Thoughts on vaccine hesitancy in the context of coronavirus disease 2019 epidemic

As of March 2022, the COVID-19 vaccination rate in Chad approximated 1%. There are no published reports of COVID-19 vaccine hesitancy or beliefs in Chad. We aimed to study COVID-19 vaccine acceptance and hesitancy among community members, patients, and health care workers in urban Chad. We recruited a prospective convenience sample of adult patients, community members, and healthcare workers from N'Djamena, Chad between August-October 2021. Participants completed a 15-minute, 25-question survey instrument exploring demographic, social, and clinical variables related to COVID-19 and an adapted WHO SAGE Vaccine Hesitancy Survey. Primary outcomes were vaccine acceptance and vaccine hesitancy. Regression models were fit to assess associations between Vaccine Hesitancy Scale (VHS) scores, ranging from 10 (least hesitant) to 50 (most hesitant) points, and pre-selected variables of interest. An inductive thematic analysis was used to analyze the qualitative vaccine hesitancy responses. Of 508 participants (32% female; mean age 32 years), 162 were patients, 153 were community members, and 193 were healthcare workers. COVID-19 vaccine acceptance was significantly higher among patients (67%) than community members (44%) or healthcare workers (47%), p < .001. The average VHS score was 29 points (patients = 27.0, community members = 28.9, healthcare workers = 29.4), and more than one-third of participants were classified as highly vaccine hesitant (score >30 points). Knowing someone who died from COVID-19, believing local healthcare workers support vaccination, trusting the government, having a higher socioeconomic status (i.e. having electricity), and reporting medical comorbidities were each associated with less vaccine hesitancy (all p < .05). The vaccine concerns most frequently endorsed were: vaccine side effects (48%), efficacy (38%), safety (34%), concerns about the pharmaceutical industry (27%), and lack of government trust (21%). Four main themes arose from qualitative vaccine hesitancy responses (n = 116): education, trust, clinical concerns, and misinformation and false beliefs. Overall, COVID-19 vaccine acceptance was low, including among health care workers, and reasons for vaccine hesitancy were broad. We detail the most commonly reported concerns of urban Chadians for receiving the COVID-19 vaccine; we also identify subgroups most likely to endorse vaccine hesitancy. These analyses may inform future vaccination outreach campaigns in N'Djamena.

BackgroundCoronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus-2 and is believed to be transmitted through respiratory droplets and contacts. Currently, although there are approved COVID-19 treatments, vaccines have been developed against the disease. Vaccine apathy, however, can limit the success of vaccination. ObjectiveThe study investigated the knowledge of COVID-19 and apathetic behavior (hesitancy) towards vaccination among the mixed professional population of sub-urban dwellers in three senatorial districts of Benue State, A state, located in central Nigeria, and is known for its agricultural richness and diverse ethnic groups, including the Tiv, Idoma, and Igede. Like most states in Nigeria, it faces significant healthcare access challenges. MethodsThe research was a cross-sectional study involving self-administered structured questionnaire of 52 questions which were validated and included sections on demographic information, COVID-19 vaccination status, reasons for vaccine acceptance or hesitancy, and preferences for different types of COVID-19 vaccines. The data generated was subjected to descriptive statistics and Chi-square. Statistical significance was placed at p < 0.05. ResultA total of 500 questionnaires were administered; however 336 respondents representing 67.2% returned questionnaires. There was no statistical difference (p < 0.05) between health workers (55.4%) and non-health workers (44.6%). There exists an association between study sites, profession, and educational qualification, with knowledge of COVID-19 and accent to vaccination. A significant (p < 0.05) 76.2% acknowledge the existence and infectivity of COVID-19. Interestingly, 39.6% and 47.3% of the study population sanctioned social distancing and hand hygiene as COVID-19 preventive measures. Although 73.0% show knowledge of various COVID-19 vaccines and profess vaccination as a protective measure, however, 65.7% were unsure whether vaccination protects against the disease. Side effects from previous immunization and perceived inadequate knowledge of managing vaccination adverse effects were among the reasons for vaccine hesitancy. ConclusionVaccination and preventive measures are top priorities in diseases with no approved treatment. An urgent increase in the level of advocacy and awareness of the disease is needed because of high vaccine hesitancy among health workers that constitute a significant proportion of the study population.

