COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns

Abstract

Background: The global effort to end the Severe Acute Respiratory Syndrome - Coronavirus 2 pandemic will depend on our ability to achieve a high uptake of the highly efficacious vaccines in all countries. India recently experienced an unprecedented transmission surge, likely fueled by a premature reopening, the highly transmissible delta variant, and low vaccination rates. Indian media have reported high degrees of vaccine hesitancy, which could interfere with efforts to prevent future surges, making it crucial to better understand the reasons for such reluctance in vulnerable populations, such as people living with HIV. Methods: We conducted telephone interviews with 438 people living with HIV who were participants in a longitudinal cohort, designed to examine and validate novel antiretroviral therapy ART adherence measures. Interviews were conducted in January and February 2021 and covered COVID-19–related questions on confidence in vaccine safety and efficacy, worries of vaccine side effects, trust in COVID-19 information from specific sources, and intent to get vaccinated. Results: Over one-third of participants (38.4%, n = 168) met our definition of “vaccine hesitant” by reporting being either unlikely to get vaccinated at all or wanting to wait. Vaccine hesitancy was associated with lack of confidence in vaccine safety, concerns about side effects and efficacy, and distrust in common sources of vaccine-related information. Discussion: These results highlight several challenges for vaccination efforts. Campaigns may benefit from using trusted sources, including antiretroviral therapy center staff, providing clear information about safety and efficacy and emphasizing the role of vaccines in preventing severe disease, hospitalizations and death, and the reduction of forward transmission to unvaccinated household members.

COVID-19 Vaccination in People Living with HIV (PLWH) in China: A Cross Sectional Study of Vaccine Hesitancy, Safety, and Immunogenicity

“…We next examined whether the CoronaVac vaccine can elicit a similar humoral response in PLWH compared with HC. Our results supported recent reports that humoral responses elicited by COVID-19 vaccines are comparable in PLWH and HC within 4 weeks [23][24][25], and we further demonstrated a similar outcome over a longer period of time, supporting the current advice for PLWH to be immunized with COVID-19 vaccines. In previous studies, PLWH with CD4 + T cells counts <200 cells/µL have shown diminished SARS-CoV-2 antibody production after acute infection [34], as well as blunted immune responses to multiple vaccine types [35].…”

“…This situation is also observed in other vaccine inoculations, such as vaccines for influenza, human papillomavirus, and hepatitis B virus [21][22][23]. In the previous studies, the rates of vaccine hesitancy among PLWH towards the COVID-19 vaccine ranged from 28.7% to 54% [12,[24][25][26]. Individually, vaccine hesitancy rates in PLWH were highest in black Americans (54%) [25] and were lowest in the French PLWH (28.7%) [12].…”

COVID-19 Vaccine Hesitancy and Associated Factors among People with HIV in the United States: Findings from a National Survey

“…Our study contributes to the limited literature on vaccine hesitancy among the nationwide sample of PWH living in the U.S., revealing most participants having some levels of hesitancy concerning COVID-19 vaccination. Previously reported vaccine hesitancy rates range from 22% to 42.4% among the adult American population [ 5 , 6 , 7 , 31 ] and 27.5% to 38.4% among PWH across various settings [ 32 , 33 , 34 ]. It is troubling that the vaccine hesitancy among PWH in our sample fell on the higher side of these ranges, as the pandemic adversely impacts HIV care with increasing loss to follow-up or disengagement [ 8 , 35 ].…”

“…These included concerns about the efficacy, safety, and side effects of the vaccine. Although COVID-19 vaccine hesitancy among PWH across the globe is still advancing, multiple studies have already highlighted similar findings across various settings [ 32 , 33 , 34 ]. This finding becomes especially relevant in the context of the reported mistrust in COVID-19 or COVID-19 vaccine information sources, which has also been correlated with vaccine hesitancy [ 8 , 32 ].…”

Mitigation strategies to safely conduct HIV treatment research in the context of COVID‐19

“…Vaccination hesitancy may be a barrier to restarting clinical research in PLWH [61,62]. Reasons for hesitancy should be explored and the protective effect of vaccination, including reassuring vaccine safety and efficacy data, shared.…”