Letter to the editor to: Verger P and Dubé E. Restoring confidence in vaccines in the COVID-19 era, expert review of vaccines, 2020; 19(11):991-3

KEYWORDS:

• COVID-19 vaccine
• vaccine acceptance
• vaccine hesitancy
• Hispanic
• COVID-19 information resources

Dear Editor,

We read the intriguing editorial titled, ‘Restoring confidence in vaccines in the COVID-19 era’ by Verger and Dubé [1]. Buttressed by examples from mainstream populations and healthcare workers, the authors discussed vaccine hesitancy and ways to restore confidence in vaccination. Vaccination issues in marginalized communities such as Hispanic populations, however, were not highlighted in the editorial. Hispanic populations in the USA have been disproportionately affected by COVID-19 along with economic and social ramifications [2]. Compared to non-Hispanic whites, the urban Hispanic/Latino population is about five times more likely to test positive for SARS-CoV-2 [3], yet focused survey addressing COVID-19 vaccine hesitancy among US Hispanic population is non-existent.

Here, we share our experience from an anonymous survey conducted among Laredo population (95.6% are Hispanics) in Texas, USA from 2nd to 14 December 2020. By using a structured online questionnaire containing 12 closed-ended questions, we assessed the willingness to receive COVID-19 vaccine, their attitude toward and perception surrounding COVID-19 vaccination, and the sources of information on COVID-19 they trust. Following approval from Texas A&M International University (TAMIU) Institutional Review Board (IRB Approval Number: 12.026), the questionnaire was uploaded to SurveyMonkey and the survey link was distributed among university staff, faculty, students and employees of TAMIU and the listserv of the Laredo Department of Health.

Complete responses were received from 259 survey participants; (65.6% [170/258]) were women, 96.9% (251/259) were of working age group (18–64 years), 67.6% (175/259) had bachelor level or higher education, and 28.6% (74/259) were professionals and office workers.

Of all, 78.4% (203/259) respondents said they would accept COVID-19 vaccine when available, 20.9% (54/259) said they would decline for the following key reasons: safety concerns (42.6% [23/54]), lack of trust in the authority (13% [7/54]), and lack of affordability (3.7% [2/54]). Older people and those with higher education and those employed in professional jobs were more willing to accept vaccination than their counterparts (Table 1).

Table 1. Characteristics of the survey respondents and their intention to receive COVID-19 vaccine (N = 259)

Charactersitics	n (%)	Intention to receive COVID-19 vaccine n (%)
Gender*
Male:	88 (34.0)	70 (79.6)
Female	170 (65.6)	132 (77.7)
Age groups
18–24	78 (30.1)	58 (74.4)
25–34	58 (22.4)	43 (74.1)
35–44	53 (20.5)	41 (77.4)
45–54	36 (13.9)	29 (80.6)
55–64	25 (9.7)	23 (92.1)
≥65	8 (3.1)	8 (100.0)
Educational level
High school education	59 (22.8)	45 (76.3)
Bachelors	73 (28.2)	59 (80.8)
Higher university education	102 (39.4)	83 (81.4)
Other (vocational etc.)	8 (3.1)	5 (62.5)
Associate degree	17 (6.6)	11 (64.7)
Occupational category
Clerical, administrative and community worker	44 (17.0)	29 (65.9)
Education sector staff	26 (10.0)	24 (92.3)
Students	28 (10.8)	23 (82.1)
Emergency medical service staff	45 (17.4)	37 (82.2)
Entertainment, hospitality and business sector staff	9 (3.5)	4 (44.4)
Professional and office worker	73 (28.2)	61 (83.6)
Retired/Not working	14 (5.4)	9 (64.3)
Other	11 (4.3)	10 (90.9)
Not reported	9 (3.5)	6 (66.7)

*One respondent did not disclose their gender.

Of all, 60.2% [156/259] reported trusting the Centers for Disease Control and Prevention (CDC) for information related to COVID-19 vaccine, only 9.7% [25/259] trusted federal government, 9.3% [24/259] trusted World Health Organization (WHO), 3.1% [8/259] trusted state government, 2.3% [6/259] trusted local government, 5% [13/259] trusted others, and 10.4% [27/259] trusted none.

