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COVID-19 vaccine perceptions and uptake: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

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Comment Published online February 8, 2022
Lancet Rheumatol 2022
Published Online
February 8, 2022
COVID-19 vaccine perceptions and uptake: results from the
COVID-19 Global Rheumatology Alliance Vaccine Survey
As access to safe and effective COVID-19 vaccinations
expands, vaccine hesitancy among people with
rheumatic diseases has become increasingly important.1,2
Before widespread vaccination programmes, potential
side-effects and flares after COVID-19 vaccination were
frequent reasons for vaccine hesitancy among people
with rheumatic disease.3,4 The study objective was to
describe the perceptions and behaviours of people with
rheumatic disease regarding COVID-19 vaccination and
to identify the information sources most likely to affect
their intention to be vaccinated.
The COVID-19 Global Rheumatology Alliance
(C19-GRA) Vaccine Survey has been described
elsewhere (appendix pp 16–93).5 Briefly, the survey
was constructed collaboratively and iteratively with
input from multiple patient partners and was launched
globally in English on April 2, 2021. 11 translations were
subsequently released (Italian, Hebrew, French, Punjabi,
Russian, Spanish, Arabic, Traditional Chinese [Mandarin],
Turkish, Simplified Chinese, Hindi). Rheumatologists
and patient-facing organisations disseminated the
survey on social media and the C19-GRA website. The
survey was anonymous, the project was approved by
Boston Children’s Hospital Institutional Review Board
and participants provided consent at the survey start.
This analysis includes 7005 vaccinated and
unvaccinated respondents from 102 countries who were
aged 18 years or older and provided consent, reported
one or more rheumatic disease (excluding osteoarthritis
and fibromyalgia), and completed the entire survey
(April 2 to July 5, 2021; appendix p 2). We asked,
“If one of the approved vaccines to prevent COVID-19
was available to you right now at no cost, would you
agree to be vaccinated?”. Respondents answering,
“Yes, I have already received at least one dose”, or
“Yes, I will get it when it is available”, were classified
as willing. Those answering, “No”, were classified as
unwilling, and the remainder selected, “Unsure”, and
were classified as unsure. Vaccination willingness was
also measured on a visual analogue scale from 0 to 10,
with 0 indicating not willing at all and 10 very willing
(appendix p 3). Vaccination perceptions were assessed
using 15 statements with five-point Likert scale response
options (appendix pp 6–7). Respondents also reported
factors influencing vaccination willingness and ranked
information sources most likely to influence their
decision, such as doctors, news media, and social media
(appendix pp 4–5). Results of the survey are described by
means, SDs, and proportions.
Of 7005 respondents, 5548 (79·2%) had already
received a COVID-19 vaccine, 883 (12·6%) were willing to
be vaccinated (when a vaccine became available to them),
275 (3·9%) were unvaccinated and unsure, and 299 (4·3%)
were unvaccinated and unwilling to receive a vaccine.
Of the 1457 unvaccinated respondents, 883 (60·6%)
were willing to receive a vaccine and 574 (39·4%) were
unsure or unwilling to receive a vaccine. The mean age
for all 7005 respondents was 53·2 years (SD 14·2). Of
the 7005 respondents, 5367 (76·6%) reported race or
ethnicity as White, 680 (9·7%) as other, 511 (7·3%) as
Hispanic or Latin American, 212 (3·0%) as Asian (south or
east Asian), 124 (1·8%) as Middle Eastern or North African,
93 (1·3%) as Black, and 18 (0·3%) as American Indian,
Alaska Native, Aboriginal, Indigenous, or First Nations.
6023 (86·0%) respondents were female, 954 (13·6%)
were male, and 28 (0·4%) were other or preferred not
to say; 3619 (51·7%) resided in the WHO Region of the
Americas, and 3119 (44·5%) were taking one or more
disease-modifying antirheumatic drug (DMARD).
Of the total respondents, 580 (8·3%) reported previous
adverse reactions to other vaccines within 2 months of
the vaccination and 5295 (75·6%) respondents reported
receiving regular influenza vaccinations. Demographics,
clinical characteristics, comorbidities, and relevant
response proportions are provided in the appendix
(pp 8, 12).
Almost all unsure or unwilling respondents
expressed concerns about side-effects, safety, and
the rapid development and use in clinical practice of
COVID-19 vaccines. However, nearly half still considered
themselves pro-vaccine, and many unwilling respondents
displayed varying degrees of hesitancy (appendix p 3).
Logistical challenges, cost, and efficacy concerns were less
common. The majority of unsure (271 [98·5%] of 275)
and unwilling (200 [66·9%] of 299) respondents reported
that their willingness to be vaccinated could increase,
For the C19-GRA website see
See Online for appendix
2 Published online February 8, 2022
particularly with rheumatologist endorsement and more
outcomes data. 562 (97·9%) of 574 respondents who
were unwilling or unsure of being vaccinated ranked
the top three sources of information most likely to
influence their decision for vaccination. Doctors or other
health professionals were most commonly ranked in
the top three among 479 (85·2%) of 562 respondents
who were uncertain or unwilling respondents (appendix
p 5). Patient or professional organisations were
second most commonly ranked in top three sources,
cited by 388 (69·0%) uncertain or unwilling respondents
(appendix p 5). The news media (74 [13·2%]), political
figures (17 [3·0%]), and advertisements (eight [1·4%])
were most infrequently cited in the top three sources of
information most likely to influence the decision to be
vaccinated (appendix p 5).
