Race, trust, and COVID-19 vaccine hesitancy in people with opioid use disorder.

Abstract

Objective: Vaccination against coronavirus disease 2019 (COVID-19) is a promising avenue for arresting the COVID-19 pandemic, yet suboptimal rates of vaccine uptake in at-risk groups may hinder efficacy and worsen existing health disparities. People with opioid use disorder (OUD) are likely to face increased vulnerability to COVID-19 due to a confluence of biological and social risk factors. We sought to assess factors associated with willingness to vaccinate against COVID-19 in people with OUD. Method: Phone surveys were conducted from May to October 2020 with participants enrolled in an urban methadone maintenance program (MMP). Participants were adults who met DSM–5 criteria for OUD and reported injection drug use or sexual risk behavior. Participants were asked about their willingness to receive a highly or partially effective vaccine. Provider trust was assessed using the Trust in Physician scale. Multinomial regression was used to assess demographic and psychosocial factors related to vaccination willingness. Results: We surveyed 109 people with OUD enrolled in a MMP (M = 47 years; 56% women; 59% White, 23% Black/African American, 14.4% Hispanic/Latinx; 1.8% other). Participants who identified as Black or African American were significantly less likely to endorse willingness to use a partially effective COVID-19 vaccine (adjusted odds ratio [aOR] = .10; 95% confidence interval (CI) [.02, .61], p = .012), although not necessarily less willing to receive a highly effective vaccine (aOR = .40; 95% CI [.09, 1.73], p = .219; n.s.). Trust in physician was positively associated with willingness to use a partially effective vaccine (aOR = 1.12; 95% CI [1.02, 1.23], p = .017), but was not significantly associated with willingness to receive a highly effective vaccine (aOR = 1.07; 95% CI [.98, 1.16], p = .162, n.s) Conclusions: Proactive outreach from trustworthy sources will be needed to counter vaccine hesitancy in people with OUD, especially among Black Americans with OUD.

COVID‐19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain

“…Previous studies on vaccine intentions related to the COVID‐19 vaccine in developed countries showed an acceptance rate of less than half among people with OUD, mainly related to concerns about vaccine safety [ 17 , 18 , 19 ]. The higher vaccination rates in this study may be explained by the fact that people were engaged in opioid agonist therapy, which is a factor that has been associated with increased uptake of other vaccines among people with OUD [ 16 , 25 ].…”

“…However, they are a population characterised by low‐estimated vaccination coverage for other recommended vaccines, including pneumococcal, diphteria, tetanus and pertussis vaccine, hepatitis A, hepatitis B and influenza [ 14 , 15 , 16 ]. In the case of the COVID‐19 vaccine, previous studies regarding the vaccine roll‐out in developed countries have shown a high prevalence of hesitancy among people with SUD [ 17 , 18 , 19 ]. Data from an Australian National Drug Surveillance System showed that only 57% of the people who inject drugs would definitely or probably receive a COVID‐19 vaccine if available, which was significantly lower than the 77% observed in the broader Australian population [ 17 ].…”

“…Less than half of the individuals from a Californian residential SUD treatment program trusted that a COVID‐19 vaccine would be safe and effective [ 18 ]. Finally, in an American methadone clinic, one‐fifth of the individuals were unwilling to be vaccinated, especially subjects who were Black [ 19 ].…”

Creating Evidence Driven Practices to Enhance Human Care Services for Unhoused and Low-Income Pet Owners

“…Unable to leave their animals unattended, pet owners chose to forego their own health, often saying "pet before self". 1 , 6 SVO's Advantage: Capitalizing on the Human/Pet Bond and a Trusting Relationship Research literature has repeatedly identi ed trust as the key component to a strong, positive patient/provider relationship 8,9 . Patients who trust their care providers are more likely to follow medical advice and seek support.…”

“…Indeed, in the last couple of years, this has been seen most clearly in the realm of COVID-19 information. The widespread, often con icting information on the disease, who it impacts, the veracity of the vaccines and what evidence is a reliable guide to addressing the pandemic has created confusion and reluctance in a large portion of our society [8][9][10] . People of color, those who have historically suffered from racial injustices in the healthcare system, have been overwhelmingly reticent about medically endorsed COVID-19 safety precautions and vaccinations [11][12][13] .…”