COVID-19 vaccine hesitancy in patients on dialysis in Italy and France.

Introduction: Patients on dialysis (HDP) are a category at high risk from COVID-19 and thus a high-priority group for vaccination. COVID-19 vaccine hesitancy has been a concern since the availability of the first vaccine. The objective of this study was to determine hesitancy rates and factors associated with hesitancy towards COVID-19 vaccination in HDP. Methods: HDP were surveyed with an ad hoc questionnaire in four large dialysis facilities in Europe: Le Mans and Paris, in France, Cagliari and Pavia, in Italy. The questionnaire explored different domains associated with vaccine hesitancy, such as perception of disease severity, sources of information about the vaccine and the disease, and confidence in the healthcare system. Results: 417 patients (average age 69, 60% men) agreed to answer the questionnaire. Hesitancy was associated with younger age (p 0.003), lower perception of disease severity (<0.001) and vaccine efficacy (p<0.001), lower trust in vaccination (p<0.001) and in the healthcare system and scientists (p<0.001) in the univariate analysis. In the multivariate models, concerns about side effects (p 0.004) and vaccine efficacy (<0.001) and living in France (p 0.04) remained associated with higher vaccine hesitancy, while having received an influenza vaccine (p 0.032) and trusting scientists (p 0.032) were associated with a more positive attitude towards vaccination. Conclusions: HDP have a good understanding of the risks associated with COVID-19. Vaccine hesitancy was not associated with educational level, age or gender but rather with lack of confidence in vaccine efficacy and concerns about safety. HDP were quite skeptical about the healthcare system but generally trusted scientists.