These survey results highlight the critical importance
of concerns related to vaccine safety and efficacy for
people with rheumatic diseases, which appear to
have persisted after widespread vaccination. Vaccine-
related adverse events do occur and include both
mild reactions (eg, fatigue, myalgias, and headaches)2
and very rare severe adverse reactions (eg, central
venous thrombosis and myocarditis).6,7 People with
rheumatic diseases might also be concerned about flares
of their underlying disease, but surveys suggest that
flares requiring changes to medications are uncommon.5
Many of the respondents who were unsure or unwilling
also questioned the benefits of vaccination. However,
formal risk–benefit assessments have consistently found
that the benefits of vaccination far outweigh potential
risks,8 and rheumatology professional societies have
concluded that the benefits of vaccination outweigh
safety concerns for people with rheumatic diseases.9
It should be emphasised that even respondents
who were unwilling to be vaccinated reported varying
degrees of hesitancy, and two-thirds reported that
their willingness could be increased. As with earlier
surveys,3 rheumatologist endorsement was commonly
a crucial factor that increased willingness to be
vaccinated. Patient or professional organisations were
also frequently ranked highly as credible sources of
information, and information about vaccination in
people like them was the second most important
factor in increasing willingness to be vaccinated. Taken
together, these findings suggest that advice from
physicians or patient and professional organisations
focusing on safety and efficacy in people with similar
rheumatic diseases might be most productive to
encourage vaccination. Evidence-based strategies for
communicating this information should be considered,
Figure 1: Vaccination perceptions among people with rheumatic diseases who were unsure of vaccination or
unwilling to become vaccinated (n=574)
Percentages were based on the total number of people for whom the question was applicable.
100 50 0 50 100
Unwilling (no)
(strongly or somewhat)
The COVID-19 vaccines were developed too quickly
Unwilling (no)
The COVID-19 vaccine will not work as well for me
Unwilling (no)
I will have a milder course of COVID-19 if I am vaccinated
Unwilling (no)
I think the COVID-19 vaccine is unsafe
Unwilling (no)
I never get very ill with infections so the COVID-19 vaccine is not needed for me
Unwilling (no)
I do not think the vaccine is helpful because it will not protect me against new variants of COVID-19
Unwilling (no)
I consider myself as being pro-vaccine
Unwilling (no)
I am worried the vaccine could cause COVID-19 infection
Unwilling (no)
I am concerned about side-effects to the COVID-19 vaccine
Neither agree
nor disagree
(strongly or somewhat)
Somewhat agree Strongly agree
Strongly disagree Somewhat disagree Neither agree nor disagree
Comment Published online February 8, 2022
such as affirming patient values, framing vaccination
in terms of personal gain or altruistic behaviour, and
providing a strong recommendation.10
Strengths of this study included participation across
numerous countries and in multiple languages and
a large sample of respondents with a wide array of
rheumatic diseases. This study also has limitations, which
include selection bias (ie, survey disseminated via patient-
facing organisations and social media; non-response rate
cannot be calculated), potentially limited generalisability
ie, (White respondents from English-speaking countries
with graduate or professional degrees were over-
represented), and response bias (ie, vaccinated people
being more willing to fill out a survey about vaccination).
This was a cross-sectional descriptive study, and causal
inferences are not possible.
In summary, in this large international survey of
people with rheumatic diseases, most people with
vaccine hesitancy would consider becoming vaccinated.
Data regarding the safety and efficacy of COVID-19
vaccination among people with rheumatic diseases,
which is delivered by rheumatologists or patient and
professional organisations, might increase vaccine
uptake. These findings highlight urgent research and
educational priorities to combat vaccine hesitancy in
people with rheumatic diseases.
