Motivations for accepting or refusing Covid-19 vaccination in nursing homes and long-term care centers in France: the Vaccovid-senior study

Vaccination against SARS-CoV-2 remains the most powerful strategy to fight against the Covid-19 pandemic around the word. Nevertheless, the level of complete vaccination (including all recommended boosters) is not optimal, even in the most vulnerable population, i.e. older adults living in nursing homes (NH) and long-term care units (LTCU). In this context, the understanding of the patients' reluctance to vaccination seems particularly important and our objective was to understand the acceptance or refusal mechanisms of the Covid-19 vaccine among people living in NH and LTCU. National French cross-sectional study conducted between June and September 202 including 101 health care professionals working in NH or LTCU and represents 10,152 residents living in the respondents' establishments. The Vaccovid-Senior cohort included 323 residents (89 ± 6.5 years, 69% women, 89.2% living in NH); 179 agreed to vaccination and 144 were not vaccinated. In multivariate analysis, the only modifiable characteristics associated with the acceptance was a regular influenza vaccination (OR = 29.43; 95CI [12.11-71.53]; p < 0.001), and with refusal was receiving information from Internet and social media (OR = 0.34; 95CI [0.13-0.88]; p = 0.026). Remarkably, the interaction analysis revealed that the residents who were usually vaccinated against influenza and able to understand the information given about Covid-19 were 17,5 times more likely to accept the Covid-19 vaccination (RR = 17,5; 95CI [4,5-68,0]) compared to residents with polypharmacy but without regular influenza vaccination. Vaccine acceptance can be improved by repeated efforts to listen to and explain the vaccine to the older population, their families, and the care teams. Isolating these situations of refusal allowed us to foresee avenues of improvement such as the communication of information on the vaccine, the nudge strategy and training to give information adapted to the level of understanding.