COVID-19 vaccine hesitancy among individuals with cancer, autoimmune diseases, and other serious comorbid conditions

Tsai, R.; Hervey, J.; Hoffman, K. D.; Wood, J.; Novack, J.; Johnson, J.; Deighton, D. C.; Loew, B.; Goldberg, S. L.

Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory clinical 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: To assess the incidence and reasons for COVID-19 vaccine hesitancy and to assess early vaccine safety. Design: Cross-sectional online survey, fielded January 15, 2021 through February 22, 2021 Setting: International participation (74% USA) Participants: Random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Measurements: A 55-item online survey Results: 21,943 individuals completed the survey (100% with comorbidities including 27% cancer, 23% autoimmune diseases, 38% chronic lung diseases). 10% declared they would not, 4% stated they probably would not, and 5% were not sure they would agree to vaccination (hesitancy rate 19%). Factors associated with hesitancy included younger age, female gender, black-Pacific-Island-Native American heritage, less formal education, conservative political tendencies, resistance to masks or routine influenza vaccinations, and distrust of media coverage. 5501 (25%) had received at least one COVID-19 vaccine injection, including 29% of US participants. Following the first injection, 69% self-reported local and 40% systemic reactions, which increased following the second injection to 76% and 67%, respectively, with patterns mimicking clinical trials. Limitations: Study was performed early during vaccine availability. Attitudes may change. Conclusion: Nearly one in five individuals with serious comorbid conditions harbor COVID-19 hesitancy. Early safety experiences among those who have been vaccinated should be reassuring.