MP, KK, and ES contributed equally and are co-first authors. JHS, JASp, and JFS
contributed equally and are co-senior authors. The authors thank
Berk Degirmenci, Christele Feliix, Shangyi Jin, Candace A Palmerlee,
Andrea Peirce, Lisa G Rider, Esra Sari, Robert Tseng, and Leslie Wang for their
invaluable contributions to the GRA Vax Survey. MP, KK, ES, SES, and JWL
contributed to data collection, data quality control, and data analysis and
interpretation. AAA, DA-R, SA, RPB, FB, IB, YPEC, RC, AD-G, ED, KLD, TAG, CLH,
JW, KJY, and EAZ-T, critically revised the manuscript and provided intellectual
content. TTM, CH, MJL, ML, GF, and LT contributed to planning and data
collection, reviewed the manuscript, and provided important intellectual
content. SB, WC, RG, PMM, PCR, PS, ZSW, and JY contributed to the acquisition,
analysis, and interpretation of the data. JASp, JFS, and JSH directed the work,
designed the data collection methods, and contributed to the analysis and
interpretation of the data. MP, KK, ES, SES, JWL, SB, WC, RG, PMM, PCR, PS,
ZSW, JY, JASp, JFS, and JSH drafted and revised the manuscript critically for
important intellectual content and gave final approval of the version to be
published. SES, JWL, KK, JFS, and JASp had full access to the data and verify the
credibility of the underlying data. All authors have read, revised, and approved
this manuscript and take final responsibility for the decision to submit for
publication. MP reports clinical trials participation with AbbVie and grants from
Rheumatology Research Foundation, outside the submitted work. ES is a board
member of the Canadian Arthritis Patient Alliance, a patient run, volunteer-
based organisation whose activities are primarily supported by independent
grants from pharmaceutical companies. JWL has received research grant
funding from Pfizer unrelated to this work. SES reports research funding related
to clinical trials from AstraZeneca (MANDARA), outside of the submitted work
and is supported by the Vasculitis Clinical Research Consortium and Vasculitis
Foundation outside of the submitted work. DA-R is a scientific advisor for
GlaxoSmithKilne unrelated to this work. RC reports speaker fees from Janssen,
Roche, Sanofi, and AbbVie, outside of the submitted work. AD-G reports grants
from the Center for Disease Control and Prevention, Rheumatology Research
Foundation, and Mayo Clinic, outside the submitted work. KLD is an unpaid
volunteer president of the Autoinflammatory Alliance and reports grants from
Novartis, Sobi, National Institutes of Health (NIH), and Horizon Bio, all received
by the non-profit organisation outside of the submitted work. CLH received
funding under a sponsored research agreement unrelated to the data in the
paper from Vifor Pharmaceuticals. RH reports grants from AbbVie, Amgen,
Boehringer Ingleheim, Johnson and Johnson, Lilly, Novartis, Pfizer, and Union
Chimique Belge, all paid to Spondylitis Association of America, consultant fees
from GlaxoSmithKline and Novartis, outside the submitted work. RH also owns
stocks (<20 shares and representing <4% of personal investments) in AbbVie,
Amgen, Bristol Myers Squibb, GlaxoSmithKline, Johnson & Johnson, Eli Lilly,
Merck, Novartis, Pfizer, Teva, and Union Chimique Belge. AHJK reports personal
fees from Exagen Diagnostics, Alexion Pharmaceuticals, and Aurinia
Pharmaceuticals, grants from National Institutes of Health, Rheumatology
Research Foundation, and Helmsley Charitable Trust, grants and personal fees
from GlaxoSmithKline, outside the submitted work. EFM reports personal fees
from Boehringer Ingelheim, and that Liga Portuguesa Contra as Doenças
Reumaticas has received grants from AbbVie, Novartis, Lilly Portugal,
Amgen Biofarmacêutica, Grünenthal, Merck Sharp & Dohme, Medac and from
A Menarini Portugal–Farmacêutica; grants and non-financial support from
Pfizer and Grünenthal, outside the submitted work. JASi has received consultant
fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two labs, Adept Field
Solutions, Clinical Care options, Clearview healthcare partners, Putnam
associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life
Science, United BioMed, Trio Health, Medscape, WebMD, and Practice Point
communications; and the National Institutes of Health, and the American
College of Rheumatology. JASi owns stock options in TPT Global Tech,
Vaxart pharmaceuticals, and Charlotte’s Web Holdings and previously owned
stock options in Amarin, Viking and Moderna pharmaceuticals. JASi is on the
speaker’s bureau of Simply Speaking and is a member of the executive of
Outcomes Measures in Rheumatology, an organisation that develops outcome
measures in rheumatology and receives funding from eight companies.
JASi also serves on the FDA Arthritis Advisory Committee and is the chair of the
Veterans Affairs Rheumatology Field Advisory Committee. JASi is also the editor
and the Director of the University of Alabama at Birmingham Cochrane
Musculoskeletal Group Satellite Center on Network Meta-analysis. MFU-G has
received research support from Pfizer and Janssen, unrelated to this work.
SB reports non-branded consulting fees from Novartis, AbbVie, Pfizer, and
Horizon Pharma, outside the submitted work, and is a Pfizer employee as of
September, 2021. RG reports personal fees from AbbVie New Zealand,
Cornerstones, Janssen New Zealand, and Novartis, and personal fees and
non-financial support Pfizer Australia (all <AU$10,000) outside the submitted
work. PMM reports personal fees from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer,
and Union Chimique Belge; and grants and personal fees from Orphazyme,
outside the submitted work. PCR reports personal fees from AbbVie, Gilead,
Lilly, and Roche; grants and personal fees from Novartis, Union Chimique Belge,
Janssen, and Pfizer; and non-financial support from Bristol Myers Squibb,
outside the submitted work. PS reports honoraria from bring the social media
editor for the American College of Rheumatology journals, outside the
submitted work. ZSW reports grants from NIH, Bristol Myers Squibb, and
Principia/Sanofi; and personal fees from Viela Bio and MedPace, outside the
submitted work. JY reports personal fees from Pfizer and Eli Lilly, and grants and
personal fees from AstraZeneca, outside the submitted work. CH reports
personal fees from AstraZeneca and Aurinia Pharmaceuticals, outside the
submitted work. MJL reports grants from American College of Rheumatology,
during the conduct of the study and consulting fees from AbbVie, Amgen,
Actelion, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Gilead, Johnson
and Johnson, Mallinckrodt, Novartis, Pfizer, Roche, Sandoz, Sanofi, Sobi, and
Union Chimique Belge, outside the submitted work. JSH reports grants from
Childhood Arthritis and Rheumatology Research Alliance and Rheumatology
Research Alliance, and personal fees from Novartis, Pfizer, and Biogen, outside
the submitted work. JASp reports grants from National Institute of Arthritis
and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation,
and R Bruce and Joan M Mickey Research Scholar Fund; and consulting fees for
AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics,
Optum, and Pfizer, unrelated to this work. JFS received research grant funding
from the National Institutes of Health unrelated to this work (NIAMS R01
AR077103, and NIAID R01 AI154533). All other authors report no competing
interests. This study was funded by the American College of Rheumatology
4 Published online February 8, 2022
(ACR). The ACR was not involved in any aspect of study design, collection,
analysis, or interpretation of data, writing of the report, or the decision to
submit the paper for publication. The views expressed here are those of the
authors and participating members of the COVID-19 Global Rheumatology
Alliance and do not necessarily represent the views of the ACR, the European
Alliance of Associations for Rheumatology, the UK National Health Service, the
National Institute for Health Research, or the UK Department of Health, or any
other organisation. Researchers interested in performing additional analyses
from survey data are invited to submit proposals through the COVID-19 Global
Rheumatology Alliance at For approved projects, we will
provide summary tables and data analyses as requested. We do not currently
have institutional review board approval to make the raw data available to
other researchers.
