54 The Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients Study

Abstract

Study Objectives: Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites and willingness to get the vaccine as part of ED care. Methods: Cross sectional survey conducted from 12/10/2020 to 3/7/21 at 15 safety net United States EDs. Primary outcomes were COVID-19 vaccine hesitancy, reasons for vaccine hesitancy, and sites (including EDs) for potential COVID-19 vaccine receipt. Results: Of 2575 patients approached, 2301 (89.4%) participated. Of the 18.4% of respondents who lacked a regular source of medical care, 65% used the ED as their usual source of health care. The overall rate of vaccine hesitancy was 39%;the range among the 15 sites was 28 to 58%. Respondents who lacked a regular source of medical care were more commonly vaccine hesitant than those who had a regular source of medical care (47 vs 38%, 9% difference, 95% CI 4 – 14%). Other characteristics associated with greater vaccine hesitancy were younger age (median 40 vs 52, p < 0.0001), (female sex (45% vs 33%;difference 12%, 95% CI 8 to 16%), African-American race (54% vs 30%;difference 24%, 95% CI 19 to 29%), Latinx ethnicity (39% vs 30%;difference 9%, 95% CI 4 to 14%), and not having a prior influenza vaccine in the past five years (58% vs 31%;difference 27%, 95% CI 23 to 32%). Homelessness and uninsured status were not associated with greater vaccine hesitancy. Fewer vaccine hesitant respondents reported that some or all of their family members would accept the COVID-19 vaccine if it was offered to them (29% vs 75%, 46% difference, 95% CI 42 to 50%). Of the 61% COVID-19 vaccine acceptors, 21% stated that they lacked a primary doctor or clinic to receive it. The vast majority (95%) of these respondents lacking primary care would accept the COVID-19 vaccine as part of their care in the ED. Conclusions: ED patients who lack a regular source of medical care are particularly hesitant to COVID-19 vaccination. Most COVID-19 vaccine acceptors would accept it as part of their care in the ED. EDs may have pivotal roles in COVID-19 vaccine messaging and delivery to highly vulnerable populations.