With approximately 476,000 patients diagnosed and treated annually [1], Lyme disease (LD) is the most common vector-borne disease in the United States. Most cases are mild, but if untreated, disease can be severe and very infrequently fatal [2]. Due to the substantial disease burden, LD has significant economic impacts [3]. Over 95 % of reported LD cases occur in 15 high-incidence states in the Northeast, Mid-Atlantic, and Midwest regions where the bacteria, Borrelia burgdorferi, is transmitted through the bite of infected Ixodes scapularis ticks. Geographic expansion from these areas of hyper-endemicity has been observed [4].

Currently, prevention of LD depends primarily on personal protective behaviors to avoid tick bites, including repellent use and avoidance of tick habitat. However, consistent adoption of these behaviors has proven difficult, and population-level impact on disease reduction has not been demonstrated [5]. For those bitten by a tick, post-exposure prophylaxis (PEP) with a single dose of doxycycline given within 72 h of a tick bite can reduce risk of LD [6]. However, because only about half of people with confirmed LD are aware of being bitten [7], PEP can only help prevent a fraction of cases. Broad uptake of a vaccine by those at risk for LD may be a critical strategy for reducing incidence, once a safe and effective vaccine becomes available.

A vaccine to prevent Lyme disease has not been available since 2002, when the first vaccine, LYMErix, was removed from the market due to low demand amid safety concerns that later proved unfounded [8]. More recently, clinical trials have commenced evaluating new LD vaccine candidates [9,10]. While recent studies have found generally high LD vaccine acceptability among the general public [11,12], recent trends in healthcare provider willingness to recommend a LD vaccine have not been described. The role of healthcare providers (HCPs) in communicating the benefits and safety of vaccines has repeatedly proven to be a significant predictor for patient vaccine acceptance [13]. In this analysis, we evaluate provider willingness to recommend LD vaccination among HCPs surveyed before and after the height of the COVID-19 pandemic to inform effective communication and education strategies for future LD vaccines.

In 2018, Porter Novelli invited 3465 HCPs to participate in the survey; 2256 (65 %) participated. In 2022, 2587 HCPs were invited to complete the survey; 1752 (68 %) participated. Of the completed surveys, 1503 (67 %) and 1502 (86 %) met the inclusion criteria in 2018 and 2022, respectively. In both survey years, about 1/3 of participants were family practitioners, 1/3 were internists, 1/6 were pediatricians, and 1/6 were nurse practitioners or physician assistants.

In this large sample of U.S. HCPs, we found that willingness to recommend a LD vaccine decreased from 2018 to 2022 but was highest overall among those who lived and worked in states with a high incidence of LD. The proportion of HCPs willing to recommend a LD vaccine in this study (71 %) was slightly higher than the 64 % - 68 % acceptability rates reported among the general public [11,12]. The greater willingness to recommend LD vaccination among HCPs in states with high LD incidence is likely due to awareness of disease risk in their area and the fact that their patients are most likely to benefit from LD vaccination [14]. Across all LD incidence categories, providers who treated more LD cases during the survey year were also more willing to recommend vaccination.

Since the onset of the COVID-19 pandemic, trust in governmental organizations like CDC and FDA has decreased among HCPs, which can influence decisions to both receive and recommend vaccines 15. Additional post-pandemic factors which may be contributing to lower rates of routine pediatric vaccinations [16] include decreased physical access to patients due to higher frequency of telehealth visits, clinical staffing shortages, and lenient enforcement of immunization requirements in schools [15,17].

HCP participants reported vaccine safety as the most important consideration when recommending LD vaccination, regardless of LD incidence category. Concerns of safety for newer vaccines among HCPs and the general public have been consistently identified as a limiting factor in successful uptake, as seen with the COVID-19 vaccines and more recently the new respiratory syncytial virus (RSV) vaccine [14,18,19]. Maintaining and improving Immunization Information Systems (IIS)⁵ and safety monitoring systems, such as VAERS and V-safe [20], to monitor uptake and safety once the vaccine is available will be critical in ensuring vaccine safety and informing communications to HCPs and the public.

This analysis is subject to several limitations. First, this cross-sectional survey administered at two time points among different samples of HCPs may not be representative of the perspectives of individual HCPs over time. Second, the survey questions pertained to a potential new vaccine for which efficacy and safety information are not yet available. Specific vaccine characteristics such as side effects, dosing schedule, cost, and patient-level characteristics such as age may be additional factors influencing providers’ willingness to recommend LD vaccination to patients. Third, combining responses by participants who reported being unsure with those who reported being unlikely or very unlikely to recommend LD vaccination might inadvertently over-estimate provider LD vaccine hesitancy. Lastly, we did not include questions about general vaccination perspectives or acceptance of non-LD vaccines in the survey, thus limiting our ability to contextualize changes in LD vaccine acceptability over time with general vaccination recommendation trends or the effect of the COVID-19 pandemic.

In conclusion, most providers were willing to recommend LD vaccination to their patients, particularly providers who work and reside in states where LD is common. After a LD vaccine becomes available, tailored vaccination education that addresses vaccine safety and targets clinicians in areas with highest LD risk will be key for a successful LD vaccination program.