COVID-19 Vaccination in Patients with Rheumatic Disease

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With a large percentage of the U.S. population unsure whether they will get vaccinated against COVID-19, rheumatology patients remain vulnerable. On May 13, the ACR hosted a virtual town hall highlighting ways rheuma­tology providers might effectively approach their patients who have not yet decided to get a COVID-19 vaccine.

Get the Slow Yes

Dr. Manning

At the outset, Kimberly Dylan Manning, MD, FACP, FAAP, a professor of medicine and the associate vice chair of diversity, equity and inclusion at Emory University School of Medicine, Atlanta, expressed her dislike of the term vaccine hesitancy. She prefers the term deliberation, the act of thinking and deciding carefully about something, which she believes imparts more power to both patients and providers. After all, different people need different information to be comfortable making big decisions.

Repeatedly, Dr. Manning emphasized the importance of building rapport: “What kind of therapeutic alliance have you worked at to make sure [your patient] wants to say yes to you?” she asked. Body language and inviting intonation are key, as are respectfully listening to patients and showing you have heard them.

From attentive listening, clinicians can gain valuable information they can use to influence their patients over time. Eventually, some patients will slowly turn from a no toward a yes. “That’s one of the most encouraging things,” said Dr. Manning. “Depending on who you are, your deliberation process might require a little bit more. Just keep planting that seed.”

Not all patients have the same questions about, or knowledge of, COVID-19 vaccination. Asking patients about their specific concerns allows clinicians to tailor the response to the patient. For example, a patient may bring up a concern about how quickly the vaccine was created. It’s helpful to acknowledge and validate the concern. Then a clinician may provide specific reassuring context—explaining that researchers have been studying other coronaviruses for years and work on mRNA vaccines is not new.

You may mention the new vaccines were subjected to all the typical steps in vaccine development and evaluation, including phase 1, 2 and 3 clinical trials. Don’t assume your patient knows what that means. Provide an explanation: “That means studies were conducted in people, not just animals, beginning with tests in a few healthy volunteers (under a hundred) and moving up to large-scale tests in people with the disease (hundreds to thousands) to ensure the vaccine is safe and works as intended. The vaccines are safe. More than 302 million people in the U.S. have now been vaccinated, with rare serious side effects and very few deaths—about 7 per 1 million vaccinated women between 18 and 49 years old—positively linked to vaccination.”¹

“When we start respecting our patients [and giving them] the science,” said Dr. Manning, “you’ll be surprised at how many people will say, ‘That makes sense.’”