Q+A: How Can We Persuade Organ Donors to Vaccinate Against COVID-19?

More than 150 million Americans – 46% of the country – has received at least one dose of a COVID-19 vaccine, and 36% of the country’s population is fully vaccinated. Despite very rare side effects, public health officials consider vaccines to be effective at preventing severe illness and be the ticket to something resembling pre-pandemic life.

Although herd immunity may not be reached, COVID-19 vaccination may be correlated with drops in COVID-19 cases, according to an ABC News analysis. Also, following a drop in cases and knowledge of the effectiveness of vaccines, the Centers for Disease Control and Prevention issued recent guidance that “fully vaccinated people no longer need to wear a mask or physically distance in any setting, except where required by federal, state, local, tribal or territorial laws, rules and regulations.”

As COVID-19 vaccines become increasingly available in the United States, public health experts are making efforts to address vaccine hesitancy, especially among healthy adults that were not prioritized for vaccines when they first became available. Healthy adults who get vaccinated against COVID-19 protect not only themselves but also the people in society who might not receive as much protection from COVID-19 vaccines, such as immunosuppressed organ transplant recipients.

Living organ donors are healthy individuals in society who have provided a selfless gift, and in doing so also have unique insights about the vulnerabilities of organ transplant recipients. In a recent study published in Kidney 360 by Meera Harhay, MD, an associate professor of Medicine in Drexel University’s College of Medicine and Dornsife School of Public Health, and co-authors including Dornsife School of Public Health Professor Ann Klassen, PhD,  and College of Medicine student Hasan Zaidi, offers new insights into what convinces some in this unique population to become vaccinated against COVID-19 and what may lead others to hesitation.

Below, Harhay shares some of the main takeaways from the paper, including how understanding hesitations may help increase the number of transplant procedures performed to pre-pandemic levels and help us all turn the tide against COVID-19.

Why is it important for living donors to be vaccinated against COVID-19?

Those who are selected to be living organ donors are some of the healthiest people in our society. But we know that even the healthiest people can be severely affected by COVID-19, and importantly, they can also transmit the virus to more vulnerable people. This is why we have to vaccinate both the vulnerable and the healthy to stop the pandemic. Very often, living donors know and love their organ recipients – it is usually a family member or friend that needed an organ transplant. And one of the best ways that we can protect organ recipients and other immunosuppressed people during the pandemic is for all of their close contacts to receive a COVID-19 vaccine. 

Your paper found that more than a fifth of living donors were unsure about taking a COVID-19 vaccine or would refuse one. Was this surprising?

The majority of donors and those planning to become donors were accepting of COVID-19 vaccines, which was reassuring because the available COVID-19 vaccines are so safe and effective. And many of the donors who were accepting of COVID-19 vaccines talked about the strong desire to protect their loved ones by becoming vaccinated. This lines up with what we know about organ donors – they are amazing people who are willing to take on the risks of surgery to save another person’s life.

And yet, although we did not expect 100% of donors to be certain about accepting a COVID-19 vaccine, it was surprising that the percentage of donors in our study who said they were not planning to receive a vaccine was so similar to the percentage in the general population (11% vs 13%). Another 12% of donors were unsure about receiving a COVID-19 vaccine. We hope that by understanding the root causes of uncertainty about COVID-19 vaccines in this unique population, we can develop strategies to address uncertainties in the general population, too.

What were the most common responses from those unsure about COVID-19 vaccination? Do you consider those to be valid reasons to be cautious?

The main themes that arose were concerns about vaccine safety, the idea that the vaccine was “rushed,” unknowns about long-term health effects, the perspective from some donors that COVID-19 was not a serious threat and that previous infection with COVID-19 was more protective than the COVID-19 vaccines. We also found that donors who did not receive yearly flu vaccines were much less likely to accept a COVID-19 vaccine, so some of these themes might apply to their perspectives about vaccines in general. I think many of these concerns are a direct result of the massive amounts of misinformation out there about vaccines and about COVID-19.

It is important to discuss peoples’ concerns in a non-judgmental way but also to provide the facts. COVID-19 is a very serious threat and it has already caused so much suffering and loss. Vaccines were developed rapidly because we were in an emergency, but scientists adhered to the strictest safety standards. Long-term effects are quite rare with any vaccines – most side effects are mild and occur within a few days, and vaccines can provide stronger protection and more long-lasting protection to people than a previous COVID-19 infection. I would also balance concerns about vaccine side effects with what we are learning about long-term symptoms after COVID-19 infection, which can be debilitating and can occur in healthy people after infection, too.

How can clinicians and other health professionals persuade those who are unsure to become vaccinated? What should they have in mind when crafting messages for this audience?

I think one key is to understand the sources that people trust for information and leverage those sources to communicate accurate information while calling out misinformation. We saw the importance of information source in our study – donors who prioritized medical and public health information sources about COVID-19 vaccines were much more likely to be accepting of vaccination than those who relied on general media, social media and other sources for information.

In terms of crafting a message, I think it is important to understand people’s motivations and priorities. A recent study in The Lancet suggested that messaging about personal benefits of vaccination was more likely to change people’s minds in favor of vaccination than messaging about benefits to others. This study aligned with our findings in that many vaccine-hesitant donors doubted personal benefits of COVID-19 vaccines because of their own good health status. So, we should certainly be crafting messages around personal benefits of vaccination. But also, given most organ donors know people (organ recipients) who are among the most vulnerable for having severe COVID-19 infections, we should be emphasizing that they can protect those people by becoming vaccinated themselves. 

How do you anticipate living organ donation trends to go in the next few months or so? How long might it take to get back to pre-pandemic levels?

Even though there was a big decline in living donations at the start of the pandemic, the number of donations steadily picked up later in 2020. The availability of COVID-19 vaccines is also a game-changer for transplants, so I’d say we have every reason to be optimistic about the future of living organ donation. 

Meera Harhay, MD, is an associate professor of Medicine in Drexel’s College of Medicine and Dornsife School of Public Health. She has been interviewed on a broad range of transplant topics in the media, most recently about racial disparities in kidney transplantation in Scientific American.

Media interested in speaking with Harhay should contact News Manager Greg Richter at gdr33@drexel.edu or 215-895-2614.

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