Studies provide insights into COVID vaccine hesitancy

Woman getting prepped for COVID vaccine
Woman getting prepped for COVID vaccine

Maryland GovPics, Patrick Siebert / Flickr cc

Two JAMA Network Open studies yesterday that looked at COVID-19 vaccine acceptance in minority groups and opinions around less-preferred vaccines provide clues for how officials might better encourage immunization.

The first study, involving 13 focus groups, reaffirmed a lack of communication and trust among racially and ethnically diverse communities in the United States.

The second study examined the effect of emphasizing different data around the Johnson & Johnson and AstraZeneca/Oxford COVID-19 vaccines: People were more interested in uptake when they were presented with the vaccines' effectiveness against death versus their effectiveness against symptomatic infection.

Concerns about trust, unequal treatment

The virtual focus groups involved 70 Los Angeles residents from Nov 16, 2020, to Jan 28, 2021. (Pfizer/BioNTech, the first emergency-use approved vaccine in the United States, received its emergency-use authorization in mid-December 2020.)

Most participants (71.4%) were female, and none were White (24.3% Black, 24.3% American Indian, 21.4% Latino, 15.7% Filipino, and 14.3% Pacific Islander). About 55.7% lived in a zip code area with high poverty, and 48.6% were essential workers.

Overall, 52.9% said they were likely to be vaccinated against COVID-19 when an option became available, and 77.1% said it was important for all people in the community to receive a COVID-19 vaccine. However, themes of medical mistrust, concern about inequitable access or differential treatment, fears around politicization or pharmaceutical influence, and uncertainty around COVID-19 vaccine information, cost, and scheduling contributed to vaccine hesitance.

For instance, participants brought up specific examples of unethical or exclusionary research as well as worries that they were being experimented on. Some were concerned that White people or those having more power might be the first to receive the vaccine or simply get a better vaccine than those offered to the marginalized. And still others discussed the difficulties that they had in scheduling and attending a COVID vaccine appointment.

"Consistent with prior COVID-19 vaccine acceptability qualitative research, we found information gaps, concerns about the vaccine's rapid development, and an absence of scientific evidence translated for diverse communities," write the researchers.

Recommendations offered or endorsed by study participants include using community engagement; improving empathetic bidirectional deliberation; ensuring timely access to critical information; promoting altruistic and culturally congruent messaging; increasing data transparency, translation, and data collection for diverse populations; and increasing accessibility through navigational and logistical vaccination support.

In a related commentary, Lilia Cervantes, MD, of the University of Colorado, adds, "The focus group study by Carson et al highlights the need for well-planned and funded health policies at the federal, state, and local levels that will not only improve COVID-19 vaccine equity but also improve investment in social resources for racial and ethnic minority groups.

"To build trust, we must engage racial and ethnic minority–serving community organizations and invite them to sit at the head of the table as we partner on strategies that will close the gaps on COVID-19 vaccine disparities."

Death prevention may be key

In the second study, which was based on an online survey from Mar 24 to 30, Canadians were randomized to answer questions about either the AstraZeneca or Johnson & Johnson vaccine. Some received no other information, some received information about vaccine effectiveness (VE) against COVID-19 symptomatic infection, some received information about VE against COVID-related death, and some received information on both statistics.

At the time, Canada had four COVID-19 vaccines authorized for emergency use—Moderna, Pfizer, AstraZeneca, and Johnson & Johnson—although each had different eligibility profiles. As an example, AstraZeneca was recommended only for adults 50 to 55 years old at first but eventually expanded to those 30 to 55.

Almost 2,560 Canadian adults responded to the survey, of whom 52% were women. The median age was 50 years.

The self-reported likelihood of receiving their assigned vaccine was higher for those who were given information about its effectiveness against COVID-related death compared with those who received no information at all (b, 0.04; 95% confidence interval [CI], 0.01 to 0.06). Receiving information about the VE against symptomatic infection, however, was linked with lower likelihood (b, -0.03; 95% CI, -0.05 to 0.00). Perceived effectiveness followed these same trends.

"Unfortunately, information about the impressive record of AstraZeneca and Johnson & Johnson at death prevention did not appear [to] counteract the negative association between providing information on their overall efficacy and perceived effectiveness or intention to vaccinate," the researchers write.

"Both pieces of information simply canceled each other out. This suggests that there is a need to focus communication strategies on this metric of performance rather than the arguably less important indicator of overall effectiveness at preventing symptomatic COVID-19."

The researchers noted that gender and age also appeared to influence the connection between death prevention and vaccine intention. Women and those who were 35 to 54 years old scored 7% and 8% higher, respectively, in their likelihood of vaccination after receiving death prevention information compared with those of other age-groups (95% CIs, 0.04 to 0.11, P < 0.001; 0.04 to 0.12, P < 0.001, respectively).

When stratifying data by vaccine brand, age—but not gender—was significant for those evaluating AstraZeneca, the researchers note. No other subgroup differences were found when analyzing the relationship between receiving all possible VE information and vaccination likelihood.

"These results can inform public health communication strategies to reduce hesitancy toward specific COVID-19 vaccines," write the researchers. "Considering the importance of the Johnson & Johnson and AstraZeneca COVID-19 vaccines to global supply, identifying ways to mitigate hesitancy toward these specific vaccines is vitally important."

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