Introduction: Challenges related to the acceptance and refusal of COVID-19 vaccination (vaccine hesitancy)emerged as a significant problem worldwide.Objectives: 1. To study socio-demographic profile of the study participants.2.To assess association betweensociodemographic characteristics and vaccine hesitancy among study participants.3. To find out the reasons for vaccination hesitancy among study participants.Methodology: A cross-sectional study was conducted at COVID-19 vaccination centre, in South India. Studyparticipants included were subjects who were due for COVID-19 vaccine. Total sample size was 385.Data wascollected by interview technique.Results: Majority,311(80.8%) of the respondents were urban residents and were in 18-30 age group. Malerespondents were higher 227, (59.0%) than female,158(41.0%). Regarding reasons for COVID-19 vaccine hesitancy, majority, 107 (27.8%) reported they were unaware of vaccination schedule followed by 97 (25.2%) not getting time to go for vaccination and 49 (12.7%) respondents reported fear of side effects of COVID-19 vaccine. We found statistically significant association between COVID-19 vaccine hesitancy and socio-demographic variables like their residence, age, gender, type of family, educational level, marital status and co-morbidity. Conclusion: Regardless of the source of vaccine hesitancy, interventions to encourage vaccination by simplifying messages and emphasizing benefits can be effective.

<h3>Context:</h3> Mass vaccination serves as a potential solution to combat the Coronavirus disease 2019 (COVID-19) pandemic, with vaccine hesitancy being a recognized impediment. Collection of data defining the characteristics of healthcare worker (HCW) attitudes towards the vaccine can provide insight into vaccine hesitancy. <h3>Objective:</h3> To determine HCWs’ attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy. <h3>Study Design and Analysis:</h3> This cross-sectional study surveyed the attitudes of HCWs in Michigan using three-point agree/disagree scale questions. t-test and analysis of variance were used to measure HCWs’ attitudes towards the COVID-19 virus and vaccines. <h3>Population studied:</h3> 120 HCWs from Isabella, Saginaw, Sanilac, and Wayne counties in Michigan. <h3>Results:</h3> Most HCWs received (95.9%) and recommended (98.3%) the COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine to a patient are: 1) Efficacy of the vaccine, 2) Current exposure to patients with active COVID-19 infection and risk of virus spread, and 3) Safety of vaccine and long-term follow-up. Being a female HCW (P=0.01) or being a HCW outside of the 55–64 years age range (P=0.036) was associated with increased concern of contracting COVID-19. Regarding the COVID-19 vaccines, our data demonstrated that: 1) HCWs who specialized in family medicine (P=0.028) were more likely to agree that there was adequate testing compared to those who did not specialize in family medicine; 2) White HCWs (P=0.024) were less concerned with the speed of development compared to non-white HCWs; 3) Of all age groups, HCWs aged 55-64 years (P=0.02) were the least concerned about side effects 4) Of all provider types, physicians (P=0.017) were the least concerned about long-term effects. <h3>Conclusion:</h3> Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among attitudes towards the COVID-19 virus and vaccines. Vaccine hesitancy among HCWs can have negative effects on their patients. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

