“I would say a minority of my patients are vaccine hesitant. When I explain that it is not a live vaccine, and that it would be worse for them if they got COVID, that helps them.”
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Explore This IssueAugust 2021
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Dr. Stromquist says most of his patients are well informed about the vaccines due to extensive news coverage of their development and clinical trial results in the past year, but some share concerns with him based on media reports regarding thrombosis risk with certain vaccines or genetically altered components of some vaccines.
In St. Louis, Alfred Kim, MD, PhD, Washington University School of Medicine Division of Rheumatology, also encounters vaccine hesitancy among some patients. He says patients most commonly express concerns about the “risk of flares, side effects and the lack of long-term safety data. They’ll say, ‘I probably won’t mount a response, so why get it?’ Or they’ll express a lack of readiness, commenting, ‘You got it because your health is stable, but mine is not. I do not want to rock the boat.’ Misinformation, such as government tracking, or belief that the virus and COVID-19 aren’t real, are infrequent reasons.”
Long COVID & Hesitancy
At her clinic at the Hospital for Special Surgery, New York City, Iris Navarro-Millan, MD, says most of her patients with rheumatic diseases have been eager to be vaccinated, because they were afraid of severe illness or death from COVID in an area especially hard-hit early in the pandemic.
She sees more vaccine hesitancy among new patients with lingering COVID-19 symptoms that mimic post-infectious rheumatic disease. While these “COVID long-hauler” patients don’t have autoimmunity, they are referred to her practice because, as a rheumatologist, she is familiar with some of their presenting symptoms, which often resemble those seen in post-infectious arthritis or rheumatic fever, such as glomerulonephritis, hematologic and neurological manifestations, as well as cognitive symptoms (e.g., lack of concentration) or chronic fatigue.
“We are finding that getting a COVID vaccine improves long-COVID symptoms,” Dr. Navarro-Millan says. However, she continues, “I have seen five patients like this who do not want to get a vaccine. They can’t really articulate why. It’s just, ‘I don’t know.’ I probe them to find out why. One person had COVID twice and is still having chronic fatigue symptoms, but still doesn’t want to get the vaccine. She says she has to think about it. She couldn’t put in words why she doesn’t want to get the vaccine, except to say, ‘It’s my right to choose.’ It’s the same with the others.”