Compared to males, females reported to have poorer access to information related to COVID-19 vaccine (61.8% [105/170] vs 75% [66/88], P < 0.05) but were more unsure about information resources. Individuals aged ≥55 years were more likely than those who were aged 35–54 years or <35 years to have access to information sources (85.3% [29/34] vs 68.5% [61/89] or 60.3% [82/136], P = 0.02, by X² for trend). Respondents with a bachelor-level or higher education were more likely than those with high school-level education or other educational background to have access to the information sources (72.6% [127/175] vs. 57.6% [34/59] or 44% [11/25], P < 0.01 by X² for trend).

As for perception about vaccine safety, males and females similarly believed COVID-19 vaccine to be safe (72.7% [64/88] vs. 62.9% [107/170], P = 0.15); however, significantly more females were unsure about vaccine safety than males (29.4% [50/170] vs 17.1% [15/88], P = 0.04), but no such difference existed by participants’ age or educational level.

Our survey involving mostly working class, well-educated, and well-employed participants in a Hispanic community in the USA showed 78% would accept COVID-19 vaccine. Older individuals, people with better education, and better jobs are more likely to receive the vaccine, but there were gender differences in terms of accessing information and expressing safety concerns.

That almost four in five survey participants expressed willingness to receive COVID-19 vaccine seems an improvement compared to results of earlier surveys; for instance, at least four earlier surveys showed over 30% Americans did not intend to pursue vaccination against COVID-19 [4–7], and in another survey 55.8% participants reported that they would definitely accept, another 34.3% were unsure but had a tendency to accept the vaccine [8]. A survey conducted in June 2020 involving 1878 individuals, 19% of whom were Hispanic, found that about 78% were very likely or somewhat likely to receive COVID-19 vaccine [9]. The differences in these surveys could be because of demographic and educational background of participants, but at least one of these studies revealed that racial and ethnic minorities had higher vaccine hesitancy (29% among Hispanics and 34% among African-Americans reporting hesitancy) than mainstream populations [9].

We also found that compared to their counterparts, older individuals, better educated, and people employed in professional and teaching jobs were more likely to receive the vaccine which corroborate findings from another study that showed individuals with lower income and education were more hesitant [9]. We also note that participants’ occupation may play a role in vaccine acceptance which was also found in a survey in Italy that showed professionals, managers and teachers were more willing to accept COVID-19 vaccine than manual workers (51.6% vs. 44.8%) [10].

Compared to males, more females were unsure about the safety of COVID-19 vaccine (29.4% vs 17.1%, P = 0.04) this could be because fewer females compared to males had access to information resources. In other surveys too females were more vaccine hesitant [4,9], and mothers, compared to fathers of children aged <18 years, were reluctant to accept the abbreviated vaccine development process (odds ratio OR 0.6; 95% confidence interval 0.5–0.8) [11].

In this survey, the most reported trusted source was CDC (60%), which corroborates findings of other studies that showed that American public trusted expert advice from national public health bodies [12], and that endorsement from CDC was associated with 7% increase in willingness to receive a vaccine from a baseline endorsement [13]. But in the survey, fewer participants trusted WHO and local, state and federal governments. It could have stemmed from a former US President’s publicly defunding of WHO and touting of unproven treatments for COVID-19 and contradicting guidance provided by experts [12]. It seems most of the hesitancy in the US population generates from layperson skepticism confounded by mistrust on politicians [14].

To our knowledge, this is the only focused survey on COVID-19 vaccine acceptance involving a US Hispanic community in a border state, and it was conducted just after the recent US election. There are some limitations, it is a small study, most participants are female, and questions gauging the causes of unwillingness of vaccination were not explored.

As Verger and Dubé suggested targeted interventions adapted to the context may be helpful in addressing vaccine hesitancy among these people [1]. An additional way forward lies in attending to negative emotions such as vaccine safety concerns and anxiety, and cultivating hope and altruism as part of vaccine education efforts [15].

In summary, although not generally highlighted in mainstream discussions, vaccine hesitancy exists among Hispanic people, especially among women, less educated, younger and less privileged sections of the community.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Acknowledgments

The authors would like to thank the anonymous respondents who took part in the survey.

Additional information

Funding

This paper was not funded.