The new coronavirus disease (COVID-19), which was detected in the Wuhan region of China in 2019 and spread rapidly all over the world, was declared a pandemic by the WHO in 2020. Since then, despite widespread recommendations to prevent the spread of the disease and provide treatment for sick people, 6,573,968 people died all over the world, 101,203 of which in Turkey. According to the international adult vaccination guidelines, pregnant women have been recommended to get vaccinated against the new coronavirus disease, as well as influenza and tetanus, during pregnancy. Before this study, not enough information was available about the vaccination awareness and vaccination hesitancy rates of pregnant women living in Turkey. For this reason, we believe that our study will contribute to filling this gap in the literature. The main objective of this study was to investigate the vaccination rates of pregnant women in a local hospital in Turkey and the reasons for vaccine hesitancy in this patient group. The minimum sample size of the study was found to be 241, with 80% power, 0.2 effect size, and 95% confidence interval, at p < 0.05 significance level. We included 247 consecutive pregnant women who applied to the Samsun Training and Research Hospital Gynecology and Obstetrics Outpatient Clinics between January 2022 and April 2022. The researchers prepared a questionnaire by taking into account the characteristics of the local community. A preliminary survey with these questions was also conducted before starting the main study. The mean age of the pregnant women participating in the study was 28.7 ± 5.3 years, and the mean gestational age was 28.2 ± 7.9 weeks. Among the participants, 26.3% were university graduates or had a higher degree, and 17% were actively working; in addition, 93 (37.7%) of the 247 pregnant women had received the COVID-19 vaccine, 203 (82.2%) had received at least one dose of the tetanus vaccine, and only 1 (0.4%) person had been administered the influenza vaccine during pregnancy. The most common reason for COVID-19 vaccine refusal and hesitancy was safety concerns, while the low rates of tetanus and influenza vaccination were due to a lack of knowledge. These results show that it is important to inform and educate the pregnant population on this subject to improve their vaccination behavior.

India has managed to successfully develop and approve two vaccines for COVID-19, namely COVAXIN and Covishield. The vaccine hesitancy phenomenon is seen even among healthcare professionals. Acceptance of vaccination by healthcare or medical students is also of paramount importance. To find out the prevalence of vaccine hesitancy and associated factors in medical students of North Delhi, India, a cross-sectional study was conducted among 210 undergraduate students from a medical college in New Delhi. The questionnaire consisted of questions about identification data, history of COVID-19 infection, and vaccine hesitancy. The collected data was analyzed in SPSS software (version 21.0), and Chi-square test was used for categorical data analysis. Among the study participants, the majority of them (77.6%) belonged to the age group of 20-25 years, and most of them were males (63.3%). The prevalence of vaccine hesitancy was 27.6% among the study participants. Factors such as semesters, mother's education, and mother's occupation of the study participants were significantly associated with vaccine hesitancy regarding COVID-19 (P<0.05). Serious side effects, vaccine effectiveness, and recent events in the past were the reasons for vaccine hesitancy. Based on the findings of the present study, about one-fourth of the participants were vaccine-hesitant. Semesters, mother's education, and mother's occupation of study participants were significantly associated with vaccine hesitancy regarding the COVID-19 vaccine (P<0.05). About one-fourth of the participants mentioned serious side effects as the reason for vaccine hesitancy. Introduction to an education curriculum in the Bachelor of Medicine and Bachelor of Surgery (MBBS) can enhance students' knowledge regarding COVID-19 vaccines and their preventive aspects for the future.

