Fear of side effects, rheumatic disease flare top reasons for COVID-19 vaccine hesitancy
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In a survey of racial and ethnic minorities with rheumatic diseases in Alabama, the most common reasons cited for COVID-19 vaccine hesitancy were fear of side effects and disease flare, according to data presented at ACR Convergence 2021.
In all, one in 10 patients surveyed said they were unlikely to get the COVID-19 vaccine. Among those who had not yet been vaccinated, half said they had not been offered the vaccine, Maria I. Danila, MD, MSc, MSPH, at University of Alabama’s Birmingham Division of Clinical Immunology and Rheumatology, said during a virtual press conference.
“Early in the pandemic, it became evident that patients belonging to racial and ethnic minority groups were more likely to be disproportionately affected by COVID-19. And then as the vaccine program rolled out in Alabama, there was a lot of concern about lack of access to vaccination and that the legacy of medical mistrust would further accentuate health disparities,” she said.
The University of Alabama at Birmingham (UAB) is a large tertiary medical care center that serves a diverse socioeconomic population, Danila said.
“Our patients, like many other rheumatology patients, are immunosuppressed or have additional medical conditions that may put them at higher risk for worse COVID-19 outcomes,” Danila said.
To analyze the concerns and beliefs regarding the COVID-19 vaccine, as well as the factors associated with receiving it, among racial and ethnic minority patients with rheumatic disease, Danila and colleagues conducted a survey of individuals completing in-person visits at UAB between April 19 and May 6, 2021. A total of 150 patients agreed to complete the survey, of whom 94% self-identified as Black or African American.
Confidence in COVID-19 vaccination was assessed using the confidence scale from the validated 5C psychological antecedents of vaccination. In addition, the researchers used descriptive statistics to summarize the assembled attitudes and beliefs regarding COVID-19 vaccination, as well as multivariable logistic regression to determine the factors associated with receiving the vaccine. Information regarding age, sex, education, vaccine confidence, safety concerns, medical mistrust and past flu vaccine receipt were included in the survey.
Although 81% of the participants said they had previously received the influenza vaccine, just two-thirds reported being vaccinated against COVID-19. Among the 50 participants who had not yet received the COVID-19 vaccine, only half had been offered the vaccine, while one-third said they did not plan to be vaccinated.
The most common reasons for avoiding the COVID-19 vaccine included concerns about side effects — cited by 56% of participants — and fear of disease flare — cited by 53%. In addition, 32% said they knew someone who had a bad experience with the vaccine, 21% shared the concern that they would get COVID-19 from the vaccine, and 18% feared that the vaccine would “modify” their DNA, according to the researchers.
Participants who had not yet received the COVID-19 vaccine expressed a need for information about its efficacy and safety in people with rheumatic disease. After multivariable adjustment, older age, not having safety concerns about the COVID-19 vaccine, previous influenza vaccination and higher vaccine confidence were associated with COVID-19 vaccination.
There was no association between reporting medical mistrust and COVID-19 vaccine receipt. However, 22% of participants said they believed they would have received better medical care if they belonged to a different race or ethnic group.
“Our study showed that about one in 10 people from racial and ethnic minority groups that were attending the rheumatology clinic in the deep South had not had the vaccine early in April 2021 and that about half of them had not been offered a vaccine in fact,” Danila said. “The way we believe that this research will influence us further is that we believe that our findings provide additional information that can influence the development of intervention that can improve COVID-19 vaccination rates and reduce health disparities, particularly in subpopulations that are at a traditionally higher risk for health disparities.”
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Danila MI. Abstract 0617. Presented at: ACR Convergence 2021; Nov. 5-9, 2021 (virtual meeting).
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