Serious underlying medical conditions and COVID-19 vaccine hesitancy

  1. Daphne Day
  2. Lisa Grech
  3. Mike Nguyen
  4. Nathan Bain
  5. Alastair Kwok
  6. Sam Harris
  7. Hieu Chau
  8. Bryan Chan
  9. Richard Blennerhassett
  10. Louise Nott
  11. Nada Hamad
  12. Annette Tognela
  13. David Hoffman
  14. Amelia McCartney
  15. Kate Webber
  16. Jennifer Wong
  17. Craig Underhill
  18. Brett Sillars
  19. Antony Winkel
  20. Mark Savage
  21. Bao Sheng Loe
  22. Daniel Freeman
  23. Eva Segelov
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Abstract

Objective

To examine vaccine uptake, hesitancy and explanatory factors amongst people with serious and/or chronic health conditions, including the impact of underlying disease on attitudes to vaccination.

Design

Cross-sectional survey.

Setting

Ten Australian health services.

Participants

4683 patients (3560 cancer, 842 diabetes and 281 multiple sclerosis) receiving care at the health services participated in the 42-item survey, between June 30 to October 5, 2021.

Main outcome measures

Sociodemographic and disease-related characteristics, COVID-19 vaccine uptake, and the scores of three validated scales which measured vaccine hesitancy and vaccine-related beliefs generally and specific to the participants’ disease, including the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale. Multivariable logistic regression was used to determine the associations between scale scores and vaccine uptake.

Results

Of all participants, 81.5% reported having at least one COVID-19 vaccine. Unvaccinated status was associated with younger age, female sex, lower education and income, English as a second language, and residence in regional areas (all p<0.05). Unvaccinated participants were more likely to report greater vaccine hesitancy and more negative perceptions toward vaccines (all p<0.05). Disease-related vaccine concerns were associated with unvaccinated status and hesitancy, including greater complacency about COVID-19 infection, and concerns relating to vaccine efficacy and impact on their disease and/or treatment (all p<0.05).

Conclusions

Disease-specific concerns impact COVID-19 vaccine-related behaviours and beliefs in people with serious and/or chronic health conditions. This highlights the need to develop targeted strategies and education about COVID-19 vaccination to support medically vulnerable populations and health professionals.

Trial registration

ACTRN12621001467820

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