Serious Underlying Medical Conditions and COVID-19 Vaccine Hesitancy: A Large Cross-Sectional Analysis from Australia

  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
  24. on behalf of the CANVACCS, DIABVACCS and MSVACCS Investigators

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Abstract

As COVID-19 vaccinations became available and were proven effective in preventing serious infection, uptake amongst individuals varied, including in medically vulnerable populations. This cross-sectional multi-site study examined 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. A 42-item survey was distributed to people with cancer, diabetes, or multiple sclerosis across ten Australian health services from 30 June to 5 October 2021. The survey evaluated sociodemographic and disease-related characteristics and incorporated three validated scales measuring vaccine hesitancy and vaccine-related beliefs generally and specific to their disease: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale-Six. Among 4683 participants (2548 [54.4%] female, 2108 [45.0%] male, 27 [0.6%] other; mean [SD] age, 60.6 [13.3] years; 3560 [76.0%] cancer, 842 [18.0%] diabetes, and 281 [6.0%] multiple sclerosis), 3813 (81.5%) self-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. Unvaccinated participants were more likely to report greater vaccine hesitancy and more negative perceptions toward vaccines. 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. This highlights the need to develop targeted strategies and education about COVID-19 vaccination to support medically vulnerable populations and health professionals.

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  1. Version published to 10.3390/vaccines10060851
  2. ScreenIT

    SciScore for 10.1101/2022.04.06.22273080: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the Monash Health Human Research Ethics Committee (RES-21-0000-364L – 76466) and registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621001467820).
    Consent: Potential participants who accessed the survey link and gave informed consent were directed to the survey, hosted on the Qualtrics® secure data capture platform.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using SPSS Statistics Version 27.0 (IBM, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: In addition to the use of validated instruments, the strengths of the present study include the broad and diverse sampling of pre-defined, high-risk participants with three disease types within a range of demographics. The three-month recruitment period spanned changing levels of community transmission and social restriction measures, including strict state-wide lockdowns, giving a broader perspective than a short ‘snapshot’ survey. Importantly, data collection commenced at least three months after the availability of vaccines to high-risk groups, allowing sufficient time for vaccination if willing. Finally, the low prevalence of COVID-19 disease in Australia at the time of the study gives insight into attitudes and actions in the setting where there is less immediate threat from COVID-19. Study limitations include recall and misclassification bias inherent in a survey-based study and availability only in English. Additionally, people who had a greater interest in COVID-19 vaccinations may have been more likely to respond. These issues should be considered when generalising findings. Given that Australia had one of the highest vaccination rates globally and relatively low community transmission during most of the period studied, results may not be directly translatable to global regions with lower vaccination rates and/or high transmission. However, within one year of the study, a period of extremely high community transmission occurred throughout A...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.04.06.22273080 on medRxiv