{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:59:18Z","timestamp":1793501958358,"version":"4.5.0"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T00:00:00Z","timestamp":1653523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>As COVID-19 vaccinations became available and were proven effective in preventing serious infection, uptake amongst individuals varied, including in medically vulnerable populations. This cross-sectional multi-site study examined vaccine uptake, hesitancy, and explanatory factors amongst people with serious and\/or chronic health conditions, including the impact of underlying disease on attitudes to vaccination. A 42-item survey was distributed to people with cancer, diabetes, or multiple sclerosis across ten Australian health services from 30 June to 5 October 2021. The survey evaluated sociodemographic and disease-related characteristics and incorporated three validated scales measuring vaccine hesitancy and vaccine-related beliefs generally and specific to their disease: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale and the Disease Influenced Vaccine Acceptance Scale-Six. Among 4683 participants (2548 [54.4%] female, 2108 [45.0%] male, 27 [0.6%] other; mean [SD] age, 60.6 [13.3] years; 3560 [76.0%] cancer, 842 [18.0%] diabetes, and 281 [6.0%] multiple sclerosis), 3813 (81.5%) self-reported having at least one COVID-19 vaccine. Unvaccinated status was associated with younger age, female sex, lower education and income, English as a second language, and residence in regional areas. Unvaccinated participants were more likely to report greater vaccine hesitancy and more negative perceptions toward vaccines. Disease-related vaccine concerns were associated with unvaccinated status and hesitancy, including greater complacency about COVID-19 infection, and concerns relating to vaccine efficacy and impact on their disease and\/or treatment. This highlights the need to develop targeted strategies and education about COVID-19 vaccination to support medically vulnerable populations and health professionals.<\/jats:p>","DOI":"10.3390\/vaccines10060851","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T05:25:42Z","timestamp":1653974742000},"page":"851","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Serious Underlying Medical Conditions and COVID-19 Vaccine Hesitancy: A Large Cross-Sectional Analysis from Australia"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8262-2441","authenticated-orcid":false,"given":"Daphne","family":"Day","sequence":"first","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Grech","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3044-1707","authenticated-orcid":false,"given":"Mike","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3320-8444","authenticated-orcid":false,"given":"Nathan","family":"Bain","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"Kwok","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bendigo Health, Bendigo, VIC 3550, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hieu","family":"Chau","sequence":"additional","affiliation":[{"name":"Department of Oncology, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia"},{"name":"School of Medicine, Griffith University, Birtinya, QLD 4575, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Blennerhassett","sequence":"additional","affiliation":[{"name":"Central Coast Haematology, North Gosford, NSW 2250, Australia"},{"name":"School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Nott","sequence":"additional","affiliation":[{"name":"Icon Cancer Centre Hobart, Hobart, TAS 7000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Hamad","sequence":"additional","affiliation":[{"name":"Department of Haematology, St Vincent\u2019s Hospital Sydney, Darlinghurst, NSW 2010, Australia"},{"name":"School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Kensington, NSW 2052, Australia"},{"name":"School of Medicine, University of Notre Dame Australia, Chippendale, NSW 2007, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Tognela","sequence":"additional","affiliation":[{"name":"Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2560, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Dr David Hoffman, Fairfield, NSW 2165, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-0736","authenticated-orcid":false,"given":"Amelia","family":"McCartney","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4350-0884","authenticated-orcid":false,"given":"Kate","family":"Webber","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"},{"name":"Monash Diabetes, Monash Health, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Underhill","sequence":"additional","affiliation":[{"name":"Border Medical Oncology, Albury, NSW 2640, Australia"},{"name":"Rural Medical School, University of New South Wales, Albury, NSW 2640, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Sillars","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6100-4764","authenticated-orcid":false,"given":"Antony","family":"Winkel","sequence":"additional","affiliation":[{"name":"School of Medicine, Griffith University, Birtinya, QLD 4575, Australia"},{"name":"Department of Neurology, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Savage","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Bendigo Health, Bendigo, VIC 3550, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Sheng","family":"Loe","sequence":"additional","affiliation":[{"name":"The Psychometrics Centre, University of Cambridge, Cambridge CB2 1AG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK"},{"name":"Oxford Health National Health Service Foundation Trust, Oxford OX3 7JX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-6144","authenticated-orcid":false,"given":"Eva","family":"Segelov","sequence":"additional","affiliation":[{"name":"Department of Oncology, Monash Health, Clayton, VIC 3168, Australia"},{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the CANVACCS, DIABVACCS and MSVACCS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"key":"ref_1","unstructured":"Organisation for Economic Co-operation and Development (2022, March 10). Health at a Glance 2021: OECD Indicators. Available online: https:\/\/www.oecd-ilibrary.org\/sites\/ae3016b9-en\/index.html?itemId=\/content\/publication\/ae3016b9-en."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_3","unstructured":"World Health Organisation (2022, March 10). Strategic Advisory Group of Experts on Immunization. WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/351138\/WHO-2019-nCoV-Vaccines-SAGE-Prioritization-2022.1-eng.pdf?sequence=1&isAllowed=y."