Public health

Rheumatologist advice is key to overcoming COVID-19 vaccine hesitancy

One in three people with rheumatic disease are vaccine hesitant but a word from the rheumatologist is enough to persuade most patients to get vaxed, Australian research shows

A Melbourne-based rheumatologist is encouraging clinicians to be proactive in discussing COVID-19 vaccines after her research showed they could play a key role in improving uptake in vaccine-hesitant patients.

Monash Health Rheumatology Fellow Dr Tina Ko co-investigated COVID-19 vaccine acceptance in rheumatic disease  patients at the beginning of the vaccine rollout in February 2021.

Of 641 patients surveyed, she found 34% were hesitant (unwilling or undecided) to get the vaccine.

Despite this, 55% of vaccine-hesitant patients said they’d be more willing to receive it if recommended by their rheumatologist, and 43%, if the recommendation came from their GP.

Given the recurring outbreaks and study results, Dr Ko said it was important for rheumatologists to engage their patients regarding the vaccine.

“At this time point, it’s really crucial for us to get all of our patients on board and, from what we saw in our study, there’s a significant rise in vaccine acceptance if recommended by a treating physician,” Dr Ko told the limbic.

“So, I think when having that role where patients put a lot of trust in us, we should be taking advantage of that and whenever a patient comes to us in the clinic, we should really be asking ‘Are you planning on getting the vaccine? If not, why not?’”

She also suggested rheumatologists could direct patients to online information sheets and resources for more general guidance about the vaccines.

“There is overwhelming medical consensus that rheumatic disease patients should receive SARS-COV-2 vaccination,” Dr Ko and her team wrote in Human Vaccines & Immunotherapeutics.

Willing patients tended to be smokers, have a history of malignancy, have had an influenza or pneumococcal vaccine in the last 12 months, adhere to more COVID-safe practices such as hand hygiene, mask wearing and social distancing, and have positive beliefs about the vaccines’ safety and efficacy, they wrote.

Vaccine choice also contributed to acceptance, they added.

Although vaccine acceptance wasn’t correlated with patients’ perceived immunosuppression or COVID-19 risk, it was affected by concerns about vaccine-related rheumatic disease flare and side-effects.

Dr Ko said she believed flares could occur if immunomodulatory therapies were paused to improve vaccine efficacy, rather than due to the vaccine itself. However she had not seen many cases in the limited time she’s spent in the public hospital.

In the study, 28% of patients were willing to withhold immunomodulators and accept the risk of RMD flare and a further 42% would do so if advised by their rheumatologist.

Dr Ko said the decision to pause immunomodulatory therapies often occurs on a case-by-case basis.

“It depends on their disease activity, how often we see them and how much we trust that our patients can contact us if they do have a flare,” she said, though they do try to space rituximab out as far as possible.

“There is a significant need for increasing levels of education regarding vaccine safety, vaccine efficacy and the risk of RMD flare,” the authors wrote.

“Clinician recommendation and vaccine choice have the potential to increase vaccination uptake in hesitant patients,” they concluded.

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