10550 Background: Despite the human papillomavirus (HPV) vaccine being safe and effective at preventing HPV-associated cancers, vaccine update is low. Several factors have been identified as barriers to getting the HPV vaccine. However, it is unclear if these factors have changed since vaccine licensure. Thus, we assessed trends in the top five reasons for vaccine hesitancy in the last decade in the US. Methods: We analyzed the 2010–2019 National Immunization Survey–Teen data, a national survey representative of the US adolescent population. We identified adolescents (n = 16,383) who had received zero dose of the HPV vaccine (unvaccinated adolescents). Parents of unvaccinated adolescents were asked how likely they will vaccinate their child in the next 12 months. Parents who responded with “not too likely”, “not likely at all” or “not sure/don’t know” (vaccine hesitant) were asked what the reasons are for their hesitancy. The top five most cited reasons for vaccine hesitancy: “not necessary”, “safety concerns”, “lack of recommendation”, “lack of knowledge”, and “not sexually active” were included in the study. Joinpoint regression estimated yearly increases/decreases in these reasons using annual percent changes. Results: The proportion of unvaccinated adolescents whose parents cited “safety concerns”’ as a reason for HPV vaccine hesitancy decreased from 2010 to 2012 but increased significantly from 2012 to 2019 at an average of 8.6% annually. The proportion of unvaccinated adolescents whose parents cited “not sexually active” as a reason for HPV vaccine hesitancy decreased on average by 33.1% from 2010-2012 and then at an average of 11.5% in the remaining years. The proportion of unvaccinated adolescents whose parents cited “not necessary” as a reason for HPV vaccine hesitancy decreased from 2010-2012 but significantly decreased by an average of 11.0% yearly from 2012-2019. The proportion of unvaccinated adolescents whose parents cited “lack of recommendation” and “lack of knowledge” as reasons for HPV vaccine hesitancy decreased over the 10-year period though not statistically significant. Conclusions: There was a decrease in most of the reasons cited by parents for vaccine hesitancy except vaccine safety which has been increasing from 2012 to 2019. These findings suggest an urgent need to combat the rising sentiment of safety concerns among parents of unvaccinated children to increase HPV vaccine confidence.

Defining the characteristics of healthcare worker (HCW) attitudes toward the coronavirus disease 2019 (COVID-19) vaccine can provide insights into vaccine hesitancy. This study's goal is to determine HCWs' attitudes regarding the COVID-19 vaccination and reasons for vaccine hesitancy. This cross-sectional study surveyed HCWs working in institutions in Saginaw, Sanilac, and Wayne counties in Michigan (N = 120) using tipping-scale questions. Analysis of variance and t-test were used to measure HCWs' attitudes toward the COVID-19 virus and vaccines. Most HCWs received (95.9%) and recommended (98.3%) a COVID-19 vaccine. The top three factors that HCWs cited for recommending a COVID-19 vaccine were: (1) efficacy of the vaccine, (2) current exposure to patients with active COVID-19 infection and risk of virus spread, and (3) safety of vaccine and long-term follow-up. Female HCWs or HCWs aged 25-54 years were more concerned about contracting COVID-19. Physicians or HCWs aged 55-64 were less concerned regarding the effectiveness and side effects of the vaccine. Gender, age, ethnicity, provider type, and medical specialty showed statistically significant differences among COVID-19 attitudes. Focusing educational efforts on HCW demographics who are more likely to have negative attitudes can potentially decrease vaccine hesitancy.

This study aimed to investigate the Coronavirus disease 2019 (COVID-19) vaccination rate, reasons for vaccine hesitancy and clinical effects on patients with Takayasu's arteritis (TAK). A web-based survey was administered to a TAK cohort established by the Department of Rheumatology, Zhongshan Hospital through WeChat in April, 2022. Responses from a total of 302 patients were received. The Sinovac or Sinopharm inactivated vaccination rate, side effects, and vaccine hesitancy reasons were analyzed. In addition, disease flare, new disease onset, and changes of immune-related parameters after vaccination were analyzed in vaccinated patients. Among 302 patients, 93 (30.79%) received the inactivated COVID-19 vaccination. Among the 209 unvaccinated patients, the most common reason for hesitancy were concern about side effects (136, 65.07%). Vaccinated patients had a longer disease duration (p = 0.08) and lower use of biologic agents (p < 0.001); 16 (17.20%) of the 93 vaccinated patients developed side effects, and most of them were mild; 8 (8.60%) developed disease flares or new-onset disease 12-128 days post-vaccination and 2 (2.15%) developed serious adverse effects (vision defect and cranial infarction). Immune-related parameters of 17 patients indicated decreases in IgA and IgM after vaccination (p < 0.05). Eighteen (19.35%) of the 93 vaccinated patients were diagnosed post-vaccination.These patients had a significantly higher percentage of CD19+ B cells at disease onset (p < 0.05) than the unvaccinated patients diagnosed at the same time. The vaccination rate was low in TAK, which was mainly caused by concerns about negative effects of vaccination on their disease. An acceptable safety profile was observed in vaccinated patients. The risk of disease flare associated with COVID-19 vaccination warrants further investigation.

