In a recent study published on medRxiv*preprint server, researchers examined uptake and hesitancy of the coronavirus disease 2019 (COVID-19) vaccine among people with chronic or severe health conditions.
Studies have reported that one in three people aged 16 or over suffers from a chronic disease. These medically vulnerable people are at high risk of serious complications and death from COVID-19. The most effective defense against the COVID-19 pandemic has been vaccines against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since its advent, vaccination against COVID-19 has had a significant impact on public health. Healthcare workers and vulnerable populations were first prioritized, and gradually the immunization program was expanded to cover different population groups.
Nevertheless, several countries have encountered difficulties in vaccinating populations and reluctance to vaccinate has increased considerably, including among the susceptible population. In 2019, the World Health Organization (WHO) ranked vaccine hesitancy as one of the top public health threats. As with vaccination against SARS-CoV-2, reports have suggested that up to half of the general population is skeptical of vaccination with regional variability.
Study: Serious Underlying Medical Conditions and COVID-19 Vaccine Hesitancy. Image Credit: FrankHH/Shutterstock
About the study
In the current study, researchers assessed SARS-CoV-2 vaccine intention, uptake, and hesitancy to understand general and disease-associated beliefs in people with diabetes, cancer, and multiple sclerosis. plates (SEP).
The study was conducted in four Australian states with a population of 4.9 million. The investigation began on June 30, 2021 and ended on October 5, 2021, a period that was marked by various lockdowns and vaccine deployments.
Eligible participants were 18 years of age or older and had past or current diagnoses of MS, diabetes, or solid organ/hematological malignancy. Demographic factors such as age, education, gender, household income bracket, and clinical parameters such as time since diagnosis and current treatment were studied.
The Oxford COVID-19 Vaccine Hesitancy Scale, a measure of vaccine uptake willingness, was adapted with minor modifications in which a higher score indicated greater hesitancy. On the 14-item Oxford COVID-19 Vaccine Confidence and Commitment Scale, 11 items were adapted for the present study, with higher scores reflecting a negative vaccination attitude. A Disease-Influenced Vaccine Acceptance Scale 6 (DIVAS-6) assessed vaccine-related views stemming from concerns about underlying conditions and patient treatment.
Differences in demographic and individual scale items were assessed using chi-square tests and independent samples t-tests. Logistic regression analysis determined whether the scales could predict vaccine status, and linear regression analysis was performed to assess whether total and subscale scores of the Oxford scales could predict vaccine acceptance.
Survey timeline for each health service and participant group, with Australian state government COVID-19 lockdowns incorporated into the study site survey period. years = years; MS = multiple sclerosis; ATAGI = Australian Immunization Technical Advisory Group; TGA = Administration of Therapeutic Goods. Australian Government Vaccine Deployment Phase Population Group Eligibility: Phase 1A Deployment = Quarantine and Border Workers, Healthcare Workers, Elderly and Disabled Residents and Staff; Phase 1B deployment = adults aged 70+, Aboriginal and Torres Strait Islander aged 55+, adults with underlying health conditions, other critical and high-risk workers; Phase 2A Deployment = Adults 50+, Aboriginal and Torres Strait Islander 18+.
4,683 responses were analyzed after removing duplicate, incomplete or ineligible responses. Of these, 3,560 responses came from cancer patients, 842 from people with diabetes and 281 from MS patients. Breast cancer (27.7%) was the most common type and more than half of cancer patients were currently receiving treatment. Type 2 diabetes was the most common (66.2%) among diabetic patients, and more than 98% of them were currently receiving treatment.
More than 81% of participants had received at least one SARS-CoV-2 vaccine, which is similar to the national average. No statistically significant differences were found in vaccination coverage among disease types. About 90% of participants mentioned they had or would accept the SARS-CoV-2 vaccine, 5.8% said they were unsure and 4.3% were hesitant. About 52% of unvaccinated participants expressed willingness to be vaccinated and 22.7% expressed hesitation. Unvaccinated subjects scored significantly higher on the Oxford Hesitation Scale, regardless of disease type.
Similarly, unvaccinated respondents had higher scores on the trust and complacency scale, pointing to a negative attitude towards COVID-19 vaccination. Overall, 60.6% of participants were concerned about SARS-CoV-2 infection and 69.9% of respondents felt that vaccination was necessary due to the presence of underlying medical conditions.
Many participants (44%) were concerned about the effectiveness of vaccines because of the underlying condition, while 39.6% (or 25.7%) were concerned about the effect of vaccines on their disease (or its treatment). Unvaccinated subjects scored higher on the DIVAS-6 total and subscale scores, reflecting greater complacency for SARS-CoV-2 infection, concerns about vaccine efficacy, and effect of vaccines on their health or treatment.
The authors observed that underlying health conditions significantly influenced uptake and attitude towards COVID-19 vaccines. The type and degree of concern was shared by the three disease groups. Given intrinsic vulnerability, vaccine hesitancy was lower in the study cohorts than in the general population. Overall, the study population exhibited a high vaccination rate and expressed a positive intention to vaccinate, which was influenced by their concerns about the impact of COVID-19 on their underlying medical conditions. .
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.
- Serious underlying medical conditions and COVID-19 vaccine hesitancy.Daphne Day, Lisa Grech, Mike Nguyen, Nathan Bain, Alastair Kwok, Sam Harris, Hieu Chau, Bryan Chan, Richard Blennerhassett, Louise Nott, Nada Hamad, Annette Tognela, David Hoffman, Amelia McCartney, Kate Webber, Jennifer Wong, Craig Underhill, Brett Sillars, Antony Winkel, Mark Savage, Bao Sheng Loe, Daniel Freeman, Eva Segelov, medRxiv 2022 preprint, DOI: https://doi.org/10.1101/ 2022.04.06.22273080, https://www.medrxiv.org/content/10.1101/2022.04.06.22273080v1