Hesitancy toward the Full COVID-19 Vaccination among Kidney, Liver and Lung Transplant Recipients in Italy

Abstract

Background: Coronavirus disease 2019 (COVID-19) vaccination hesitancy is a threat as COVID-19 vaccines have reduced both viral transmission and virus-associated mortality rates, particularly in high-risk subgroups. Solid organ transplant recipients (SOTRs) are particularly vulnerable, as the underlying causes of their organ failure and the chronic immunosuppression are associated with a lower immune response to COVID-19 vaccines, and with an excessive risk of death due to SARS-CoV-2 infection. We aimed to evaluate COVID-19 vaccination hesitancy and its reasons in a population of SOTRs. Methods: All the SOTRs attending our post-transplant clinics were asked to fill in a vaccination status form with specific validated questions related to their willingness to receive a third vaccine dose. In the case of negative answers, the patients were encouraged to explain the reasons for their refusal. Among the SOTRs (1899), 1019 were investigated (53.7%). Results: Overall, 5.01% (51/1019) of the SOTRs raised concerns regarding the future third dose vaccination. In more detail, hesitancy rates were 3.3% (15/453), 4.2% (7/166), and 7.3% (29/400) among the investigated liver, lung, and kidney transplant recipients, respectively (p = 0.0018). The main reasons for hesitancy were fear of adverse events (30/51, 58.8%) and perceived lack of efficacy (21/51, 41.2%). Conclusions: Full adherence to ongoing or future vaccination campaigns is crucial to prevent, or at least reduce, COVID-19-related morbidity and mortality in fragile patients. The identification of the reasons influencing COVID-19 vaccination hesitancy in these patients is very important to establish appropriate and targeted patient–doctor communication strategies, and to further implement specific vaccination campaigns.

Long-Term Assessment of Antibody Response to COVID-19 Vaccination in People with Cystic Fibrosis and Solid Organ Transplantation

“…Reasons for this hesitancy have yet to be investigated. An Italian working group conducted a questionnaire study in which fear of adverse events and perceived lack of efficacy were found to be the main reasons for hesitancy [ 24 ]. Although less than half of the patients received a fourth vaccination, half of them had a COVID-19 infection during the observation period.…”

Perceptions of COVID-19 Vaccination among Organ Transplant Recipients

“…In May 2021 in China, 77.2% of 813 OTR surveyed were classified as vaccine-hesitant, and only 5.7% were vaccinated at the time [22]. On the contrary, in early 2022, of 1019 OTR surveyed at a single center in Italy who had already received 2 immunizations and were eligible for a third, only 5% were considered hesitant [9].…”

“…Vaccine hesitancy encompasses a spectrum of beliefs that result in indecision, ambivalence, or resistance to a given vaccine. Its wide range of causes includes barriers to access, medical misinformation or lack of information, concerns regarding adverse effects, administration mechanisms, efficacy against infection, and mistrust in the medical system, drug testing process, or the state [8][9][10].…”

Vaccination in kidney disease: what did we learn from COVID-19 pandemic

“…Although patients with CKD were prioritized during vaccination rollout, vaccine hesitancy, shortages and mass vaccine distribution challenges were reported to be barriers to successful achievement of global vaccination rates [75]. Similar to data from the general population, surveys conducted among dialysis patients as well as kidney transplant recipients include a lack of confidence in vaccine efficacy, concerns about safety, scepticism about healthcare systems [76,77].…”