International Practices on COVID-19 Vaccine Mandates for Transplant Candidates

Abstract

Background. The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods. We administered an electronic survey to staff at transplant centers outside the United States (10/14/21-0½8/22) addressing the reasons cited by transplant centers for or against implementing a vaccine mandate. Each responding center was represented once in the analysis. Results. Respondents (n=90) represented 27 countries on 5 continents. Half (51%) of responding transplant center representatives reported implementing a vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pre-transplant vaccination versus post-transplant, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status, and regardless of pre-vaccination spike-protein antibody titer or other markers or prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure to transplant candidates, insufficient evidence to support vaccine mandate, equity, and legal considerations. Conclusions. The approach to pre-transplant COVID-19 vaccination mandate policies in centers outside the United States is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.

Comparison of outcomes in vaccinated versus unvaccinated COVID‐19 kidney transplant recipients, a single center retrospective study—Is the taboo justified?

“…4,5 This led many centers to halt transplants during the peak of the pandemic and implement vaccine mandates. 4,5 The 1-year mortality pre-COVID is reported to be 15%-20%, and the 5-year mortality is 50% in the ESRD population. 14 There is also a significant impact on the quality-of-life and other comorbidities while on dialysis.…”

“…4,5 It might mean waiting for a deceased donor rather than receiving a living donor transplant. 4,5 It can also effect transplants outcomes as sometimes these patients must travel many miles to a transplant center that accepts them despite their vaccine status. 4,5 The repeated delivery of consistent, clear, and pertinent information regarding SARS-CoV-2 and the COVID-19 vaccines from trusted healthcare providers and organizations/societies can decrease vaccine hesitancy in this higher-risk cohort.…”

“…4,5 Centers not implementing a vaccine mandate cited reasons including undue pressure on transplant candidates, administrative, insufficient evidence to support vaccine mandates, equity, and legal considerations. 4,5 The primary reasons for COVID-19 vaccine hesitancy include concerns about rushed vaccine development, limited data on long-term vaccine safety, variation in recommendations provided by governmental organizations/healthcare professionals, social-racial inequities, and perceptions of vaccination of those underrepresented in SOT programs. [6][7][8] The gravity of the problem of COVID-19 has reduced.…”

“…States and internationally are inconsistent in vaccination policies. 4,5 Our study builds on previous studies that compared data in SOT recipients based on their COVID-19 vaccination status. [9][10][11][12] Our study differs from previous studies as it has a longer follow-up period and includes transplant recipients earlier in the post-transplant period when immunosuppression is highest.…”

“…5 The rationale for the mandates included the efficacy of pretransplant vaccination, importance of public health, stewardship obligations to ensure organs were transplanted into lowest risk patients, and minimizing risks of exposure to caregivers. 4,5 Centers not implementing a vaccine mandate cited reasons including undue pressure on transplant candidates, administrative, insufficient evidence to support vaccine mandates, equity, and legal considerations. 4,5 The primary reasons for COVID-19 vaccine hesitancy include concerns about rushed vaccine development, limited data on long-term vaccine safety, variation in recommendations provided by governmental organizations/healthcare professionals, social-racial inequities, and perceptions of vaccination of those underrepresented in SOT programs.…”