*Michael Putman, Kevin Kennedy, Emily Sirotich,
Jean W Liew, Sebastian E Sattui, Tarin T Moni,
Akpabio A Akpabio, Deshire Alpizar-Rodriguez,
Saskya Angevare, Richard P Beesley, Francis Berenbaum,
Inita Bulina, Yu Pei Eugenia Chock, Richard Conway,
Ali Duarte-García, Aman Dev Singh, Eimear Duff,
Karen L Durrant, Tamer A Gheita, Catherine L Hill,
Richard Howard, Bimba F Hoyer, Evelyn Hsieh, Lina el Kibbi,
Adam Kilian, Alfred H J Kim, David F L Liew, Chieh Lo,
Elsa F Mateus, Bruce Miller, Serena Mingolla, Michal Nudel,
Jasvinder A Singh, Namrata Singh, Manuel F Ugarte-Gil,
John Wallace, Kristen J Young, Erick Adrian Zamora-Tehozol,
Suleman Bhana, Wendy Costello, Rebecca Grainger,
Pedro M Machado, Philip C Robinson, Paul Sua,
Zachary S Wallace, Jinoos Yazdany, Carly Harrison,
Maggie J Larché, Mitchell Levine, Gary Foster,
Lehana Thabane, Jonathan S Hausmann, Jeffrey A Sparks,
Julia F Simard
Medical College of Wisconsin, Milwaukee, WI 53226, USA (MP); Department of
Health Research Methods, Evidence, and Impact (KK, ES, ML, GF, LT), Department
of Biochemistry and Biomedical Sciences (TTM), Division of Rheumatology,
Department of Medicine (MJL), Division of Clinical Immunology and Allergy,
Department of Medicine (MJL), Department of Health Research Methods,
Evidence, and Impact (ML); Department of Medicine (ML, GF); Department of
Clinical Pharmacology & Toxicology (ML), McMaster University, Hamilton, ON,
Canada; Canadian Arthritis Patient Alliance, Toronto, ON, Canada (ES); Section of
Rheumatology, Boston University School of Medicine, Boston, MA, USA (JWL);
Division of Rheumatology, Department of Medicine, University of Pittsburgh
Medical Center, Pittsburg, PA, USA (SES); Department of Rheumatology, Sheffield
Teaching Hospitals NHS Trust, Sheffield, UK (AAA); Research Unit, Colegio
Mexicano de Reumatología, Mexico City, Mexico (DA-R); Stichting KAISZ,
Amsterdam, The Netherlands (SA); ENCA, Paris, France (SA); Autoinflammatory
Alliance, Amsterdam, The Netherlands (SA); Juvenile Arthritis Research, London,
UK (RPB); Sorbonne University, INSERM, AP-HP Saint-Antoine hospital, Paris,
France (FB); Center of Rheumatology, Pauls Stradins Clinical University Hospital,
Riga, Latvia (IB); Section of Rheumatology, Allergy and Immunology, Yale School
of Medicine, Yale University, New Haven, CT, USA (YPEC, EH); Department of
Rheumatology, St James’s Hospital, Dublin, Ireland (RC, ED); Division of
Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
(AD-G); Department of Community Medicine, GMC Patiala, Punjab, India (ADS);
Autoinflammatory Alliance, San Francisco, CA, USA (KLD); Rheumatology and
Clinical Immunology, Faculty of Medicine, Cairo University, Egypt (TAG);
Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
(CLH); Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
(CLH); Spondylitis Association of America, Encino, CA, USA (RH); Department of
Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University
Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (BFH); Section of
Rheumatology, VA Connecticut Healthcare System, West Haven, CT, USA (EH);
Specialized Medical Center, Riyadh, Saudi Arabia (LeK); Saint Louis University,
St Louis, MO, USA (AK); Division of Rheumatology, Department of Medicine,
Washington University School of Medicine, University of Washington, St Louis,
MO, USA (AHJK, NS); Department of Rheumatology, Austin Health, Melbourne,
VIC, Australia (DFFL); Department of Medicine, University of Melbourne,
Melbourne, VIC, Australia (DFFL); School of Medicine, College of Medicine, I-Shou
University, Kaohsiung, Taiwan (CL); Portuguese League Against Rheumatic
Diseases, Comprehensive Health Research Centre, Lisbon, Portugal (EFM);
Department of Medicine, University of California, San Diego, La Jolla, CA, USA
(BM); Associazione Nazionale Persone con Malattie Reumatologiche e Rare
APMARR APS, Lecca, Italy (SM); Mifrakim Tz’eirim Association, Israel (MN);
Medicine Service, VA Medical Center, Birmingham, AL, USA (JASi); Department of
Medicine at the School of Medicine, University of Alabama at Birmingham,
Birmingham, AL, USA (JASi); Department of Epidemiology, School of Public
Health, University of Alabama at Birmingham, Birmingham, AL, USA (JASi);
Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen,
EsSalud and School of Medicine, Universidad Cientifica del Sur, Lima, Peru
(MFU-G); London, UK (JW); Division of Rheumatic Diseases, University of Texas
Southwestern Medical Center, Dallas, TX, USA (KJY); Centro Médico Pensiones,
Autoimmunity Division, Mérida, Yucatán, Mexico (EAZ-T); Crystal Run
Healthcare, Middletown, NY, USA (SB); Irish Children’s Arthritis Network (iCAN),
Tipperary, Ireland (WC); Department of Medicine, University of Otago,
Wellington, New Zealand (RG); Centre for Rheumatology & Department of
Neuromuscular Diseases, University College London, London, UK (PMM);
National Institute for Health Research, University College London Hospitals
