COVID-19 Vaccine Coverage and Hesitancy in Long-Term Care Facilities, Houston, Texas

Background Vaccine hesitancy threatens a reversal of progress made in tackling vaccine-preventable diseases. The Houston, Texas, Health Department assessed COVID-19 vaccine availability and uptake in these facilities after the emergency use authorization of the COVID-19 vaccines in United States. Population and Methods A facility-based cross-sectional study was conducted using a structured interviewer-administered questionnaire to elicit data on facility demographics, vaccine availability, residents and staff vaccine uptake at time of assessment. The unit of inquiry was the facility. We calculated frequencies and assessed association with facility type. Facilities were classified as: small-scale facilities (SSF) ≤ 10 beds, medium scale (MSF) 11-50 beds, and large-scale (LSF) > 50 beds. Results A total of 118 facilities were enrolled, with 2,431 residents and 2,290 staff. Twenty-five (14.5%) of the facilities were LSF, 47 (39.8%) MSF, and 46 (39.0%) SSF. Overall, 70 (59.3%) facilities had COVID-19 vaccine available. The staff of these facilities were four-times as likely as the patients to be unvaccinated (prevalence ratio= 4.1; 95% CI= 3.7, 4.6) since the vast majority of residents, (86.5%), were vaccinated but less than half of staff (44.2%) were (P < 0.0001). Reasons provided for vaccine hesitancy included fear of side effects from a new vaccine, need to wait and see what happens to others, government distrust, religious beliefs, conspiracy theories among other things. Discussion The findings supported highlighted a preventable gap in the protection of the elderly in these facilities and prompted a health education campaign tackling vaccine hesitancy and encourage vaccine uptake.