JMIR Publications

ABSTRACT

Background:

Background:

Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials with 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:

Objective:

We sought to assess the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities, and to assess self-reported side-effects among those who had received the vaccine.

Methods:

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:

Results:

Of the 996,500 members of the Inspire health community who were invited to participate responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (74% USA), had a median age range 56-65 years, were highly educated (60% holding college or post-graduate degrees), and had diverse political leanings. All respondents self-reported at least one co-morbidity, with 27% having cancer, 23% autoimmune diseases, and 38% chronic lung diseases. COVID-19 vaccine hesitancy was identified in 18.6%, with 2190 (10.3%) declaring that they would not, 742 (3.4%) stating that they probably would not, and 1028 (4.8%) not sure whether they would agree to be vaccinated. Hesitancy was expressed by 13.4% cancer patients, 19.4% with autoimmune diseases, and 17.8% with chronic lung diseases. Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio 1.53), trust in responsible vaccine development (odds ratio 14.04), residing in the USA (odds ratio 1.31) and never smoker status (odds ratio 1.06). Hesitancy was increased with a history of prior COVID-19 (odds ratio .86), conservative political leaning (odds ratio .93), younger age (odds ratio .83), and lower education level (odds ratio .90). One quarter (5501 participants) had received at least one COVID-19 vaccine injection and 1390 (6.2%) completed a two-dose series. Following the first injection, 69% self-reported local and 40% systemic reactions, which increased following the second injection to 76% and 67%, respectively.

Conclusions:

Conclusions:

In this survey of individuals with serious comorbid conditions significant vaccine hesitancy remains. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for healthcare 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 have already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Healthcare related social media forums which rapidly disseminate accurate information about the COVID-19 vaccine may play an important role.