Biomedical Research Centre, University College London Hospitals National Health
Service Foundation Trust, London, UK (PMM); Department of Rheumatology,
Northwick Park Hospital, London North West University Healthcare NHS Trust,
London, UK (PMM); Faculty of Medicine, University of Queensland, Brisbane,
QLD, Australia (PCR); HealthPartners, St Paul, MN, USA (PS); Clinical
Epidemiology Program, Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital (ZSW), Program in Rheumatology, Boston
Children’s Hospital and Division of Rheumatology and Clinical Immunology, Beth
Israel Deaconess Medical Center (JSH), Harvard Medical School, Boston, MA, USA;
Division of Rheumatology, Department of Medicine, University of California,
San Francisco, San Francisco, CA, USA (JY); LupusChat, New York, NY, USA (CH);
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
(JASp); Department of Epidemiology and Population Health, and Division of
Immunology and Rheumatology, Department of Medicine, Stanford University
School of Medicine, Palo Alto, CA, USA (JFS)
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... Rheumatology providers can help facilitate patient decision making about vaccines by providing information to promote more accurate perceptions of the risks and benefits of COVID-19 vaccination. Attitudes towards COVID-19 vaccines can change over time [26], and provider endorsement may increase vaccine uptake among the reluctant [27]. ...
... We identified motivations for resisting COVID-19 vaccines consistent with those previously reported [6,7,27,28]. RMD patients may fear the vaccine's impact on their health or mistrust those promoting vaccination. ...
Full-text available
Background Although patients with rheumatic and musculoskeletal diseases (RMDs) are at increased risk for adverse outcomes of COVID-19 illness compared to healthy controls, they also have lower rates of willingness to be vaccinated. Previous research has identified reasons for vaccine hesitancy among patients with RMDs (such as concerns about side effects and flares), but little is known about what these reasons mean in the context of patients’ lives, or how vaccine decision making is experienced from a patient perspective. Our objective was to describe decision-making about COVID-19 vaccination among RMD patients. Methods Participants in a RMD registry were invited to complete monthly online surveys regarding COVID-19 vaccination from March-June 2021. We qualitatively analyzed comments from two open-ended survey questions reporting general experiences with vaccination and side effects. Comments were coded for attitudes towards COVID-19 vaccination, vaccine access, rheumatologic medication management around vaccination, and vaccine side effects. Themes were identified for the process and context of COVID-19 vaccine decisions, patient motivations for receiving or avoiding vaccination, and consistency of peri-vaccine medication management with current ACR guidelines. Results We analyzed 710 comments from 537 respondents. Commenting respondents had a mean age of 64 years, were 87% female, 94% white, and 93% received/intended to receive ≥ 1 dose of a COVID-19 vaccine. Desire for protection and a return to normal routines motivated some commenters to get vaccinated, while concerns about vaccine side effects motivated others to delay or avoid vaccination. Several commenters reported disease flares following vaccination. Some commenters did not consult their providers about vaccination and failed to withhold immunomodulatory medications during vaccination, while others withheld medications more conservatively than recommended by current ACR guidelines, either on their own or directed by their provider. Conclusions While most commenters were vaccine-accepting, challenges to COVID-19 vaccine uptake in the RMD population may include fears of side effects, including worsened RMD symptoms, and perceptions that vaccination is unnecessary. Addressing these concerns and beliefs may be critical for promoting vaccination in this population.
... Our findings suggest that there is an unmet need to improve awareness of eligibility for vaccination. HCP recommendation and annual vaccination reviews improve vaccine uptake, potentially because physician recommendation overcomes ambivalence to vaccination [24,[28][29][30][31]. Interestingly, we found that many participants relied upon and sought advice on the safety and suitability of vaccination with respect to their disease or its treatment from their specialist, despite vaccination being a core activity of primary care. ...
... IMID patient organisations were identified as a useful and trusted source of information in participants' decision-making process for vaccination in our study, which is consistent with recent survey [31]. Patients actively avoided taking vaccine information from social media, contrary to vaccine-hesitant individuals in the general public [23,33]. ...
