COVID-19 vaccination hesitancy among people with chronic neurological disorders: A position paper

Martin Rakusa; Serefnur Öztürk; Elena Moro; Raimund Helbok; Claudio L Bassetti; Ettore Beghi; Daniel Bereczki; Benedetta Bodini; Giovanni Di Liberto; Thomas M Jenkins; Antonella Macerollo; Luis F Maia; Filippo Martinelli-Boneschi; Antonio Pisani; Alberto Priori; Anna Sauerbier; Riccardo Soffietti; Pille Taba; Tim J von Oertzen; Marialuisa Zedde; Michael Crean; Anja Burlica; Francesco Cavallieri; Johann Sellner; European Academy of Neurology NeuroCOVID-19 Task Force

doi:10.1111/ene.15368

COVID-19 vaccination hesitancy among people with chronic neurological disorders: A position paper

Eur J Neurol. 2022 Aug;29(8):2163-2172. doi: 10.1111/ene.15368. Epub 2022 May 10.

Authors

Martin Rakusa¹, Serefnur Öztürk², Elena Moro³, Raimund Helbok^{4

5}, Claudio L Bassetti⁵, Ettore Beghi⁶, Daniel Bereczki⁷, Benedetta Bodini^{8

9}, Giovanni Di Liberto¹⁰, Thomas M Jenkins^{11

12}, Antonella Macerollo^{13

14}, Luis F Maia^{15

16}, Filippo Martinelli-Boneschi^{17

18}, Antonio Pisani^{19

20}, Alberto Priori²¹, Anna Sauerbier²², Riccardo Soffietti²³, Pille Taba^{24

25}, Tim J von Oertzen^{26

27}, Marialuisa Zedde²⁸, Michael Crean²⁹, Anja Burlica²⁹, Francesco Cavallieri^{28

30}, Johann Sellner³¹; European Academy of Neurology NeuroCOVID-19 Task Force

Affiliations

¹ Department of Neurologic Diseases, Maribor University Medical Center, Maribor, Slovenia.
² Department of Neurology and Neurointensive Care, Selcuk University Faculty of Medicine, Konya, Turkey.
³ Division of Neurology, University Hospital Center of Grenoble, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble, France.
⁴ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁵ Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁶ Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy.
⁷ Department of Neurology, Semmelweis University, Budapest, Hungary.
⁸ Department of Neurology, Saint Antoine Hospital, Public Hospital Network of Paris, Paris, France.
⁹ Paris Brain Institute, Sorbonne University, Paris, France.
¹⁰ Department of Clinical Neurosciences, Vaudois University Hospital Center and University of Lausanne, Lausanne, Switzerland.
¹¹ Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.
¹² Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK.
¹³ Walton Centre National Health Service Foundation Trust for Neurology and Neurosurgery, Liverpool, UK.
¹⁴ Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK.
¹⁵ Department of Neurology, Saint Antonio Hospital, Porto University Hospital Center, Porto, Portugal.
¹⁶ Institute of Research and Innovation in Health, University of Porto, Porto, Portugal.
¹⁷ Neurology Unit and Multiple Sclerosis Center, Ca' Granda Ospedale Maggiore Hospital Polyclinic, Scientific Institute for Research and Health Care Foundation, Milan, Italy.
¹⁸ Department of Pathophysiology and Transplantation, Dino Ferrari Center, Neuroscience Section, University of Milan, Milan, Italy.
¹⁹ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁰ Mondino Foundation, Scientific Institute for Research and Health Care, Pavia, Italy.
²¹ Division of Neurology, Department of Neurology, Aldo Ravelli Research Center, University of Milan and ASST Saints Paul and Charles, Milan, Italy.
²² Department of Neurology, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany.
²³ Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy.
²⁴ Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Tartu, Estonia.
²⁵ Tartu University Hospital, Tartu, Estonia.
²⁶ Department of Neurology, Neuromed Campus, Kepler University Hospital, Linz, Austria.
²⁷ Medical Faculty, Johannes Kepler University, Linz, Austria.
²⁸ Neurology Unit, Neuromotor and Rehabilitation Department, USL-IRCCS Company of Reggio Emilia, Reggio Emilia, Italy.
²⁹ European Academy of Neurology Head Office, Vienna, Austria.
³⁰ Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
³¹ Department of Neurology, Mistelbach-Gänserndorf State Hospital, Mistelbach, Austria.

Abstract

Background and purpose: Health risks associated with SARS-CoV-2 infection are undisputed. Moreover, the capability of vaccination to prevent symptomatic, severe, and fatal COVID-19 is recognized. There is also early evidence that vaccination can reduce the chance for long COVID-19. Nonetheless, the willingness to get vaccinated and receive booster shots remains subpar among people with neurologic disorders. Vaccine scepticism not only jeopardizes collective efforts to end the COVID-19 pandemic but puts individual lives at risk, as some chronic neurologic diseases are associated with a higher risk for an unfavorable COVID-19 course.

Methods: In this position paper, the NeuroCOVID-19 Task Force of the European Academy of Neurology (EAN) summarizes the current knowledge on the prognosis of COVID-19 among patients with neurologic disease, elucidates potential barriers to vaccination coverage, and formulates strategies to overcome vaccination hesitancy. A survey among the Task Force members on the phenomenon of vaccination hesitancy among people with neurologic disease supports the lines of argumentation.

Results: The study revealed that people with multiple sclerosis and other nervous system autoimmune disorders are most skeptical of SARS-CoV-2 vaccination. The prevailing concerns included the chance of worsening the pre-existing neurological condition, vaccination-related adverse events, and drug interaction.

Conclusions: The EAN NeuroCOVID-19 Task Force reinforces the key role of neurologists as advocates of COVID-19 vaccination. Neurologists need to argue in the interest of their patients about the overwhelming individual and global benefits of COVID-19 vaccination. Moreover, they need to keep on eye on this vulnerable patient group, its concerns, and the emergence of potential safety signals.

Keywords: COVID-19; SARS-CoV-2; advocacy; infectious disease prevention; neurological disorders; vaccination; vaccine skepticism.

MeSH terms

COVID-19 Vaccines* / administration & dosage
COVID-19* / complications
COVID-19* / prevention & control
Humans
Nervous System Diseases*
Pandemics
Post-Acute COVID-19 Syndrome
SARS-CoV-2
Vaccination / psychology
Vaccination Hesitancy*

Substances

COVID-19 Vaccines