COVID-19 Vaccine Hesitancy Among Vulnerable Cancer Populations: How SGO Members Can Contribute to the Solution

Jeffrey F. Hines, MD; Warner K. Huh, MD; Amanda Nickles Fader, MD; Joshua Kesterson, MD; Bhavana Pothuri, MD, MS; Eloise Chapman-Davis, MD; Sandra E. Brooks, MD, MBA

The COVID-19 pandemic remains a global health care crisis. However, the development of COVID-19 vaccines, approved for emergency use authorization by the U.S. Food and Drug Administration (FDA) in December 2020, and others in the pipeline, hold the promise of widespread inoculation against the SARS-CoV-2 virus. The Society of Gynecologic Oncology (SGO), along with other national and international women’s health professional societies, released a unified statement on Dec. 15, 2020, endorsing vaccination for all members, patients and society at large [1]. Approximately 25 – 35% of patients enrolled in the Phase III COVID-19 vaccine trials were Black, LatinX/Hispanic, Indigenous Americans, or of other racial/ethnic background [2]. Despite the significant vaccine efficacy observed in these trials and the substantial representation of racial/ethnic minorities, vaccine hesitancy among these cohorts poses a major barrier to population-based vaccination efforts.

Racial/ethnic minorities have been disproportionately affected by the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC), Blacks, LatinX/Hispanics and Indigenous Americans are disproportionately represented among COVID-19 cases (1.4x, 1.7x, and 1.4x, respectively), hospitalizations (3.7 x, 4.1, and 4.0, respectively) and deaths (2.8 x, 2.8, and 2.6, respectively) [3]. In a recent survey, however, distrust of the COVID-19 vaccine remains high, particularly among Black adults, 35% of whom stated they definitely or probably would not get vaccinated [4]. Distrust is a significant driver for this hesitancy, fueled by a history of discrimination, health inequities and culturally incompetent care. Doubts regarding the COVID-19 vaccine among many ethnic and racial patient populations are related to its safety and effectiveness, rapid development, suspicion of policymakers, vaccine developers and medical institutions, as well as concerns that the needs of vulnerable populations were not considered [4]; yet these populations are potentially among the most in need of vaccination.

SGO acknowledges that high-risk populations, including patients with health conditions, cancer, and those who have disproportionately been impacted by COVID-19 (e.g., racial/ethnic minorities and those from low socioeconomic communities) should be prioritized for vaccination. Recent reports suggest that Black, LatinX and other patients are likely to listen to their trusted physicians [4, 5]; therefore, it is incumbent upon SGO members to discuss the COVID-19 vaccination with their patients.

Actionable considerations for SGO membership include:

• Educating themselves thoroughly on the available COVID-19 vaccines [6]
• Participating in empathetic, culturally sensitive conversations with their patients regarding the safety and efficacy of COVID-19 vaccines
• Discussing with Black, LatinX/Hispanic, Indigenous Americans and other vulnerable patients about their potentially higher risk of infection, hospitalization and death from COVID-19
• Dispelling general vaccine misconceptions
• Acknowledging with patients that vaccine hesitancy and distrust are legitimate concerns
• Considering additional opportunities at the Institutional or Community levels to educate racial/ethnic minorities about vaccination [Figure 1]

Figure 1: Suggested strategies to address vaccine hesitancy in vulnerable populations.

References:

1. Joint Statement: COVID-19 Health Measures
2. Minority numbers up in clinical trials for vaccine, but not enough, experts say
3. COVID-19 Hospitalization and Death by Race/Ethnicity
4. COVID-19 Mortality Among American Indian and Alaska Native Persons
5. KFF COVID-19 Vaccine Monitor: December 2020
6. Clinical Resources for Each COVID-19 Vaccine