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Objectives To explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases (IMIDs). Methods Recruiting through national patient charities and a local hospital, participants were invited to take part in an in-depth, one-to-one, semi-structured interview with a trained qualitative researcher between November 2021 and January 2022. Data were analysed thematically in NVivo, cross-validated by a second coder and mapped to the SAGE vaccine hesitancy matrix. Results Twenty participants (75% female, 20% non-white) were recruited. Barriers and facilitators spanned contextual, individual/group and vaccine/vaccination-specific factors. Key facilitators to all vaccines were higher perceived infection risk and belief that vaccination is beneficial. Key barriers to all vaccines were belief that vaccination could trigger IMID flare, and active IMID. Key facilitators specific to COVID-19 vaccines included media focus, high incidence, mass-vaccination programme with visible impact, social responsibility, and healthcare professionals’ (HCP) confirmation of the new vaccines’ suitability for their IMID. Novel vaccine technology was a concern, not a barrier. Key facilitators of influenza/pneumococcal vaccines were awareness of eligibility, direct invitation, and, clear recommendation from trusted HCP. Key barriers of influenza/pneumococcal vaccines were unaware of eligibility, no direct invitation or recommendation from HCP, low perceived infection risk, and no perceived benefit from vaccination. Conclusions Numerous barriers and facilitators to vaccination, varying by vaccine-type, exist for immunosuppressed-IMID patients. Addressing vaccine benefits and safety for IMID-patients in clinical practice, direct invitation, and public-health messaging highlighting immunosuppression as key vaccination-eligibility criteria may optimise uptake, although further research should assess this.
... These findings are consistent with the results reported from the COVID-19 Global Rheumatology Alliance Vaccine Survey study. (31) While over 75% of responders had spoken with healthcare providers regarding COVID-19 ...
Objective To identify the factors that impact COVID-19 vaccine decision-making in individuals diagnosed with a rheumatologic condition, given that previous international studies have demonstrated that a significant proportion of rheumatology patients are vaccine hesitant. Methods This cross-sectional study involved an online survey with adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic between June and August 2021. Quantitative results were descriptively analyzed, while qualitative thematic analysis was conducted for open-ended responses. Results The survey had a response rate of 70.9% (n= 231). Regarding COVID-19 vaccines, rheumatology patients were most concerned about the possible impact of vaccination on their rheumatic condition (45.2%), and concerns of vaccine effectiveness (45.1%). Most patients had discussed COVID-19 vaccination (75.9%) and its risks and benefits (66.1%) with their medical team and 83.6% of respondents were confident in the information provided. Patients' perceptions of the government's role in handling COVID-19 pandemic varied, 33% reported they found government-instituted public health measures effective. Surprisingly, 9.7% of rheumatology patients still reported concerns that they could develop COVID-19 from an approved SARS-CoV-2 vaccine. Conclusion This study describes factors implicated in COVID-19 vaccine decision-making in rheumatology patients. Three important themes were possible adverse effect of vaccine on rheumatic disease control, reduced vaccine efficacy due to rheumatic disease/treatment, and risk of contracting SARS-CoV-2 from the COVID-19 vaccine. Knowledge from this study can assist healthcare providers looking after rheumatology patients to initiate discussions with patients to share evidence-based vaccine information and assist informed decision-making.
... This focus on individual drivers means healthcare professionals must seek to understand patients' motivators within these frameworks. Although this study does not establish a causal link between increased healthcare provider involvement in vaccine education and reduced vaccine hesitancy, it underscores the need for greater education from healthcare professionals to maximise the effectiveness of these (26). We have seen, both in this study and in broader Australian national data, that vaccine hesitancy is fluid and amenable to change. ...
Objectives To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. Methods Prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Association Database (ARAD). Two surveys were conducted, one immediately prior to (pre-pandemic) and then approximately one year after the start of the pandemic (follow-up). COVID-19 vaccine hesitancy was measured at follow-up and general vaccine hesitancy was inferred pre-pandemic; these were used to identify factors associated with fixed and changing vaccine beliefs, including sources of information and broader beliefs about medication. Results Of the 594 participants who completed both surveys, 74 (12%) were COVID-19 vaccine hesitant. This was associated with pre-pandemic beliefs about medications being harmful (p< 0.001) and overused (p= 0.002), with stronger beliefs resulting in vaccine hesitancy persistent over two time points (p= 0.008, p= 0.005). For those not vaccine hesitant pre-pandemic, the development of COVID-19 vaccine hesitancy was associated with a lower likelihood of seeking out vaccine information from healthcare professionals (p< 0.001). COVID-19 vaccine hesitancy was not associated with new influenza vaccine hesitancy (p= 0.138). Conclusion In this study of vaccine beliefs before and during the COVID-19 pandemic, factors associated with COVID-19 vaccine hesitancy in inflammatory arthritis patients varied, depending on vaccine attitudes immediately prior to the start of the pandemic. Fixed beliefs reflected broader views about medications, while fluid beliefs were highly influenced by whether they sought out information from healthcare professionals, including rheumatologists.