Uptake of the COVID-19 vaccine among pregnant persons is lower than the general population. This scoping review explored pregnant people’s attitudes towards the COVID-19 vaccine, reasons for vaccine hesitancy, and whether attitudes about COVID-19 vaccines differ by country of origin. A scoping review was conducted across PubMed, Embase, CINHAL, and Scopus. Inclusion criteria were articles published in English from 2019–2022 focused on attitudes towards COVID-19 vaccination among pregnant persons. Data analysis was done via the 5Cs framework for vaccine hesitancy: Constraints, Complacency, Calculation, Confidence, and Collective Responsibility. 44 articles were extracted. A lack of confidence in vaccine safety was the most prevalent theme of hesitancy among pregnant persons. This was largely driven by a lack of access to information about the vaccine as well as mistrust of the vaccine and medical professionals. Meanwhile, vaccine acceptance was mostly driven by a desire to protect themselves and their loved ones. Overall, COVID-19 vaccine hesitancy among pregnant persons continues to be high. Vaccine hesitancy is primarily driven by fear of the unknown side effects of the vaccine on pregnant persons and their fetuses along with a lack of information and medical mistrust. Some differences can be seen between high income and low- and middle-income countries regarding vaccine hesitancy, showing that a single solution cannot be applied to all who are vaccine hesitant. General strategies, however, can be utilized to reduce vaccine hesitancy, including advocating for inclusion of pregnant persons in clinical trials and incorporating consistent COVID-19 vaccine counseling during prenatal appointments.

Mexico has become one of the most highly affected countries by coronavirus disease 2019 (COVID-19) pandemic in Latin America. Therefore, efficient vaccination programs are needed to address COVID-19 pandemic. Although recent advances around the world have made it possible to develop vaccines in record time, there has been increasing fear and misinformation around the vaccines. Hence, understanding vaccine hesitancy is imperative for modeling successful vaccination strategies. In this study, we analyzed the attitude and perceptions toward COVID-19 vaccination, in a Mexican population (n = 1,512), using the proposed COVID-19 Vaccine Acceptance and Hesitancy Questionnaire (COV-AHQ) (Cronbach's alpha > 0.8), which evaluates a mild perception of danger and contamination with respect to COVID-19, a moderate perception of xenophobia generated throughout COVID-19 quarantine, fear of adverse effects of COVID-19 vaccination, and hesitancy of parent toward vaccination of children; furthermore, a section including sociodemographic variables was included. According to the results of this study, the statistical correlation analysis of the general vaccination posture seems to correlate significantly (p < 0.05) with a mild perception of danger and contamination with respect to COVID-19, a moderate perception of xenophobia generated throughout COVID-19 quarantine, hesitancy of parent toward vaccination of children, willingness to get COVID-19 vaccine, previous influenza vaccination, perception of the vaccine that could help the economy of country, occupation, gender, age, and participants actively researching COVID-19 vaccine information. An in-depth analysis assisted by binary logistic regression concluded that the young adult population around ages 18–34 years are the most likely to get vaccinated. This posture seems to be highly influenced by a mild perception of danger and contamination with respect to COVID-19, a moderate perception of xenophobia generated throughout COVID-19 quarantine, fear of adverse effects of COVID-19 vaccination, and hesitancy of parents toward vaccination of children. While their own personal religious beliefs and economic status, the level of education does not seem to have an effect on the willingness to get vaccinated neither did having a previous COVID-19 diagnosis or even knowing someone with a positive COVID-19 diagnosis. Health authorities and policymakers could use the results of this study to aid in modeling vaccination programs and strategies and identify population groups with high vaccine hesitancy prevalence and assess significant public health issues.

