COVID-19 vaccines and patients with multiple sclerosis: willingness, unwillingness and hesitancy: a systematic review and meta-analysis

Yazdani, Amid; Mirmosayyeb, Omid; Ghaffary, Elham Moases; Hashemi, Mozhgan Sadat; Ghajarzadeh, Mahsa

doi:10.1007/s10072-022-06051-6

Cited by 19 publications

(11 citation statements)

References 18 publications

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“…The current findings are consistent with those of previous meta-analyses, which estimated the prevalence of vaccine hesitancy in the general population at 26-42% [15,[80][81][82][83]. In special populations, previous meta-analyses revealed that the hesitancy for COVID-19 vaccination was estimated at 24%, 27%, and 26% in multiple sclerosis patients, older people, and healthcare students, respectively [84][85][86]. Furthermore, hesitancy to receive a COVID-19 booster was reported at 21% in the general population [87].…”

Section: Discussionsupporting

confidence: 91%

Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis

et al. 2022

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Countries worldwide have deployed mass COVID-19 vaccination drives, but there are people who are hesitant to receive the vaccine. Studies assessing the factors associated with COVID-19 vaccination hesitancy are inconclusive. This study aimed to assess the global prevalence of COVID-19 vaccination hesitancy and determine the potential factors associated with such hesitancy. We performed an organized search for relevant articles in PubMed, Scopus, and Web of Science. Extraction of the required information was performed for each study. A single-arm meta-analysis was performed to determine the global prevalence of COVID-19 vaccination hesitancy; the potential factors related to vaccine hesitancy were analyzed using a Z-test. A total of 56 articles were included in our analysis. We found that the global prevalence of COVID-19 vaccination hesitancy was 25%. Being a woman, being a 50-year-old or younger, being single, being unemployed, living in a household with five or more individuals, having an educational attainment lower than an undergraduate degree, having a non-healthcare-related job and considering COVID-19 vaccines to be unsafe were associated with a higher risk of vaccination hesitancy. In contrast, living with children at home, maintaining physical distancing norms, having ever tested for COVID-19, and having a history of influenza vaccination in the past few years were associated with a lower risk of hesitancy to COVID-19 vaccination. Our study provides valuable information on COVID-19 vaccination hesitancy, and we recommend special interventions in the sub-populations with increased risk to reduce COVID-19 vaccine hesitancy.

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Section: Discussionsupporting

confidence: 91%

Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis

et al. 2022

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“…Similar to concerns about the rapidity of development of the vaccines seen in the general community and other chronic disease populations, our data reinforced safety and efficacy concerns balanced with COVID-19 disease and complication prevention and coupled with intersecting decision factors terms of the long-term impact on their disease [ 13 , 47 , 48 ].…”

Section: Discussionsupporting

confidence: 67%

Factors Influencing COVID-19 Vaccine Hesitancy among Patients with Serious Chronic Illnesses during the Initial Australian Vaccine Rollout: A Multi-Centre Qualitative Analysis Using the Health Belief Model

et al. 2023

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Background: People with chronic illnesses have increased morbidity and mortality associated with COVID-19 infection. The influence of a person’s serious and/or comorbid chronic illness on COVID-19 vaccine uptake is not well understood. Aim: To undertake an in-depth exploration of factors influencing COVID-19 vaccine uptake among those with various serious and/or chronic diseases in the Australian context, using secondary data analysis of a survey study. Methods: Adults with cancer, diabetes and multiple sclerosis (MS) were recruited from 10 Australian health services to undertake a cross-sectional online survey (30 June to 5 October 2021) about COVID-19 vaccine uptake, vaccine hesitancy, confidence and complacency and disease-related decision-making impact. Free-text responses were invited regarding thoughts and feelings about the interaction between the participant’s disease, COVID-19, and vaccination. Qualitative thematic analysis was undertaken using an iterative process and representative verbatim quotes were chosen to illustrate the themes. Results: Of 4683 survey responses (cancer 3560, diabetes 842, and MS 281), 1604 (34.3%) included free-text comments for qualitative analysis. Participants who provided these were significantly less likely to have received a COVID-19 vaccination than those who did not comment (72.4% and 86.2%, respectively). People with diabetes were significantly less likely to provide free-text comments than those with cancer or MS (29.0%, 35.1% and 39.9%, respectively). Four key themes were identified from qualitative analysis, which were similar across disease states: (1) having a chronic disease heightened perceived susceptibility to and perceived severity of COVID-19; (2) perceived impact of vaccination on chronic disease management and disease-related safety; (3) uncertain benefits of COVID-19 vaccine; and (4) overwhelming information overload disempowering patients. Conclusions: This qualitative analysis highlights an additional layer of complexity related to COVID-19 vaccination decision making in people with underlying health conditions. Appreciation of higher susceptibility to severe COVID-19 outcomes appears to be weighed against uncertain impacts of the vaccine on the progression and management of the comorbid disease. Interactions by clinicians addressing individual factors may alleviate concerns and maximise vaccine uptake in people with significant underlying health conditions.

