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

Full text

Since January 2020 Elsevier has created a COVID-19 resource centre with
free information in English and Mandarin on the novel coronavirus COVID-
19. The COVID-19 resource centre is hosted on Elsevier Connect, the
company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related
research that is available on the COVID-19 resource centre - including this
research content - immediately available in PubMed Central and other
publicly funded repositories, such as the WHO COVID database with rights
for unrestricted research re-use and analyses in any form or by any means
with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre
remains active.

Comment
www.thelancet.com/rheumatology Published online February 8, 2022 https://doi.org/10.1016/S2665-9913(22)00001-7
1
Lancet Rheumatol 2022
Published Online
February 8, 2022
https://doi.org/10.1016/
S2665-9913(22)00001-7
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
www.rheum-covid.org
See Online for appendix

Comment
2
www.thelancet.com/rheumatology Published online February 8, 2022 https://doi.org/10.1016/S2665-9913(22)00001-7
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.
11%
11%
18%
10%
42%
47%
38%
40%
35%
22%
24%
34%
33%
26%
32%
26%
21%
23%
3%
4%
71%
79%
100 50 0 50 100
Unwilling (no)
(9)
Unsure
Disagree
(strongly or somewhat)
The COVID-19 vaccines were developed too quickly
26%
22%
32%
32%
Unwilling (no)
(8)
Unsure
The COVID-19 vaccine will not work as well for me
20%
39%
43%
21%
Unwilling (no)
(7)
Unsure
I will have a milder course of COVID-19 if I am vaccinated
19%
13%
46%
65%
Unwilling (no)
(6)
Unsure
I think the COVID-19 vaccine is unsafe
69%
47%
8%
19%
Unwilling (no)
(5)
Unsure
I never get very ill with infections so the COVID-19 vaccine is not needed for me
26%
22%
41%
52%
Unwilling (no)
(4)
Unsure
I do not think the vaccine is helpful because it will not protect me against new variants of COVID-19
20%
25%
47%
48%
Unwilling (no)
(3)
Unsure
I consider myself as being pro-vaccine
46%
48%
33%
29%
Unwilling (no)
(2)
Unsure
I am worried the vaccine could cause COVID-19 infection
2%
5%
96%
92%
Unwilling (no)
(1)
Unsure
I am concerned about side-effects to the COVID-19 vaccine
Neither agree
nor disagree
Agree
(strongly or somewhat)
Somewhat agree Strongly agree
Strongly disagree Somewhat disagree Neither agree nor disagree

Comment
www.thelancet.com/rheumatology Published online February 8, 2022 https://doi.org/10.1016/S2665-9913(22)00001-7
3
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,
RH, BFH, EH, LK, AK, AHJK, DFLL, CL, EFM, BM, SM, MN, ADS, JASi, NS, MFU-G,
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

Comment
4
www.thelancet.com/rheumatology Published online February 8, 2022 https://doi.org/10.1016/S2665-9913(22)00001-7
(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 rheumcovid.org. 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
mputman@mcw.edu
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)
1 Machingaidze S, Wiysonge CS. Understanding COVID-19 vaccine hesitancy.
Nat Med 2021; 27: 1338–39.
2 Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2
mRNA COVID-19 vaccine. New Engl J Med 2020; 383: 2603–15.
3 Felten R, Dubois M, Ugarte-Gil MF, et al. Vaccination against COVID-19:
expectations and concerns of patients with autoimmune and rheumatic
diseases. Lancet Rheumatol 2021; 3: e243–45.
4 Vieira Rezende RP, Braz AS, Guimarães MFB, et al. Characteristics associated
with COVID-19 vaccine hesitancy: a nationwide survey of 1000 patients
with immune-mediated inflammatory diseases. Vaccine 2021;
39: 6454–59.
5 Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19
vaccination in adults with systemic rheumatic diseases: results from the
COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021;
7: e001814.
6 Østergaard SD, Schmidt M, Horváth-Puhó E, Thomsen RW, Sørensen HT.
Thromboembolism and the Oxford–AstraZeneca COVID-19 vaccine:
side-effect or coincidence? Lancet 2021; 397: 1441–43.
7 Kim HW, Jenista ER, Wendell DC, et al. Patients with acute myocarditis
following mRNA COVID-19 vaccination. JAMA Cardiol 2021; 6: 1196-201.
8 Rosenblum H. COVID-19 vaccines in adults: benefit-risk discussion. ACIP
Meeting. July 22, 2021. https://www.cdc.gov/vaccines/acip/meetings/
downloads/slides-2021-07/05-COVID-Rosenblum-508.pdf (accessed
Jan 22, 2022).
9 Curtis JR, Johnson SR, Anthony DD, et al. American College of
Rheumatology guidance for COVID-19 vaccination in patients with
rheumatic and musculoskeletal diseases: version 1.
Arthritis Rheumatol 2021; 73: 1093–107.
10 Finney Rutten LJ, Zhu X, Leppin AL, et al. Evidence-based strategies for
clinical organizations to address COVID-19 vaccine hesitancy.
Mayo Clin Proc 2021; 96: 699–707.