Introduction The Coronavirus Disease 2019 (COVID-19) pandemic has had devastating consequences for persons with opioid use disorder (OUD). Yet, little is known about how people seeking treatment for OUD perceive the risks of COVID-19 and how their perception interplays with their health behaviours. Methods In-depth interviews were conducted from September 2021 to March 2022 with 32 patients seeking medication treatment for OUD (MOUD) in Southern California. All interviews were conducted virtually and lasted between one and two hours. Interviews were recorded and transcribed verbatim. Two qualitative researchers independently conducted a content analysis of the transcripts to identify themes. Results Three primary themes were identified: (1) perceptions and beliefs about COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed in their beliefs of susceptibility to contracting COVID-19 and the severity of the disease if contracted. Some participants reported taking precautions to mitigate their chances of acquiring COVID-19, and other participants reported that COVID was not a big concern as substance use took priority. For many of the participants, COVID-19 concerns were overshadowed by the risk of overdosing on substances and other risky substance use behaviour. Most of the participants (n = 23; 72%) had received at least one COVID-19 vaccine by the time of the interview, but over half (n = 19; 59%) expressed vaccine hesitancy. Vaccine hesitancy was driven by concerns about the unknown long-term side effects and potential interactions of the vaccine with MOUD. Conclusions Our study provides insight into COVID-19 prevention measures as well as vaccination perceptions and hesitancy among people who received treatment for OUD. Key messages Participants expressed diverse perceptions of the seriousness of COVID-19, with some taking precautions to mitigate their chances of acquiring COVID-19 and others perceiving that the risk of contracting COVID-19 was less than the risk of overdosing. Substance use, social isolation, vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring phenomena that have potentially overlapping relationships that can influence behaviours that impact health and well-being.

Kidney transplant recipients are at increased risk of severe outcomes from coronavirus disease 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination has been shown to reduce hospitalisation and mortality rates in kidney transplant recipients, but vaccine hesitancy remains a concern. We surveyed kidney transplant recipients in a single centre to examine their perceptions and attitudes towards SARS-CoV-2 vaccination. A cross-sectional survey of kidney transplant recipients was conducted between June 2021 and August 2021. Questionnaire responses collected included demographic data, intention to receive SARS-CoV-2 vaccine and factors related to vaccine acceptance or hesitance. Predictors and reasons for vaccine acceptance were analysed. In the sampled cohort of 313 respondents, the vaccine acceptance rate was 75%; 61% of the respondents were aged 51-70 years, and 31% had transplant vintages of 10-20 years. In a multivariable model, transplant physicians' recommendation (odds ratio [OR] 4.1, 95% confidence interval [CI] 2.4-7.1, P < 0.001), male gender (OR 2.3, 95% CI 1.3-4.0, P = 0.003) and transplant vintage of <10 years (OR 2.0, 95% CI 1.2-3.5, P = 0.01) were predictors of vaccine acceptance. Recipients' perceptions that SARS-CoV-2 vaccination confers protection and their trust in the government and health authorities on vaccine efficacy and safety were reasons for vaccine acceptance, while concerns about the effects of vaccination on allograft function and the safety and efficacy of vaccines were reasons for vaccine hesitancy. Assurance from transplant physicians played an important role in increasing vaccine acceptance. A high level of knowledge and trust in the doctor-patient relationship remain critical for kidney transplant recipients to improve vaccine acceptance. Continued efforts are required to address concerns about vaccine efficacy and safety in this population.

