Improvement in COVID-19 Vaccine Hesitancy Rates Between 2020-2021 in an Inner-City Dialysis Population and Associated Factors

ABSTRACT

Background: Studying how vaccination hesitancy has changed since the onset of the pandemic and understanding what changed people's opinions could help improve vaccination rate in susceptible populations with high background refusal rates. Method(s) Randomly selected hemodialysis patients in an inner-City Unit were surveyed in 2020 (19 by telephone) and 2021 (31 face to face) about vaccination history and attitudes towards vaccines. In 2020 participants were asked if they would receive a COVID-19 vaccine if available and in 2021 if they had received the vaccine. Respondents who planned to received the vaccine (2020) or received one or both doses (2021) were counted as VACYES while those who were unsure or refused were classified as VACNO. Respondents were also asked their primary reasons for their choice. Result(s) The 2021 group had a mean age of 56.1 +/- 17.9 yrs., mean time on dialysis was 6.2 +/- 7.2 yrs. There were 18 (58%) women and 13 (42%) men, 28 (90%) identified as black. The 2020 and 2021 groups were similar with respect to age, time on dialysis, sex, and race. In 2020, 21% were classified as VACYES compared to 84% of the 2021 sample (p < 0.001). Among VACNO pts the most commonly cited reason was "Safety" (80%). Between vaccinated and unvaccinated patients in 2021, there were no statistically significant differences with respect to age, time on dialysis, sex, race, education, insurance status and presence of diabetes. Among VACYES pts. the three most commonly cited reasons for their choice were "Recommended for people with underlying conditions" (38%), "Trust in healthcare" (45%), and "Safety of the vaccine" (44%). Conclusion(s) In our inner-city population 1. Although people in our catchment have a low vaccination rate the majority of the dialysis population studied received the vaccine despite initial hesitancy. 2. Recommendations related to underlying conditions, improved confidence in the safety of the vaccine and trust in healthcare were the most important reasons for acceptance. 3. With vaccine efforts still underway, education programs should continue to focus on stressing the importance in people with underlying conditions, improving patient-provider partnering, and disseminating information regarding vaccine safety in order to improve adherence in our kidney disease patients, in whom almost 20% remain unvaccinated.