Facilitators and barriers for vaccination in patients with inflammatory rheumatic musculoskeletal diseases: a prospective cohort study

Introduction To identify facilitators and barriers towards vaccination in general and specifically against pneumococci, influenza and SARS-CoV-2 in patients with rheumatic musculoskeletal diseases (RMD). Methods Between February and April 2021, consecutive patients with RMD were asked to complete a structured questionnaire on general knowledge about vaccination, personal attitudes and perceived facilitators and barriers towards vaccination. General facilitators (n=12) and barriers (n=15) and more specific ones for vaccination against pneumococci, influenza and SARS-CoV-2 were assessed. Likert scales had four response options: from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination records and attitudes towards vaccination against SARS-CoV-2 were assessed. Results 441 patients responded to the questionnaire. Knowledge about vaccination was decent in ≥70% of patients, but <10% of patients doubted its effectiveness. Statements on facilitators were generally more favourable than on barriers. Facilitators for SARS-CoV-2 vaccination were not different from vaccination in general. Societal and organisational facilitators were more often named than interpersonal or intrapersonal facilitators. Most patients indicated that recommendations of their healthcare professional would encourage them to be vaccinated—without preference for general practitioner or rheumatologists. There were more barriers towards SARS-CoV-2 vaccination than to vaccination in general. Intrapersonal issues were most frequently reported as a barrier. Statistically significant differences in response patterns to nearly all barriers between patients classified as definitely willing, probably willing and unwilling to receive SARS-CoV-2 vaccines were noted. Discussion Facilitators towards vaccination were more important than barriers. Most barriers against vaccination were intrapersonal issues. Societal facilitators identified support strategies in that direction.

[1]  J. Lazarus,et al.  A survey of COVID-19 vaccine acceptance across 23 countries in 2022 , 2023, Nature Medicine.

[2]  U. Karbach,et al.  Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease: a scoping review , 2022, RMD Open.

[3]  M. Bromberg,et al.  COVID-19 vaccine hesitancy among Israeli adults before and after vaccines’ availability: A cross-sectional national survey , 2022, Vaccine.

[4]  M. Tai-Seale,et al.  COVID-19 vaccine hesitancy: Associations with gender, race, and source of health information. , 2022, Families, systems & health : the journal of collaborative family healthcare.

[5]  D. N. Roy,et al.  Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review , 2022, PloS one.

[6]  T. Shimabukuro,et al.  Safety of mRNA vaccines administered during the initial 6 months of the US COVID-19 vaccination programme: an observational study of reports to the Vaccine Adverse Event Reporting System and v-safe , 2022, The Lancet Infectious Diseases.

[7]  M. Levine,et al.  COVID-19 vaccine perceptions and uptake: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey , 2022, The Lancet Rheumatology.

[8]  J. Braun,et al.  SARS-CoV-2 vaccination willingness and predictors in patients with chronic inflammatory rheumatic diseases (CIRD) and without CIRD , 2022, Therapeutic advances in musculoskeletal disease.

[9]  X. Mariette,et al.  Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry , 2021, Annals of the Rheumatic Diseases.

[10]  Ramey Moore,et al.  Trusted Sources of COVID-19 Vaccine Information among Hesitant Adopters in the United States , 2021, Vaccines.

[11]  B. Fasolo,et al.  COVID-19 Vaccine Hesitancy in Eight European Countries: Prevalence, Determinants and Heterogeneity , 2021 .

[12]  G. Burmester,et al.  Risk of herpes zoster (shingles) in patients with rheumatoid arthritis under biologic, targeted synthetic and conventional synthetic DMARD treatment: data from the German RABBIT register , 2021, Annals of the Rheumatic Diseases.

[13]  G. Stoker,et al.  Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy , 2021, Vaccines.

[14]  K. Costenbader,et al.  Avoidable Acute Care Use for Vaccine‐Preventable Illnesses Among Medicaid Beneficiaries With Lupus , 2021, Arthritis care & research.

[15]  P. Machado,et al.  SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: the Euro-COVIMID multicentre cross-sectional study , 2021, The Lancet Rheumatology.

[16]  J. Braun,et al.  Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study , 2021, RMD Open.

[17]  C. Betsch,et al.  Decreasing vaccine hesitancy with extended health knowledge: Evidence from a longitudinal randomized controlled trial. , 2021, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[18]  N. Wulffraat,et al.  Point of view on the vaccination against COVID-19 in patients with autoimmune inflammatory rheumatic diseases , 2021, RMD Open.

[19]  L. Trupin,et al.  Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry , 2021, Annals of the Rheumatic Diseases.

[20]  H. Lorenz,et al.  Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases , 2021, RMD Open.

[21]  K. Kim,et al.  What Is COVID-19? , 2020, Frontiers for Young Minds.

[22]  R. Desai,et al.  Risk of admission to hospital for serious infection after initiating tofacitinib versus biologic DMARDs in patients with rheumatoid arthritis: a multidatabase cohort study. , 2020, The Lancet. Rheumatology.

[23]  M. Dougados,et al.  Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations , 2019, RMD Open.

[24]  A. Schneider,et al.  Measles Status-Barriers to Vaccination and Strategies for Overcoming Them. , 2018, Deutsches Arzteblatt international.

[25]  Cornelia Betsch,et al.  Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016 , 2017, PloS one.

[26]  Cornelia Betsch,et al.  Using Behavioral Insights to Increase Vaccination Policy Effectiveness , 2015 .

[27]  N. MacDonald.  Vaccine hesitancy: Definition, scope and determinants. , 2015, Vaccine.

[28]  P. Tugwell,et al.  Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis , 2015, The Lancet.

[29]  S. Toovey,et al.  Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study , 2012, BMC Musculoskeletal Disorders.

[30]  R. Voll,et al.  Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study , 2012, Rheumatology International.

[31]  S. Gabriel,et al.  Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. , 2002, Arthritis and rheumatism.

[32]  K. Glanz,et al.  An Ecological Perspective on Health Promotion Programs , 1988, Health education quarterly.

[33]  C. Betsch,et al.  [Psychological antecedents of vaccination: definitions, measurement, and interventions]. , 2019, Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz.

[34]  J. Braun,et al.  [Practical problems by implementation of vaccination recommendations]. , 2012, Zeitschrift fur Rheumatologie.