BACKGROUND: People who inject drugs (PWID) are disproportionately impacted by SARS-CoV-2 and COVID-19, yet frequently do not accept vaccinations against SARS-CoV-2 when offered.
OBJECTIVE: To explore why PWID decline free vaccinations against SARS-CoV-2, and how barriers to vaccination can potentially be addressed.
METHODS: We conducted semi-structured qualitative interviews with 17 unvaccinated adult PWID during August and September 2021, at a New York City syringe service program where approximately three quarters of participants identify as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants’ understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among PWID.
RESULTS: Participants acknowledged they faced increased risk from SARS-CoV-2 due to their injection drug use, but feared long term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to significant ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination.
CONCLUSIONS: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines’ ability to prevent inadvertently infecting loved ones, may help increase uptake. Community focused messaging strategies, like those used to increase HIV/HCV testing and overdose prevention among PWID, may prove similarly effective.
How vaccine ambivalence can lead people who inject drugs to decline COVID-19 vaccination, and ways this can be addressed: A qualitative study
JMIR Formative Research, 6 (3), e35066. doi: 10.2196/35066. PMCID: PMC8945077.