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9.","DOI":"10.1101\/2020.12.28.20248950"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1038\/s41591-020-1124-9","article-title":"A global survey of potential acceptance of a COVID-19 vaccine","volume":"27","author":"Lazarus","year":"2021","journal-title":"Nat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4048","DOI":"10.1080\/21645515.2021.1958611","article-title":"SARS-COV-2 vaccine acceptance in patients with rheumatic diseases: A cross-sectional study","volume":"17","author":"Ko","year":"2021","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: Definition, scope and determinants","volume":"33","author":"MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"ref_8","unstructured":"World Health Organisation (2022, March 10). Top Ten Threats to Global Health in 2019. Available online: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Freeman, D., Loe, B.S., Chadwick, A., Vaccari, C., Waite, F., Rosebrock, L., Jenner, L., Petit, A., Lewandowsky, S., and Vanderslott, S. (2020). COVID-19 vaccine hesitancy in the UK: The Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol. Med., 1\u201315.","DOI":"10.1017\/S0033291720005188"},{"key":"ref_10","unstructured":"Melbourne Institute of Applied Economic and Social Research (2022, February 19). Tracking COVID-19 Vaccine Hesitancy Across Australia Using Taking the Pulse of the Nation (TTPN) Survey Data. Available online: https:\/\/melbourneinstitute.unimelb.edu.au\/publications\/research-insights\/ttpn\/vaccination-report."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"575950","DOI":"10.3389\/fpsyg.2020.575950","article-title":"A proactive approach for managing COVID-19: The importance of understanding the motivational roots of vaccination hesitancy for SARS-CoV2","volume":"11","author":"Taylor","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1056\/NEJMoa2102214","article-title":"Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant","volume":"384","author":"Madhi","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S1470-2045(21)00213-8","article-title":"Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: Interim analysis of a prospective observational study","volume":"22","author":"Monin","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/14760584.2022.2035222","article-title":"COVID-19 vaccine effectiveness among immunocompromised populations: A targeted literature review of real-world studies","volume":"21","author":"Lin","year":"2022","journal-title":"Expert Rev. Vaccines"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1056\/NEJMoa2110362","article-title":"Effectiveness of Covid-19 vaccines in ambulatory and inpatient care settings","volume":"385","author":"Thompson","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kelkar, A.H., Blake, J.A., Cherabuddi, K., Cornett, H., McKee, B.L., and Cogle, C.R. (2021). Vaccine enthusiasm and hesitancy in cancer patients and the impact of a webinar. Healthcare, 9.","DOI":"10.3390\/healthcare9030351"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ejca.2021.05.006","article-title":"The first report on coronavirus disease 2019 (COVID-19) vaccine refusal by patients with solid cancer in Italy: Early data from a single-institute survey","volume":"153","author":"Renna","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Grech, L., Loe, B., Day, D., Freeman, D., Kwok, A., Nguyen, M., Bain, N., and Segelov, E. The Disease Influenced COVID-19 Vaccine Acceptance Scale-Six (DIVAS-6): Validation of a measure to assess disease-related COVID-19 vaccine attitudes and concerns. Behav. Med., 2022. in press.","DOI":"10.1080\/08964289.2022.2082358"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Elm","year":"2007","journal-title":"BMJ"},{"key":"ref_22","unstructured":"Australian Government Department of Health (2022, February 19). COVID-19 Vaccine Rollout Update\u20145 October 2021, Available online: https:\/\/www.health.gov.au\/sites\/default\/files\/documents\/2021\/10\/covid-19-vaccine-rollout-update-5-october-2021_0.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e29872","DOI":"10.2196\/29872","article-title":"COVID-19 vaccine hesitancy and acceptance among individuals with cancer, autoimmune diseases, or other serious comorbid conditions: Cross-sectional, internet-based survey","volume":"8","author":"Tsai","year":"2022","journal-title":"JMIR Public Health Surveill."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103175","DOI":"10.1016\/j.msard.2021.103175","article-title":"Willingness to receive a COVID-19 vaccine in people with multiple sclerosis\u2014UK MS Register survey","volume":"55","author":"Huang","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chan, W.-L., Ho, Y.-H.T., Wong, C.K., Choi, H.C., Lam, K.-O., Yuen, K.-K., Kwong, D., and Hung, I. (2021). Acceptance of COVID-19 vaccination in cancer patients in Hong Kong: Approaches to improve the vaccination rate. Vaccines, 9.","DOI":"10.3390\/vaccines9070792"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.4161\/hv.24657","article-title":"Vaccine hesitancy: An overview","volume":"9","author":"Laberge","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Willis, D.E., Selig, J.P., Andersen, J.A., Hall, S., Hallgren, E., Williams, M., Bryant-Moore, K., and McElfish, P.A. (2022). Hesitant but vaccinated: Assessing COVID-19 vaccine hesitancy among the recently vaccinated. J. Behav. Med., 1\u201310.","DOI":"10.1007\/s10865-021-00270-6"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1046\/j.1369-6513.2000.00076.x","article-title":"Clinical decision-making in the context of chronic illness","volume":"3","author":"Watt","year":"2000","journal-title":"Health Expect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s00432-022-03961-y","article-title":"Attitudes toward a COVID-19 vaccine and vaccination status in cancer patients: A cross-sectional survey","volume":"148","author":"Heyne","year":"2022","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_30","unstructured":"National Multiple Sclerosis Society (2022, March 10). COVID-19 Vaccination Guidance for People Living with MS. Available online: https:\/\/www.nationalmssociety.org\/coronavirus-covid-19-information\/multiple-sclerosis-and-coronavirus\/covid-19-vaccine-guidance."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nguyen, M., Bain, N., Grech, L., Choi, T., Harris, S., Chau, H., Freeman, D., Kwok, A., Williams, J., and McCartney, A. (2022). COVID-19 vaccination rates, intent, and hesitancy in patients with solid organ and blood cancers: A multicenter study. Asia-Pac. J. Clin. Oncol., early view.","DOI":"10.1111\/ajco.13754"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/6\/851\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:19:02Z","timestamp":1760138342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/6\/851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,26]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["vaccines10060851"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10060851","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2022.04.06.22273080","asserted-by":"object"}]},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,26]]}}}