Hesitancy and reactogenicity to mRNA-based COVID-19 vaccines–Early experience with vaccine rollout in a multi-site healthcare system

Background Hesitancy and incomplete vaccination against coronavirus disease 2019 (COVID-19) remains an obstacle to achieving herd immunity. Because of fear of vaccine reactions, patients with medical and allergic co-morbidities express heightened hesitancy. Limited information is available to guide these patients. We sought to identify factors associated with mRNA-based COVID-19 vaccines hesitancy and reactogenicity. Methods We surveyed employees of a multi-site health system in central Pennsylvania who were offered the COVID-19 vaccine (N = 18,740) inquiring about their experience with the Moderna and Pfizer-BioNTech mRNA-based vaccines. The survey was administered online using the REDCap platform. We used multivariable regression analysis to determine whether a particular factor(s) (e.g., demographics, selected co-morbid allergic and medical conditions, vaccine brand, and prior COVID-19) were associated with vaccine reactogenicity including the occurrence and severity of local and systemic reactions. We also explored factors and reasons associated with vaccine hesitancy. Results Of the 5709 who completed the survey (response rate, 30.4%), 369 (6.5%) did not receive the vaccine. Black race and allergy to other vaccines were associated with vaccine hesitancy. Reaction intensity following the first vaccine dose and allergic co-morbidities were associated with incomplete vaccination. Older individuals (>60 years) experienced less reactogenicity. Females had higher odds of local and systemic reactions and reported more severe reactions. Asians reported more severe reactions. As compared to Pfizer-BioNTech, the Moderna vaccine was associated with higher odds of vaccine reactions of higher severity. Prior COVID-19 resulted in more severe reactions following the first dose, but less severe reactions following the second dose. Conclusions Targeted campaigns to enhance vaccination acceptance should focus on Black individuals, females, and those with allergic co-morbidities. Prior COVID-19 caused more severe reactions after the first but not the second vaccine dose. Moderna vaccine caused more vaccine reactions. Lessons learned from the early rollout of COVID-19 vaccine may serve to inform future novel vaccine experiences.

[1]  Samsul Anwar,et al.  Willingness-to-pay for COVID-19 vaccine in ten low-middle-income countries in Asia, Africa and South America: A cross-sectional study , 2022, Narra J.

[2]  E. Sprecher,et al.  Short-Term Safety of Booster Immunization With BNT162b2 mRNA COVID-19 Vaccine in Healthcare Workers , 2021, Open forum infectious diseases.

[3]  Samsul Anwar,et al.  Acceptance of COVID-19 vaccination at different hypothetical efficacy and safety levels in ten countries in Asia, Africa, and South America , 2021, Narra J.

[4]  P. Offit,et al.  Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia , 2021, Infection Control & Hospital Epidemiology.

[5]  K. Volpp,et al.  Incentives for Immunity - Strategies for Increasing Covid-19 Vaccine Uptake. , 2021, The New England journal of medicine.

[6]  Casey A. Klofstad,et al.  The Limits of Medical Trust in Mitigating COVID-19 Vaccine Hesitancy among Black Americans , 2021, Journal of General Internal Medicine.

[7]  A. Majeed,et al.  Covid-19 vaccination hesitancy , 2021, BMJ.

[8]  D. Swerdlow,et al.  Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data , 2021, The Lancet.

[9]  J. Gee,et al.  Reactogenicity Following Receipt of mRNA-Based COVID-19 Vaccines. , 2021, JAMA.

[10]  V. Simon,et al.  Antibody Responses in Seropositive Persons after a Single Dose of SARS-CoV-2 mRNA Vaccine , 2021, The New England journal of medicine.

[11]  Paige G. Wickner,et al.  Acute Allergic Reactions to mRNA COVID-19 Vaccines. , 2021, JAMA.

[12]  M. Sotir,et al.  First Month of COVID-19 Vaccine Safety Monitoring — United States, December 14, 2020–January 13, 2021 , 2021, MMWR. Morbidity and mortality weekly report.

[13]  T. Shimabukuro,et al.  Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. , 2021, JAMA.

[14]  D. Klonoff,et al.  COVID-19 vaccines: comparison of biological, pharmacological characteristics and adverse effects of Pfizer/BioNTech and Moderna Vaccines. , 2021, European review for medical and pharmacological sciences.

[15]  J. Mascola,et al.  Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine , 2020, The New England journal of medicine.

[16]  P. Dormitzer,et al.  Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine , 2020, The New England journal of medicine.

[17]  A. Coustasse,et al.  Letters to the Editor: COVID-19 and Vaccine Hesitancy: A Challenge the United States Must Overcome. , 2020, The Journal of ambulatory care management.

[18]  S. Cauchemez,et al.  COVID-19 herd immunity: where are we? , 2020, Nature Reviews Immunology.

[19]  S. Crawford,et al.  Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults , 2020, Annals of Internal Medicine.

[20]  Jennifer Abbasí.  COVID-19 and mRNA Vaccines-First Large Test for a New Approach. , 2020, JAMA.

[21]  S. Saccardo,et al.  Lifestyle and mental health disruptions during COVID-19 , 2020, Proceedings of the National Academy of Sciences.

[22]  S. Galea,et al.  COVID-19 Pandemic, Unemployment, and Civil Unrest: Underlying Deep Racial and Socioeconomic Divides. , 2020, JAMA.

[23]  J. Ulmer,et al.  mRNA as a Transformative Technology for Vaccine Development to Control Infectious Diseases. , 2019, Molecular therapy : the journal of the American Society of Gene Therapy.