... COVID-19 VH was maximum among those with existing comorbidities, probably driven by reports similar to those by Kaur et al., which cautioned against administering COVID-19 vaccines in females and those with co-morbidities. Additionally, a large multi-centered survey among rheumatology patients from 102 countries (n = 7005) suggested that VH was mainly associated with a fear of side effects [17]. Recent articles claimed that COVID-19 vaccines protect individuals from severe infections for up to a period of 9 months, and the immunity may wane within a few months [18,19]. ...
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Introduction: Vaccines are the best tools to end the pandemic, and their public acceptance is crucial in achieving herd immunity. Despite global efforts to increase access to vaccination, the World Health Organization explicitly lists vaccination hesitancy (VH) as a significant threat. Despite robust safety reports from regulatory authorities and public health advisories, a substantial proportion of the community remains obsessed with the hazards of vaccination. This calls for identifying and eliminating possible causative elements, among which this study investigates the inappropriate dissemination of medical literature concerning COVID-19 and adverse events following immunization (AEFI), its influence on promoting VH, and proposals for overcoming this problem in the future. Methods: We searched PubMed, Embase, and Scopus databases, using the keywords "adverse events following immunization (AEFI)", "COVID-19", "vaccines" and "hesitancy" and related medical and subjective headings (MeSH) up to 31 March 2022, and extracted studies relevant to the COVID-19 AEFI and associated VH. Finally, 47 articles were chosen to generate a narrative synthesis. Results: The databases depicted a steep rise in publications on COVID-19 AEFI and COVID-19 VH from January 2021 onwards. The articles depicted multiple events of mild AEFIs without fatal events in recipients. While documenting AEFIs is praiseworthy, publishing such reports without prior expert surveillance can exaggerate public apprehension and inappropriately fuel VH. VH is a deep-rooted phenomenon, but it is difficult to zero in on the exact reason for it. Spreading rumors/misinformation on COVID-19 vaccines might be an important provocation for VH, which includes indiscriminately reporting AEFI on a massive scale. While a number of reported AEFIs fall within the acceptable limits in the course of extensive COVID-19 vaccinations, it is important to critically evaluate and moderate the reporting and dissemination of AEFI in order to allay panic. Conclusions: Vaccination programs are necessary to end any pandemic, and VH may be attributed to multiple reasons. VH may be assuaged by initiating educational programs on the importance of vaccination, raising public awareness and monitoring the inappropriate dissemination of misleading information. Government-initiated strategies can potentially restrict random AEFI reports from lay epidemiologists and healthcare practitioners.
Objective To understand how people with chronic immune-mediated inflammatory diseases (IMIDs) trade-off the benefits and risks of COVID-19 vaccine options. Methods We conducted an online discrete-choice experiment in people with IMIDs to quantify the relative importance of attributes relevant to COVID-19 vaccination. Participants were recruited between May-Aug 2021 through patient groups and clinics in Canada and completed 10 choices where they selected one of 2 hypothetical vaccine options or no vaccine. The relative importance (RI) of each attribute was estimated and heterogeneity was explored through latent class analysis. Results The survey was completed by 551 people (89% female, mean age 46 years) with a range of IMIDs (48% IBD, 38% RA, 16% SLE). Most had received one (94%) or two (64%) vaccines. Across the ranges of levels considered, vaccine effectiveness was most important (RI = 66%), followed by disease flare (21%), rare but serious risks (9%) and number/timing of shots (4%). Patients would accept a risk of disease flare requiring a treatment change of 8.8% or less, for a vaccine with a small absolute increase in effectiveness (10%). Of the three latent classes, the group with the greatest aversion to disease flare were more likely to be male and have lower incomes, but this group still valued effectiveness higher than other attributes. Conclusion Patients perceived the benefits of COVID-19 vaccination to outweigh rare serious risks and disease flare. This supports COVID-19 vaccine strategies that maximize effectiveness, while recognizing the heterogeneity in preferences that exists.
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Data regarding the willingness of patients affected by inborn errors of immunity to accept vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. Therefore, this study assessed SARS-CoV-2 vaccination coverage and hesitancy in immunodeficient patients by surveying adults with primary immune deficiencies and autoinflammatory and rheumatic diseases on biologic therapy. The study was conducted from September 20, 2021, to January 22, 2022, when the primary coronavirus disease 2019 (COVID-19) vaccinations were available to all adults in Poland. We included 207 participants consecutively recruited from five referral centers (57% female; median age: 42.6 [range: 18–76, standard deviation ± 14.70] years). Overall, 55% (n = 114), 17% (n = 36), and 28% (n = 57) of the patients had primary immune deficiencies, autoinflammatory diseases, and rheumatic diseases, respectively. Among the entire cohort, 168 patients (81%) were vaccinated, and 82% were willing to receive a booster dose. Patients with autoinflammatory diseases had the highest vaccination rate (94.4%). A strong conviction that it was the correct decision (72%), fear of getting COVID-19 (38%), and expert opinions (34%) influenced the decision to vaccinate. Among the unvaccinated patients, 33.3% had primary or vocational education (p <0.001). Furthermore, only 33% believed they were at risk of a severe course of COVID-19 (p = 0.014), and 10% believed in vaccine efficacy (p <0.001). They also doubted the safety of the vaccine (p <0.001) and feared a post-vaccination flare of their disease (p <0.001). Half of the unvaccinated respondents declared that they would consider changing their decision. Vaccination coverage in immunodeficient patients was higher than in the general Polish population. However, the hesitant patients doubted the vaccine’s safety, feared a post-vaccination disease flare, and had primary or vocational education. Therefore, vaccination promotion activities should stress personal safety and the low risk of disease flares due to vaccination. Furthermore, all evidence must be communicated in patient-friendly terms.
