Points of View: COVID Vaccines in the Immunocompromised

Soiffer, Hematology/Oncology: There are a number of patients who are anxious about receiving a vaccine for a variety of different reasons. They may have had bad experiences with vaccines in the past. They may have had reactions to vaccines. They may have heard about patients who've had complications of vaccines.

We know that the COVID vaccines that are out there do have a small number of side effects. Some of them can produce allergic reactions. Some of them can lead to a transient of temporary myocarditis, decreased cardiac function in some patients, particularly younger men. And some of them can also lead to increased clotting. But the truth is the incidence of these complications is very low and it's far outweighed, in our opinion, by the benefit conferred by the vaccination process.

So we counsel our patients to go ahead and have the vaccine, understanding there is a small risk, but we think that risk is extremely small, and we think, again, that's outweighed by the benefits of not landing in a hospital or conceivably in an ICU on a ventilator or even death. In addition, there are some patients who come to us with the belief that the vaccine may accelerate their malignancy and there’s no evidence of that at the current time that that’s true. So we try to reassure our patients that there’s been no evidence that the vaccines will promote the growth of their malignancy or promote its spread.

Calabrese, Rheumatology: All medical professionals who care for immunocompromised people have had really a humbling experience in encountering and dealing with all different levels of vaccine hesitancy since the start of the pandemic.

Misinformation remains the greatest source of that hesitancy as well as personal anecdotes. We had many patients tell us their neighbor died after they got the vaccine or something similar.

You have to appreciate that someone’s very scared and had a real-life close encounter with something scary that happened after a vaccine. The most important thing for me that I found to be most effective is to just listen and first ask what is the source of their hesitancy? Then just listen so that you can know where to take it from there.

Understanding why they’re hesitant is so important to guide the rest of that conversation. I've had patients even tell me thanks for not yelling at them for not being vaccinated and actually asking them about their concerns. Then you can share correct information; ... that is probably the most important strategy.

We have endless amounts of data through physician surveys and other studies to show that the number one thing that can convince or change someone’s mind to get a vaccine is hearing the recommendation from their health care professional. This carries a lot of weight, especially with rheumatology patients. A lot of patients look at us as their primary care doctor, so hearing that this is what we think the right thing to do is very powerful.

Patel, Allergy: Vaccine hesitancy is still a very difficult topic and subject, both for providers and for patients. We know that most recently, when the FDA approved the Pfizer vaccine for children less than five, only one in five parents were willing to or actually eager to get their pediatric patient vaccinated.

Vaccine hesitancy is real. It is important because it can be a huge public health burden as well as an economic burden.

The other thing that vaccine hesitancy actually prevents us from reaching a threshold where we may be able to achieve herd immunity. ... The vaccine hesitancy is an important topic, and it’s important that we address it and that physicians are aware, and providers are aware of what is out there in terms of why people are not getting the vaccine.

The most common reason for vaccine hesitancy is side effects of the vaccine, but also some people believe that because they already had COVID, why should they get vaccinated, or that the vaccine side effects outweigh, or are larger than getting the COVID vaccine or getting the COVID infection itself.

For us to address vaccine hesitancy, particularly in immunocompromised patients who are at increased risk, we have to listen. We have to be empathetic. We have to understand where the patient is coming from, and then I think we will be able to move the needle from vaccine hesitancy to vaccine acceptance.