COVID-19 vaccine hesitancy among individuals with cancer, autoimmune diseases, and other serious comorbid conditions

BackgroundIndividuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory clinical trials with COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. MethodsTo assess the incidence and reasons for COVID-19 vaccine hesitancy and to assess early vaccine safety, we conducted a cross-sectional online survey, fielded January 15, 2021 through February 22, 2021, with international participation (74% USA). A random sample of members of Inspire, anonline healthcommunityof over 2.2million individualswith comorbid conditions, completed a 55-item online survey. Results21,943 individuals completed the survey (100% with comorbidities including 27% cancer, 23% autoimmune diseases, 38% chronic lung diseases). 10% declared they would not, 4% stated they probably would not, and 5% were not sure they would agree to vaccination (hesitancy rate 19%). Factors associated with hesitancy included younger age, female gender, black-Pacific-Island-Native American heritage, less formal education, conservative political tendencies, resistance to masks or routine influenza vaccinations, and distrust of media coverage. 5501 (25%) had received at least one COVID-19 vaccine injection, including 29% of US participants. Following the first injection, 69% self-reported local and 40% systemic reactions, which increased following the second injection to 76% and 67%, respectively, with patterns mimicking clinical trials. ConclusionNearly one in five individuals with serious comorbid conditions harbor COVID-19 hesitancy. Early safety experiences among those who have been vaccinated should be reassuring. HighlightsO_LIIndividuals with serious comorbid conditions, including cancer, have been disproportionately affected by COVID-19 and therefore have been prioritized for vaccination C_LIO_LIAn online survey of nearly 22,000 individuals with comorbid conditions revealed that nearly one in 5 expressed vaccine hesitancy. C_LIO_LIReasons for hesitancy in this comorbid population mimicked surveys of the general population. C_LIO_LISelf-reported safety profiles among individuals with comorbid conditions were acceptable, and generally milder than reports in clinical trials among the general population. C_LI