NewYork-Presbyterian Hospital, New York, NY, and Division of Abdominal Transplant, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Am J Health Syst Pharm. 2021 Nov 9;78(22):2040-2045. doi: 10.1093/ajhp/zxab272.
Solid organ transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19), but limited vaccine access and vaccine hesitancy can complicate efforts for expanded vaccination. We report patient perspectives and outcomes from a vaccine outreach initiative for a vulnerable population of transplant recipients living in New York City.
This was a retrospective review of qualitative perspectives from a COVID-19 vaccine outreach initiative. In the outreach effort, kidney and pancreas transplant recipients under care at the transplant center at NewYork-Presbyterian Hospital were initially contacted electronically with educational material about vaccination followed by telephone outreach to eligible unvaccinated patients. Calls were used to schedule vaccine appointments for patients who agreed, answer questions, and assess attitudes and concerns for patients not yet ready to be vaccinated, with conversational themes recorded.
Of the 1,078 patients living in the 5 New York City boroughs who had not reported receiving COVID-19 vaccination, 320 eligible patients were contacted by telephone. Of these, 210 patients were scheduled for vaccination at our vaccine site (including 13 who agreed to vaccination after initially declining), while 110 patients were either not ready or not interested in being vaccinated. The total number of patients willing to be vaccinated was 554 when also including those already vaccinated. Unwillingness to be vaccinated was associated with younger age (median age of 47 vs 60 years, P < 0.001), Black race (P = 0.004), and residence in Bronx or Brooklyn counties (P = 0.018) or a zip code with a medium level of poverty (P = 0.044). The most common issues raised by patients who were ambivalent or not interested in vaccination were regarding unknown safety of the vaccines in general, a belief that there was a lack of data about the vaccines in transplant recipients, and a lack of trust in the scientific process underlying vaccine development, with 34% of the patients contacted expressing vaccine hesitancy overall.
Our qualitative summary identifies determinants of COVID-19 vaccine hesitancy in a diverse transplant patient population, supporting the need for transplant centers to implement tailored interventions to increase vaccine acceptance in this vulnerable population.
实体器官移植受者罹患 2019 年冠状病毒病（COVID-19）的发病率和死亡率增加，但疫苗接种机会有限和疫苗犹豫会使扩大疫苗接种复杂化。我们报告了一项针对居住在纽约市的弱势移植受者群体的疫苗推广计划的患者观点和结果。
这是一项针对 COVID-19 疫苗推广计划的定性观点的回顾性研究。在推广工作中，首先通过电子邮件向纽约长老会医院移植中心护理的肾和胰腺移植受者发送有关疫苗接种的教育材料，然后对未接种疫苗的合格患者进行电话外展。对于同意接种疫苗的患者，电话用于预约疫苗接种，解答问题，并评估尚未准备好接种疫苗的患者的态度和顾虑，记录对话主题。
在居住在纽约市 5 个行政区且未报告接种 COVID-19 疫苗的 1078 名患者中，有 320 名符合条件的患者通过电话联系。其中，210 名患者在我们的疫苗接种点接种了疫苗（包括 13 名最初拒绝接种但后来同意接种的患者），而 110 名患者尚未准备好或对接种疫苗不感兴趣。当还包括已经接种疫苗的患者时，愿意接种疫苗的患者总数为 554 名。不愿意接种疫苗与年龄较小（中位数年龄 47 岁 vs 60 岁，P <0.001）、黑人种族（P = 0.004）、居住在布朗克斯或布鲁克林县（P = 0.018）或贫困程度中等的邮政编码（P = 0.044）有关。对疫苗犹豫不决或不感兴趣的患者提出的最常见问题是一般疫苗的安全性未知，认为在移植受者中缺乏关于疫苗的数据，以及对疫苗开发背后的科学过程缺乏信任，34%的患者接触者总体上表示对疫苗犹豫不决。
我们的定性总结确定了一个多样化的移植患者群体中 COVID-19 疫苗犹豫的决定因素，支持移植中心实施有针对性的干预措施，以提高这一弱势群体对疫苗的接受度。