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Objective We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). Methods We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021–15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression. Results We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81). Conclusion Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.
Importance Kawasaki disease (KD) symptoms significantly overlap with multisystem inflammatory syndrome in children due to COVID-19. Patients with KD may be at risk for adverse outcomes from exposure to SARS-CoV-2 infection or vaccination. Objective To describe the outcomes of patients with KD to SARS-CoV-2 infection or vaccination. Design, Setting, and Participants This case series evaluated 2 cohorts using an existing KD database and reviewed individual electronic medical records for the period spanning January 1, 2020, through January 31, 2022, via electronic medical records that include Washington state immunization records. Vaccine cohort inclusion criteria consisted of being 21 years or younger at immunization and receiving 1 or more BNT162b2 (Pfizer-BioNTech) or messenger RNA (mRNA)–1273 (Moderna) vaccine doses. The COVID-19 cohort included patients 21 years or younger with positive polymerase chain reaction or nuclear capsid IgG findings for SARS-CoV-2. Participants included 826 patients from a preexisting KD database. One hundred fifty-three patients received at least 1 BNT162b2 or mRNA-1273 vaccine dose and were included in the mRNA vaccine cohort. Thirty-seven patients had positive test results for SARS-CoV-2 and were included in the COVID-19 cohort. Exposures SARS-CoV-2 vaccination and/or infection. Main Outcomes and Measures Adverse events after mRNA vaccination and/or COVID-19, including clinician visits, emergency department encounters, or hospitalizations. Results Among the 153 patients included in the mRNA vaccination cohort (mean [SD] age, 13.0 [4.3] years; 94 male [61.4%]), the BNT162b2 vaccine was provided for 143 (93.5%), and the remaining 10 (6.5%) received mRNA-1273 or a combination of both. Among patients in the vaccine cohort, 129 (84.3%) were fully vaccinated or received a third-dose booster. No clinically severe adverse events occurred, and there were no reports of vaccine-related hospitalizations or outpatient visits. The COVID-19 cohort included 37 patients (mean [SD] age, 11.0 [5.5] years; 22 male [59.5%]). No patients required hospitalization due to COVID-19. The most common symptoms included low-grade fever, fatigue, cough, and myalgia with resolution within a few days. Two patients, aged 9 and 19 years, had extended cough and fatigue for 3 to 4 weeks. One patient developed COVID-19 within 6 weeks of receiving intravenous immunoglobulin for KD. Conclusions and Relevance These findings suggest that the mRNA vaccines may be safe and COVID-19 may not be severe for patients with a history of KD.
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Objectives To identify potential predictors of COVID-19 vaccine hesitancy (C19-VH) in adults with immune-mediated inflammatory diseases (IMID). Methods A total of 1000 IMID patients were enrolled in this web-based cross-sectional study. A standardised and self-administered survey was designed by members of the Brazilian Society of Rheumatology Steering Committee for Infectious and Endemic diseases and distributed to IMID patients spread across Brazil. Results Of the 908 (90.8%) respondents eligible for analysis, 744 (81.9%) were willing to get vaccinated against COVID-19. In our multivariable logistic regression model, concurrent malignancy, fibromyalgia, hydroxychloroquine use, and recent corticosteroid pulse therapy were independently associated with higher odds of C19-VH. The short duration of COVID-19 vaccine clinical trials was the main reason for C19-VH. Conclusion We identified novel characteristics potentially associated with C19-VH among adults with IMID. Greater awareness on the safety and efficacy of COVID-19 vaccines is needed for both IMID patients and attending physicians.
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Background We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. Methods From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. Results We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. Conclusion Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently. Methods Download a PDF of the Research Summary. In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety. Results A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups. Conclusions A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; number, NCT04368728.)
"A new study unpacks the complexities of COVID-19 vaccine hesitancy and acceptance across low-, middle- and high-income countries...The world shares a collective responsibility in fighting this pandemic; therefore, continued research on COVID-19 vaccine acceptance and hesitancy should be a priority. Such research should then be used to inform contextualized campaigns and information-sharing that will ultimately result in increased confidence in and uptake of available vaccines."
Importance Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown. Objective To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination. Design, Setting, and Participants All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview. Exposures mRNA COVID-19 vaccine. Main Outcomes and Measures Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Results In the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 [Moderna], and 2 received BNT162b2 [Pfizer]). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2. Conclusions and Relevance In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.
Objective To provide guidance to rheumatology providers on the use of COVID‐19 vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). Methods A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID‐19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 1 to 9 point numerical rating scale using a modified Delphi process and the RAND/UCLA appropriateness method, with refinement and iteration over two sessions. Consensus was determined based on the distribution of ratings. Results Despite a paucity of direct evidence, seventy‐four draft guidance statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID‐19 vaccines in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. Conclusion These guidance statements, made in the context of limited clinical data, are intended to provide direction to rheumatology healthcare providers on how to best use COVID‐19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.
The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal to vaccinate despite the availability of services, threatens to undermine the success of COVID-19 vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. While the experience of recent lethal surges of COVID-19 infections have underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multi-level, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the U.S. toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong healthcare system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.