “If not, do you intend to receive one?” [22] , [23] . Based on prior research [24] , [25] , participants were classified as “vaccine accepting” if they responded “yes” or “I intend to receive it as soon as possible” 1 , “vaccine hesitant” if they responded “I intend to wait to see how it affects others in the community before I get it” or “I do not intend on getting it soon, but might sometime in the future”, and “vaccine resistant” if they responded “I do not intend to ever get the vaccine”. Participants who chose the “prefer not to answer” response option were excluded from data analysis (see Results section).…”

COVID-19 vaccine effectiveness among immunocompromised populations: a targeted literature review of real-world studies

“…In a recent study of approximately 22,000 US survey respondents with comorbid conditions all participating in an online health community, of whom 27% reported having cancer and 23% reported having an autoimmune disease, approximately 20% expressed COVID-19 vaccine hesitancy [ 57 ]. In light of this finding, in addition to the substantial number of people who have IC conditions and/or take immunosuppressive medications, and the potential for waning COVID-19 VE and emergence of new SARS-CoV-2 variants, it is critical to rapidly advance our understanding of COVID-19 VE and duration of response among IC populations, including specific IC condition groups and IC individuals who have other COVID-19 risk factors (e.g.…”