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“…In addition to the unanimous agreement that VH was a policy problem, most reviews (28/49; 57%), suggested that the problem was widespread relative to the goal of achieving quasi-total vaccine confidence / acceptance / uptake, and therefore did not study a specific demographic group. Remaining reviews focused on pregnant women (63,75,83,(85)(86)(87)(88)(89), healthcare workers (56,67,68,86,90), college students (52,56,67), racial/ethnic minorities (16,53,79), parents or guardians (48,73), older adults (61), LGBTQ+ individuals (51), and multiple sclerosis patients (91).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…41/49; 84%) presented COVID-19 as "lethal", while a small minority (8/49; 16%) did not use that word, but still implied that reported death counts (e.g., by the WHO) were higher than deaths caused by other diseases, thus reason for concern(17,47,57,66,70,85,86,91). Five reviews among those referring to COVID-19 as "lethal" (5/41; 12%) asserted that vaccines were critical to decrease COVID-specific mortality, especially among demographic groups deemed at high risk(50,52,59,65,92).…”

mentioning

confidence: 99%

The balance of risks and benefits in the COVID-19 “vaccine hesitancy” literature: An umbrella review

Chaufan¹,

Heredia²,

McDonald³

et al. 2023

Preprint

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Background: “Vaccine hesitancy” (VH) has been described as a “threat to global health”, especially in the COVID-19 era. Research on VH indicates that the concerns of vaccine recipients with the balance of risks and benefits of COVID-19 vaccination, which involve safety and effectiveness considerations (hereafter “safety concerns”), are a leading driver of VH. However, what explains these concerns is underexplored. Goal: We conducted a qualitative umbrella review following PRISMA guidelines and informed by a critical perspective to examine how the safety concerns of COVID-19 vaccine recipients are addressed in the VH literature. Methods: We searched PubMed, the Epistemonikos COVID-19 platform (COVID-19 L. OVE), and the WHO Global Research on COVID-19 Database. We included 49 refereed reviews examining VH in any population involved with COVID-19 vaccination decisions for themselves or as caretakers, with no methodological, quality, temporal, or geographic restrictions, and were published in English, excluding those that authors did not identify as “systematic”. Two reviewers completed article screening and data extraction and synthesis. Thematic synthesis was used to identify themes and frequencies were calculated to assess the strength of support for themes. Disagreements were resolved through full team discussion. The protocol was registered with PROSPERO (ID CRD42022351489) and partially funded by a SSHRC grant (# 435-2022-0959).Findings: All reviews assumed that VH was a major barrier to ending the COVID-19 crisis. With vaccines assumed to be “safe and effective”, recipients’ safety concerns were downplayed. Evidence incompatible with “VH-as-a-problem”, whenever mentioned, was dismissed as “misinformation”. Informed consent was either not discussed or was presented as a potential threat to “vaccine confidence”. We observed no differences regardless of study population, methodology, or other study characteristics. Limitations are discussed. Conclusions: Neglecting or dismissing vaccine recipients’ safety concerns contributes to the problem that research on COVID-19 VH purports to address. It also undermines the implementation of informed consent, critical to ethical medical and public health research, policy, and practice. The scant attention to bioethical considerations in current COVID-19 VH research is concerning.

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COVID-19 vaccines and patients with multiple sclerosis: willingness, unwillingness and hesitancy: a systematic review and meta-analysis

Cited by 19 publications

References 18 publications

Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis

Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis

Factors Influencing COVID-19 Vaccine Hesitancy among Patients with Serious Chronic Illnesses during the Initial Australian Vaccine Rollout: A Multi-Centre Qualitative Analysis Using the Health Belief Model

The balance of risks and benefits in the COVID-19 “vaccine hesitancy” literature: An umbrella review

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