ABSTRACT
Introduction: The COVID-19 pandemic continues to be a major socioeconomic disruptor worldwide. The intervention that has a far-reaching impact is the adoption of an efficient nationwide vaccination campaign with the effective COVID-19 vaccines. The success of this strategy is dependent on the capacity of the existing healthcare systems and the public vaccine acceptance. Vaccine hesitancy is considered among the top global health threats. Its patterns and intensity vary by geosocial contexts. Due to the roll-out of the vaccine which was followed by the booster dose, we explored the demographic pattern and reasons behind the primary and secondary COVID-19 vaccine hesitancy among our ArkLATX cancer patients. Methods: Two cohorts were used to conduct this study (cohort 1 for primary and Cohort 2 for secondary vaccine hesitancy). An in-person survey of a random sample was conducted across 5 Hematology-Oncology clinics asking the veterans whether they are interested in receiving the initial COVID-19 vaccine and later the booster dose. If the veterans declined, they were asked to state the reason behind their decision. Age, sex, race, and state of residence were captured for each participant. Descriptive statistics were calculated and X2 and logistic regression were carried out to determine the impact of demographic factors on COVID-19 vaccine hesitancy. Results: Cohorts 1&2 consisted of 240 and 303 veterans, respectively. The median age was 71 years. The participants were around 92% male vs 8% female and around 41% Black vs 59% White. In cohort-1, 21% declined due to concerns about safety (33%), not wanting to be the first (33%), anti-vaxxer stance (14%), and inadequate information (8%). Among other reasons (12%), 3 saw no reason for the vaccination, 2 cited severe reactions to prior vaccines, and 1 cited mistrust of the government. In cohort-2, 14% declined booster dose due to concerns about the need (55%) and safety (14%), anti-vax (19%), suspicious (5%), and medical reason and timing (7%). There were no statistical differences between veterans that approved of or declined receiving the vaccine with respect to demographic characteristics. Conclusions: Our survey indicates that the majority of ArkLATX high-risk veterans with cancer are willing to be vaccinated against COVID-19. The major reasons behind vaccine primary and secondary hesitancy seem to be categorized as information issues consisting of questions about safety and the need for the vaccine. For primary hesitancy another major group consisted of a diffusion of innovation late majority that are open to COVID-19 vaccination, but they do not want to be the first to take it. Such barriers can be potentially circumvented by providing the appropriate targeted information campaigns and provider counseling.
ABSTRACT
Introduction: The COVID-19 pandemic continues to be a major socioeconomic disruptor worldwide. The intervention that has a far-reaching impact is a global vaccination campaign with the currently available and highly effective COVID-19 vaccines. Unfortunately, cancer patients are at a higher risk of contracting COVID-19 infection. Furthermore, they tend to experience a higher rate of morbidity and mortality than the general population. Therefore, we conducted this study to explore the efficacy of mRNA COVID-19 vaccines in a cohort of rural veterans with cancer in the ArkLATX. Methods: A cohort of 361 consecutive veterans across 5 Hematology-Oncology clinics were included in this study. An in-person survey was conducted asking the veterans whether they received the COVID-19 vaccine;if so, whether they had any reactions to it;whether they had any COVID-19 infections;and if they were vaccinated whether the infection was pre- or post-vaccination. They were also asked to determine the severity of their infection and their reactions to the vaccine when applicable. Age, sex, and race were captured for each participant. Descriptive statistics were calculated, and X2 and logistic regression were carried out to determine the impact of factors on the outcome and the significance of differences found between the studied subgroups. Results: The cohort consisted of 361 veterans, 303 vaccinated and 58 unvaccinated. The mean ages were 69 and 65 years, respectively. Among the vaccinated, 30% experienced vaccine adverse events, but only 2% reported it as severe. While there were more whites in the unvaccinated, there was no difference by sex. Only 2% of the vaccinated reported post-vaccine COVID19 infections versus 22% of the unvaccinated. One and 2 patients reported severe COVID19 infection in the vaccinated and unvaccinated subgroups, respectively. There was one patient who had a severe COVID19 infection before and after. The absolute and relative risk reduction for COVID19 vaccines were 20% and 91%, respectively. The number of patients needed to vaccinate to prevent one adverse outcome was 5. Conclusions: The current mRNA vaccines showed 91% efficacy at preventing COVID-19 infections in this high-risk rural veteran patient population with cancer. Aside from primarily mild transient local and systemic reactions, no safety concerns were identified by our patients. This real-life patient-reported outcome study confirms the efficacy and safety of COVID19 vaccines found in the general population.
ABSTRACT
Background: In response to COVID-19, the Department of Veterans Affairs (VA) adopted social distancing to slowthe spread of the virus and minimize the risk of viral transmission to its high-risk patients. To help protect veteransand VA providers while ensuring that veterans continue to receive high-quality care, the VA embraced telehealthplatforms such as VVC, where the provider conducts a real-time video visit through a secure connection to thepatients' computer, smart phone, or e-pad. While this platform is touted to be fast and easy, it still requires notabletechnical, skills, and knowledge components to be successful, which can be challenging in an older rural population.The Hematology-Oncology service of the Overton Brooks VA Medical Center embarked on a survey to explore theacceptability and the barriers to VVC care among our cancer patients. Methodology: A phone survey of a random sample was conducted across five Hematology-Oncology clinics askingthe veterans to consent for VVC visits and, if the veteran declined, to indicate the reason behind this decision. Itspecifically asked the veteran to categorize the reason as related to Equipment, Connectivity, Literacy, Privacy, Financial, or Other/Explain. Age, sex, and race characteristics were captured for each participant. Descriptivestatistics and logistic regression were carried out. Results: The sample consisted of 101 veterans from Arkansas, Texas, and Louisiana. The median age was 71 withthe majority between ages 61-85 years. The participants were 96% male vs. 4% female and 45% Black vs. 55%White. Only 13% consented to VVC care. Among the veterans who declined, the reasons were related to lack of theappropriate equipment (53%), lack of adequate connection (14%), literacy (14%), and concerns with privacy (9%).No one cited financial issues. Among those who provided other reasons (10%), the majority did not see theadvantage of VVC over a regular phone call. Except for “Other,” which consisted of 78% White, the rest of thecategories' racial breakdown mirrored the whole sample. Stepwise logistic regression revealed age (p=0.03) to bethe only statistically significant factor that is inversely related to VVC acceptability. Conclusion: These results confirm our experience that the older the veteran, the less the acceptability of VVC care.However, our survey indicates that 86% of the barriers to VVC use can be potentially overcome by providing theappropriate equipment along with education and training. Still, 14% of our veterans lack access to the internet. Withappropriate funding and veteran training, VVC has the potential to play a major role in rural veteran cancer careduring the COVID19 pandemic.