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
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.