Winning Solution: Characterizing and Targeting Vaccine Hesitancy Among End-Stage Kidney Disease (ESKD) Patients

Individuals with end-stage kidney disease, undergoing in-center hemodialysis (HD) therapy are at increased risk of COVID-19 morbidity and mortality. Data indicates mortality risk of approximately 30% in end-stage kidney disease (ESKD) patients hospitalized with COVID-19.
The best approach to build widespread COVID-19 immunity requires a mass vaccination campaign. Vaccine development efforts are accelerating at miraculous speed, and to date, multiple vaccines have shown very promising results. It is estimated that vaccines will be available for widespread use in the spring of 2021.

While scientists are rushing to create an effective vaccine, reports on high rates of vaccine hesitancy are concerning. A poll in mid-May found that only 25% and 37% of Black and Hispanic people, respectively, will take the vaccine, while the remaining participants were unsure or planning to refuse the vaccine. Consistent with these data, a high percentage of adult in-center HD patients stated that, if a vaccine against COVID-19 becomes available, they would refuse it.

Our hypothesis is that vaccine hesitancy is widespread among individuals with ESKD, which will impede vaccination uptake in this particularly vulnerable population. However, we believe vaccine uptake can be improved using tailored and targeted interventions. We propose to characterize determinants of COVID-19 vaccine hesitancy in a diverse ESKD population by performing a mixed-methods study of ESKD patients across multiple dialysis units in New York City (~550 ESKD patients). We will explore perceptions of discrimination, mistrust, and stigma surrounding communicable disease, as well as individual and group-based factors that influence vaccination hesitancy. These data will be the foundation for multidisciplinary and tailored interventions, based on an adaptation of the theory of reasoned action and theory of planned behavior, to increase vaccine acceptance in the ESKD patients with vaccine hesitancy. The primary outcome of the intervention will be to increase vaccination uptake to greater than 70% within three months following implementation.

Lama Nazzal, MD, is Assistant Professor, Department of Medicine at NYU Grossman School of Medicine and Medical Director, Lower Manhattan Dialysis Center.