A nationwide survey distributed among 150 randomly selected dialysis facilities in the USA has found that a “substantial proportion” of patients receiving in-centre haemodialysis are hesitant about seeking a COVID-19 vaccination. Notably, this proportion is still thought to be close to half of that seen across the general US population. The findings of this report, which are published in the Journal of the American Society of Nephrology (JASN), also indicate that the odds of vaccine hesitancy are higher among younger patients, women, and Black, Native American and Pacific Islander patients.
“Our results highlight opportunities for improving SARS-CoV-2 vaccine uptake through dialysis facilities,” Pablo Garcia, Shuchi Anand (Department of Medicine [Nephrology], Stanford University, Stanford, USA) and colleagues write in their report. “On the basis of these survey results, we would advise dialysis organisations and patient advocacy groups to focus vaccine promotion efforts among younger age groups, women, and Black, Native American, and Pacific Islander patients, and to develop patient-friendly educational material describing the rates and nature of vaccine-related adverse effects.
“The caveats that side-effects and efficacy have not been specifically evaluated in patients on dialysis complicate outreach efforts. Dialysis care providers and public health agencies should capture data on safety (adverse effects) and provisional efficacy (seroconversion) in the dialysis population, and rapidly disseminate these data to facilitate vaccine uptake.”
The report’s authors note that patients on dialysis are at an increased risk of experiencing COVID-19-related complications—but a significant fraction of these patients also belong to racial, ethnic, socioeconomic, cultural and religious groups that previous studies have shown are more likely to be vaccine hesitant.
In an effort to inform programmes and policies aimed at promoting COVID-19 vaccine uptake in this vulnerable population, Garcia, Anand et al offered an anonymised online survey to patients undergoing in-centre haemodialysis in 150 facilities, which were randomly selected from a pool of 331 haemodialysis facilities with ≥30 patients, managed by US Renal Care, from 8 January to 11 February 2021. The survey was available in both English and Spanish, and featured 28 questions under four major subheadings: COVID-19 and vaccine; COVID-19 effects; responder health and family structure; and demographic data.
A total of 1,515 patients—14% of the 10,974 patients considered eligible—responded to the survey. Some 20% of all responders were “reluctant” to seek the COVID-19 vaccine, even if it was considered safe for the general population. Younger age groups (aged 18–44 years) and Black responders were found to be more likely to indicate hesitancy, with both groups reporting hesitancy at a rate of 29%, compared to older age groups (aged 45–80 or more years) and non-Hispanic white patients, respectively. Odds of vaccine hesitancy were also higher among women compared to men, and patients categorised as “other” in terms of race or ethnicity—a group largely comprised of patients identifying as Native Americans or Pacific Islanders—compared to non-Hispanic white patients.
The overriding concern of patients who were vaccine hesitant related to side-effects, Garcia, Anand et al add, followed by doubts about the efficacy of the vaccine, and being uncomfortable with vaccines in general. The main sources respondents were reportedly receiving information about COVID-19 vaccines from were television news (68%), followed by dialysis staff (38%).
“In summary, in our vaccine acceptability survey broadly representative of the US dialysis population, we found that approximately one in five patients on in-centre haemodialysis was reluctant to receive the COVID-19 vaccine,” the authors write. “Overall, vaccine hesitancy rates were nearly half that of the most recently reported rates for the general US population.”
They also note that characteristics of patients who were vaccine hesitant were similar to those described for both the general population and for the dialysis population—those being younger age, Black race, and a lack of a college education. One aspect in which their survey’s results differed from the general population, however, was the fact that women receiving haemodialysis were found to hold a higher rate of vaccine hesitancy than men.
The strengths of the survey, according to Garcia, Anand et al, included its broad and timely reach, particularly with regard to Hispanic populations, via the use of a Spanish language version and a broadly representative sample, while its limitations were the requirement to interface with an online platform—which may be more challenging for older patients, patients with lower levels of education, and those with visual impairment—as well as a relatively low response rate, responders not having an opportunity to ask for clarification, the absence of responses from the Northwestern region of the USA, and the survey being a single time-point snapshot.