COVID‐19 vaccine hesitancy among patients in two urban emergency departments

Abstract

Background Widespread vaccination is an essential component of the public health response to the COVID‐19 pandemic, yet vaccine hesitancy remains pervasive. This prospective survey investigation aimed to measure the prevalence of vaccine hesitancy in a patient cohort at two urban Emergency Departments (EDs) and characterize underlying factors contributing to hesitancy. Methods Adult ED patients with stable clinical status (Emergency Severity Index 3‐5) and without active COVID‐19 disease or altered mental status were considered for participation. Demographic elements were collected, as well as reported barriers/concerns related to vaccination and trusted sources of health information. Data were collected in‐person via a survey instrument proctored by trained research assistants. Results 1,555 patients were approached, and 1,068 patients completed surveys (completion rate 68.7%). Mean age was 44.1 y (SD 15.5, range 18‐93), 61% were female, and 70% were Black. 31.6% of ED patients reported vaccine hesitancy. Of note, 19.7% of the hesitant cohort were healthcare workers. In multivariable regression analysis, Black race (OR 4.24, 95%CI 2.62‐6.85) and younger age (age 18‐24 y, OR 4.57, 95%CI 2.66‐7.86; age 25‐35 y, OR 5.71, 95% CI 3.71‐8.81) were independently associated with hesitancy, to a greater degree than level of education (high school education or less, OR 2.27, 95%CI 1.23‐4.19). Hesitant patients were significantly less likely to trust governmental sources of vaccine information than non‐hesitant patients (39.6% vs 78.9%, p<0.001); less difference was noted in the domain of trust towards friends/family (51.1% vs. 61.0%, p=0.004). Hesitant patients also reported perceived vaccine safety concerns and perceived insufficient research. Conclusions Vaccine hesitancy is common among ED patients, and more common among Black and younger patients, independent of education level. Hesitant patients report perceived safety concerns and low trust in government information sources, but less so friends or family. This suggests strategies to combat hesitancy may need tailoring to specific populations.

A Stanford Conference on Social Media, Ethics, and COVID-19 Misinformation (INFODEMIC): Qualitative Thematic Analysis

“…In the case of COVID-19, this hesitancy occurs despite an excellent vaccine safety profile. COVID-19 vaccine hesitancy is higher in some demographic groups who have even lower vaccination rates than the general population, demonstrating that the infodemic may disproportionately affect some communities [ 8 , 9 ].…”

Patients’ Perspectives on Emergency Department COVID-19 Vaccination and Vaccination Messaging Through Randomized Vignettes

“…Our findings largely confirm the findings of population-based surveys identifying similar trends among people who remain unvaccinated and vulnerable to COVID-19 [16][17][18][19][20] as well as the 2 previously published ED-based surveys. 10,11 Furthermore, our findings suggest that, as community vaccination campaigns Abbreviations: OR, odds ratio; RRR, relative risk ratio.…”

“…Our findings largely confirm the findings of population-based surveys identifying similar trends among people who remain unvaccinated and vulnerable to COVID-19 16 - 20 as well as the 2 previously published ED-based surveys. 10 , 11 Furthermore, our findings suggest that, as community vaccination campaigns experience challenges in engaging populations with hesitancy or barriers to vaccination, EDs might serve as an important access point to engage patients routinely encountered by EDs for other reasons.…”

“…Two prior ED surveys revealed that the ED might serve a substantial portion of patients who have hesitancy or barriers to vaccination elsewhere and that most ED patients are accepting of vaccination. 10 , 11 One other observational study reported on a successful experience delivering vaccinations to populations at disproportionate risk of poor outcomes from COVID-19 in an ED. 12 Despite these initial encouraging reports, gaps in knowledge remain in understanding ED patients’ perspectives and willingness to accept vaccination according to their prior degree of vaccine hesitancy and in elucidating the optimal messaging to offer vaccinations in clinical settings.…”

Assessing the Profile of Unvaccinated COVID-19 Individuals in African American and Latinx Communities in Eastern Pennsylvania

“…Since vaccine hesitancy is context-specific, recommended mitigation strategies often include engaging with local communities to collectively develop solutions that address their reluctance toward vaccination [7, 8]. Despite several studies being conducted at the national level [7,9,14], few studies have examined factors driving hesitancy among ethnic minorities by state and even fewer for the state of Pennsylvania (PA) [15, 16]. Our research aimed to identify factors influencing vaccine disparities in eastern PA.…”