COVID-19 vaccine hesitancy among Tunisian cancer patients in the Salah Azaeiz Institute of Cancer

Abstract

Background Vaccination against SARS-CoV-2 is the most effective way to stop the pandemic and to avoid its related deaths. COVID-19 vaccine hesitancy, represent now a major hurdle to achieve herd immunity. Cancer patients constitute a prioritized group for COVID-19 vaccination as they are particularly vulnerable to severe infection and death. The aim of this study was to assess vaccine hesitancy among cancer patients of the Salah Azaiez Institute (SAI) of cancer and to identify its knowledge and attitudes associated factors. Methods A cross sectional study was conducted among all inpatients aged above 18 years old during the month of February 2021. Participants were asked according to a well-structured questionnaire about knowledge (vaccine literacy) and attitudes towards COVID-19 vaccine. Vaccine literacy was assed using two scales (functional and interactive-critical scales) for which a global score was calculated ranging from 1 to 4. A lower score corresponding to lower vaccine literacy. Chi square test and student's t test were used to identify knowledge and attitudes associated with COVID-19 vaccine hesitancy. A p value equal or less than 0.05 was considered statistically significant. Results Two hundred cancer patients were included with a mean age of 54.4±12.7 and a gender ratio equal to 0.5. Sixty-five percent reported that they would not receive the COVID-19 vaccine. Vaccine hesitancy was associated with lower interactive vaccine literacy score (1.6±0.8 vs 2.0, p = 0.002), skepticism regarding COVID-19 vaccine efficacy and safety (73.8% vs 38.5%, p < 0.001) and believing that health authorities will not be able to vaccinate the majority of the population (71,2% vs 55.7% p = 0.037). Conclusions The proportion of COVID-19 vaccine hesitancy among cancer patients is high. Mass media campaigns for vaccine promotion should be enhanced. Physicians and health care workers play a key role in increasing acceptance and uptake of COVID-19 vaccine among high risk patients. Key messages Majority of cancer patients were unwilling to receive the COVID-19 vaccine. Patient education about the benefits of vaccination against SARS-CoV-2 should be an integral part of oncology visits.

Experiences and perspectives of cancer stakeholders regarding COVID‐19 vaccination

“…Like recent international studies, we found that most cancer patients intended to be or were vaccinated. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Our research also found that additional cancer stakeholder groups, such as family members, HPs, and NGOs, all expressed pro COVID-19 vaccination attitudes and behaviors.…”

“…All stakeholder groups reported barriers to COVID‐19 vaccination uptake in this population, supporting the previous research. Barriers included lack of confidence in science and vaccine efficacy, 16 , 19 , 21 , 23 , 24 fear of side effects, 16 , 21 , 22 , 23 , 24 , 25 , 26 , 30 belief that COVID‐19 is benign, 16 , 23 , 25 and concern about vaccine impact on treatment. 18 , 22 , 26 Notably, most hesitation related to the lack of information about vaccine efficacy and impacts within the cancer context, rather than general antivaccination sentiment.…”

“…International research has reported that while the majority of cancer patients intended to be vaccinated as soon as the COVID‐19 vaccine was available, there were still a proportion who were undecided or hesitant about vaccination. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The research indicates that cancer patients who are female, 20 , 21 , 23 , 27 , 29 , 30 younger in age, 20 , 21 , 23 , 24 , 27 , 30 less educated/health literate, 19 , 23 , 24 , 26 , 27 , 29 , 30 have worse health status, 20 , 22 and are non‐white 21 , 27 , 29 are more likely to be hesitant. Commonly reported barriers to vaccine uptake include lack of confidence in science and vaccine efficacy, 16 , 19 , 21 , 23 , 24 fear of side effects, 16 , 21 , 22 , 23 , 24 , …”

“… 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The research indicates that cancer patients who are female, 20 , 21 , 23 , 27 , 29 , 30 younger in age, 20 , 21 , 23 , 24 , 27 , 30 less educated/health literate, 19 , 23 , 24 , 26 , 27 , 29 , 30 have worse health status, 20 , 22 and are non‐white 21 , 27 , 29 are more likely to be hesitant. Commonly reported barriers to vaccine uptake include lack of confidence in science and vaccine efficacy, 16 , 19 , 21 , 23 , 24 fear of side effects, 16 , 21 , 22 , 23 , 24 , 25 , 26 , 30 belief that COVID‐19 is benign,…”

“…International research has reported that while the majority of cancer patients intended to be vaccinated as soon as the COVID‐19 vaccine was available, there were still a proportion who were undecided or hesitant about vaccination 16–30 . The research indicates that cancer patients who are female, 20,21,23,27,29,30 younger in age, 20,21,23,24,27,30 less educated/health literate, 19,23,24,26,27,29,30 have worse health status, 20,22 and are non‐white 21,27,29 are more likely to be hesitant.…”