Covid-19 pandemic: an opportunity to seize to increase awareness and vaccine coverage in at-risk populations

ABSTRACT

We aimed to assess the impact of the Covid-19 pandemic on the risk perception and attitudes concerning influenza and pneumococcal vaccination in an at-risk population. We performed an online survey between July 29th and October 12th 2020 in patients at risk of severe influenza and/or pneumococcal disease recruited from Ipsos internal panel or through AVNIR (Associations VacciNation Immunodéprimées Réalité), a group of patient associations. Among the 2177 respondents, 1350 were female (62%), median age was 58 years (IQR 47-69), 62% were immunocompromised. In total, 86% of respondents declared being favorable to vaccination in general and felt at high-risk of more severe forms of Covid-19 (81%), pneumococcal disease (76%) and influenza (74%). More than half (52%, 388/746) of patients were eager to be vaccinated annually against influenza for the next 2020/2021 season and pneumococcal disease in the future: 62% (376/606). In this sample of patients at-risk of severe forms of influenza, pneumococcal diseases and Covid-19, the self-perception of risk for these three diseases and positive opinion on vaccination in general were high. It is very likely that the pandemic will lead to an increase in influenza and pneumococcal vaccine coverage in this at-risk population.

Influenza affects 2 to 6 million people each year in France; responsible for approximately 12,000 deaths annually over the last 3 years. Pneumococcus is responsible for about 125,000 cases of pneumonia and around 10,000 deaths per year in France, particularly in winter. These two infections share many of the same risk factors as Covid-19. Seasonal influenza and pneumococcal vaccines are indicated for the most at-risk populations. However, France has one of the highest rates of vaccine hesitancy in the world,¹ leading to low vaccine coverage in several diseases, including seasonal influenza (less than 45% coverage in patients ≥65 years and less than 15% in those ˂65 years of age at-risk between 2012 and 2015).²

This vaccine hesitancy will likely affect the French national Covid-19 vaccination campaign roll-out, as highlighted in a survey performed after the first national lockdown in which 26% of respondents reported reluctance to be vaccinated against SARS-CoV-2 if a vaccine were available.³ This rate rose to 46% in France in a more recent online study of 18,526 adults aged 16–74 across 15 countries,⁴ partly explained by concern about potential side effects and the rapid pace at which vaccines were moving through clinical trials. However, it is possible that the recommendations for influenza and pneumococcal immunizations made in the context of Covid-19 pandemic may have had a positive impact on vaccine coverage of these well-known vaccines.

We aimed to assess the impact of the current context on the risk perception and attitudes concerning influenza and pneumococcal vaccination in an at-risk population.

We performed an online survey between July 29th and October 12th 2020 in patients at risk of severe influenza and/or pneumococcal disease recruited from Ipsos internal panel or through AVNIR (Associations VacciNation Immunodéprimées Réalité), a group of patient associations including 11 nonprofit French organizations supporting immunocompromised patients and those with chronic conditions aiming to reduce the burden of infectious diseases.

Among the 2177 respondents, 1350 were female (62%), median age was 58 years (IQR 47-69), 62% were immunocompromised (mainly due to immunosuppressive therapy for psoriasis (18%), rheumatoid arthritis (10%), psoriatic arthritis (7%) and solid organ transplant (5%)) and 38% had chronic diseases (mainly pulmonary hypertension (10%), COPD (8%) and diabetes mellitus (7%)).

In total, 86% of respondents declared being favorable to vaccination in general and felt at high-risk of more severe forms of Covid-19 (81%), pneumococcal disease (76%) and influenza (74%), compared to the general population. Influenza vaccine coverage for the 2019/2020 season was 63%; this rate was higher in those who felt themselves to be at higher risk of contracting flu than the general population, compared to those who felt at the same risk (81% (947/1169) vs 43% (388/901), p < .001). Main reasons for not being vaccinated were fear of side effects (31%, 247/795) and doubts of efficacy (26%, 207/795). Most patients were unsure of their pneumococcal vaccination status (43%), whilst 41% were up-to-date and 16% were not. Main reasons for not being vaccinated were not having been offered the vaccine (64%, 220/343) and fear of side effects (21%, 72/343).

Only 33% of respondents were completely convinced of the necessity of being up-to-date with recommended vaccines during the Covid-19 pandemic. This rate was significantly higher in those favorable to vaccination in general compared to those unfavorable (38% (710/1869) vs 4% (12/308), p < .001). Likewise, 52% (388/746) of patients were eager to be vaccinated annually against influenza for the next 2020/2021 season and pneumococcal disease in the future: 62% (376/606) among those in those favorable to vaccination in general compared to 6% (8/140) in those unfavorable (p < .001).

In this sample of patients at-risk of severe forms of influenza, pneumococcal diseases and Covid-19, with suboptimal 2019/2020 influenza and pneumococcal self-declared vaccination coverage, the self-perception of risk for these three diseases and positive opinion on vaccination in general were high. It is very likely that the pandemic will lead to an increase in influenza and pneumococcal vaccine coverage in this at-risk population. The greatest challenges will be to maintain this increase and promote the safety and efficacy of these vaccines among the more indecisive.

Author contribution

PL conceived and coordinated the study and wrote the first draft of the manuscript.

AS contributed to the redaction of the manuscript. All authors approved the final version of the manuscript.

AVNIR Group and Sante Respiratoire France contributed to the study design.

AVNIR Group is composed of the following patients’ associations

ACS: Action contre les Spondylarthropathies

Action Leucémies

Alliance du Cœur

ANDAR: Association Nationale de Defense contre la polyArthrite Rhumatoide

ASF: Association de Sclerodermiques de France

AFS: Association France Spondylarthrites

France Lymphome Espoir

Association France Psoriasis

France Rein

HTAP France

Renaloo

Disclosure of potential conflicts of interest

PL has received personal fees and non-financial support from Pfizer and Sanofi Pasteur outside the submitted work.

AS has received personal fees from Sanofi Pasteur outside the submitted work.

Acknowledgments

We thank Sarah Kabani for her editing assistance.

Additional information

Funding

A prospective web-based survey was conducted by Ipsos, the largest French company in market and public opinion research, from July 29th, 2020, to October 12th, 2020. The sample has been previously targeted and investigated throughout the Ipsos Access panel and through AVNIR. Ipsos was in charge of the recruitment of 800 from its own panel, of the hosting of the whole sample data of 2177 respondents and achieved data processing.Ipsos was funded by Pfizer.Pfizer contributed to the study design with PL and AVNIR.Pfizer had no role in data analysis, decision to publish or preparation of the manuscript.