Hesitancy about COVID-19 vaccination persists nationwide, although it varies by region and sociodemographic group, according to first-quarter 2021 survey data from the U.S. Department of Health and Human Services (HHS):
- About 8% of Americans said they were “strongly hesitant” to be vaccinated;
- The greatest decreases in vaccine hesitancy were among adults between 18 and 24 years old (from 26% in January to 18% in March), and Black adults (from 34% in January to 18% in March);
- The highest rates of vaccine hesitancy were among non-college-educated, multi-racial adults (27%); non-college-educated, non-Hispanic Blacks (21%); and non-college-educated, non-Hispanic whites (20%); and
- Vaccine hesitancy is higher in the South, Great Plains and Alaska.1
Rheumatologists say taking a proactive, encouraging approach with patients about vaccination works—most of the time.
“If patients don’t bring up vaccines, I bring it up,” says Don Stromquist, MD, a rheumatologist with University of Utah Health practicing in Salt Lake City and Farmington. “I’m very gratified by the way my patients do bring it up. The great majority of my patients have either had a vaccine or are planning to get one.”
Although he and other rheumatologists say most of their patients are being vaccinated against COVID-19, hesitancy or fear persists among a few. To shore up trust in vaccines, rheumatologists say nonjudgmental conversations and plain-language answers to questions are needed.
There is a newer worry: Recent evidence reveals a blunted antibody response to the COVID-19 vaccines among patients taking certain immunomodulatory therapies. The ACR has updated its COVID vaccine guidance to help improve antibody response among at-risk patient populations.2
Some patients express concerns about post-vaccine adverse effects because of their disease or current treatment, as well as worries about side effects they read about on social media.
“I am trying to just listen to their questions and concerns,” says Dr. Stromquist. “I have only had a few patients who were dead-set against getting a COVID vaccine. They ask the typical questions and may mention things they have seen in the media. Or they may say, ‘I will see if my friends get it and then see how they respond.’ I try to respond to them, validate their worries and hear them out. Building trust is so important.”
Dr. Stromquist and other rheumatologists say some patients worry the vaccine will cause an autoimmune disease flare.
“We have told our patients with rheumatic diseases—especially patients with lupus—in the past not to get live vaccines, because it could cause a disease flare,” says Julie J. Paik, MD, MHS, assistant professor of medicine at the Johns Hopkins Myositis Center, Baltimore. “But I explain to them that the new mRNA vaccines for COVID are not live-virus vaccines.