Broad adoption of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is key to successfully fighting the spread of coronavirus disease 2019 (COVID-19). When fallen ill with COVID-19, in-center hemodialysis patients are at particularly high risk for morbidity and mortality.1Goicoechea M. Sánchez Cámara L.A. Macías N. et al.COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain.Kidney Int. 2020; 98: 27-34Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar,2Lano G. Braconnier A. Bataille S. et al.Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort.Clin Kidney J. 2020; 13: 878-888Crossref PubMed Google Scholar Therefore, attaining high vaccination rates in both dialysis patients and staff is of utmost importance. The New York State Department of Health COVID-19 vaccination plan calls for a phased distribution of the vaccine (https://covid19vaccine.health.ny.gov/phased-distribution-vaccine). In accordance with that plan, all outpatient/ambulatory front-line, high-risk health care workers of any age who provide direct in-person patient care are eligible for vaccination; this definition includes dialysis staff. Here we report dialysis staff vaccination acceptance and hesitancy rates from 4 Renal Research Institute dialysis clinics and a home dialysis program located in New York, New York. Inoculation of the first dose was done between 13 and 21 January 2021. The staff count was 157, including full-time and part-time employees, temporary workers, and per diem staff. Staff who were pregnant or breast feeding, were on leave of absence, had contracted COVID-19 less than 90 days ago, or explicitly expressed vaccination hesitancy were not offered inoculation. Staff with a history of confirmed COVID-19 more than 90 days ago or at some unknown time in the past were offered vaccination; while in principle willing to get inoculated, these staff members wished to receive the vaccine later. Six employees (3.8%) explicitly expressed vaccination hesitancy (Table 1).Table 1Vaccination of Renal Research Institute dialysis staff in New York City, New York, January 2021StaffNot vaccinated (n = 42 [26.8])VaccinatedbThis number includes 3 staff members who were vaccinated by a different health care provider.Leave of absencePregnancy or breast feedingPast COVID-19 infectionVaccination hesitancy>90 days≤90 daysUnknownaThese individuals had tested positive for SARS-CoV-2 antibodies but had no confirmed COVID-19 infection.1574 (2.5)8 (5.1)14 (8.9)6 (3.8)4 (2.5)6 (3.8)115 (73.2)COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.Data are presented as number (%).a These individuals had tested positive for SARS-CoV-2 antibodies but had no confirmed COVID-19 infection.b This number includes 3 staff members who were vaccinated by a different health care provider. Open table in a new tab COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Data are presented as number (%). In preparation of the vaccination rollout, we have undertaken several measures to attain a low vaccination hesitancy rate, including extensive information on vaccination and in-person briefings, if requested. The vaccination was endorsed unanimously by medical and staff leadership. Also, the fact that New York City was hit hard by the pandemic and that many staff members have witnessed COVID-19 firsthand in patients, family, and friends may have contributed to the high vaccination rate. Finally, since spring 2020, clinic staff have been actively involved in quality improvement and clinical research projects related to COVID-19.3Wang X. Patel A. Tisdale L. et al.SARS-CoV-2 in spent dialysate from chronic peritoneal dialysis patients with COVID-19.Kidney360. 2021; 2: 86-89Crossref Google Scholar,4Preciado P. Tapia Silva L.M. Ye X. et al.Arterial oxygen saturation and hypoxemia in hemodialysis patients with COVID-19.Clin Kidney J. 2021; : sfab019Crossref Scopus (1) Google Scholar We believe that these factors in aggregate contributed to the high vaccination acceptance rate we observed. Lastly, there are additional opportunities to increase vaccination rates. First, because reinfection with COVID-19 is possible, the Centers for Disease Control and Prevention recommends that the vaccine should be offered to individuals with previous COVID-19 infection. However, while vaccine supply remains limited, persons with recent documented acute SARS-CoV-2 infection may choose to temporarily delay vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html). Second, it will be important to communicate that pregnant women may choose to be vaccinated. The authors are employees of the Renal Research Institute, a wholly owned subsidiary of Fresenius Medical Care (FMC). PK and TS hold stock in FMC. 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Engaging Nursing Assistants to Enhance Receptivity to the Coronavirus Disease 2019 Vaccine