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Letter to the editor to: Verger P and Dubé E. Restoring confidence in vaccines in the COVID-19 era, expert review of vaccines, 2020; 19(11):991-3

Dear Editor, We read the intriguing editorial titled, ‘Restoring confidence in vaccines in the COVID-19 era’ by Verger and Dubé [1]. Buttressed by examples from mainstream populations and healthcare workers, the authors discussed vaccine hesitancy and ways to restore confidence in vaccination. Vaccination issues in marginalized communities such as Hispanic populations, however, were not highlighted in the editorial. Hispanic populations in the USA have been disproportionately affected by COVID-19 along with economic and social ramifications [2]. Compared to non-Hispanic whites, the urban Hispanic/Latino population is about five times more likely to test positive for SARS-CoV-2 [3], yet focused survey addressing COVID-19 vaccine hesitancy among US Hispanic population is non-existent. Here, we share our experience from an anonymous survey conducted among Laredo population (95.6% are Hispanics) in Texas, USA from 2nd to 14 December 2020. By using a structured online questionnaire containing 12 closedended questions, we assessed the willingness to receive COVID-19 vaccine, their attitude toward and perception surrounding COVID-19 vaccination, and the sources of information on COVID-19 they trust. Following approval from Texas A&M International University (TAMIU) Institutional Review Board (IRB Approval Number: 12.026), the questionnaire was uploaded to SurveyMonkey and the survey link was distributed among university staff, faculty, students and employees of TAMIU and the listserv of the Laredo Department of Health. Complete responses were received from 259 survey participants; (65.6% [170/258]) were women, 96.9% (251/259) were of working age group (18–64 years), 67.6% (175/259) had bachelor level or higher education, and 28.6% (74/259) were professionals and office workers. Of all, 78.4% (203/259) respondents said they would accept COVID-19 vaccine when available, 20.9% (54/259) said they would decline for the following key reasons: safety concerns (42.6% [23/54]), lack of trust in the authority (13% [7/54]), and lack of affordability (3.7% [2/54]). Older people and those with higher education and those employed in professional jobs were more willing to accept vaccination than their counterparts (Table 1). Of all, 60.2% [156/259] reported trusting the Centers for Disease Control and Prevention (CDC) for information related to COVID-19 vaccine, only 9.7% [25/259] trusted federal government, 9.3% [24/259] trusted World Health Organization (WHO), 3.1% [8/259] trusted state government, 2.3% [6/259] trusted local government, 5% [13/259] trusted others, and 10.4% [27/259] trusted none. Compared to males, females reported to have poorer access to information related to COVID-19 vaccine (61.8% [105/170] vs 75% [66/88], P < 0.05) but were more unsure about information resources. Individuals aged ≥55 years were more likely than those who were aged 35–54 years or <35 years to have access to information sources (85.3% [29/34] vs 68.5% [61/89] or 60.3% [82/136], P = 0.02, by X for trend). Respondents with a bachelorlevel or higher education were more likely than those with high school-level education or other educational background to have access to the information sources (72.6% [127/175] vs. 57.6% [34/59] or 44% [11/25], P < 0.01 by X for trend). As for perception about vaccine safety, males and females similarly believed COVID-19 vaccine to be safe (72.7% [64/88] vs. 62.9% [107/170], P = 0.15); however, significantly more females were unsure about vaccine safety than males (29.4% [50/170] vs 17.1% [15/88], P = 0.04), but no such difference existed by participants’ age or educational level. Our survey involving mostly working class, well-educated, and well-employed participants in a Hispanic community in the USA showed 78% would accept COVID-19 vaccine. Older individuals, people with better education, and better jobs are more likely to receive the vaccine, but there were gender differences in terms of accessing information and expressing safety concerns. That almost four in five survey participants expressed willingness to receive COVID-19 vaccine seems an improvement compared to results of earlier surveys; for instance, at least four earlier surveys showed over 30% Americans did not intend to pursue vaccination against COVID-19 [4–7], and in another survey 55.8% participants reported that they would definitely accept, another 34.3% were unsure but had a tendency to accept the vaccine [8]. A survey conducted in June 2020 involving 1878 individuals, 19% of whom were Hispanic, found that about 78% were very likely