Vaccine Hesitancy Against COVID-19 Vaccines in Patients with Autoimmune Rheumatic Diseases and Effect of Specialist Counselling on Vaccine-hesitant Patients

Objectives: To assess causes of vaccine hesitancy to COVID-19 vaccines in patients with autoimmune rheumatic diseases (AIRD). Methods: Study design: We conducted a cross-sectional observational survey-based study of patients attending Rheumatology OPD regarding the reason for vaccine hesitancy, counselled by treating rheumatologists and responses regarding willingness recorded after counselling. Convenience sampling was done by including all adults (>18 years) with AIRD attending rheumatology OPD. Those vaccinated, recently infected (within six weeks), and non-AIRD patients were excluded. The questionnaire included details about patients' demography, medication and reason for vaccine hesitancy. Statistical analysis was performed using measures of central tendency for quantitative variables and using counts and percentages for qualitative variables. Results: A total of 322 patients participated in the study with a mean age of 40 years (18-76), with 73% (234) females and 27% (88) males. Most patients had RA (40%) followed by SpA (27%), SLE (13%) and were on immunosuppressive medications (95%). A significant proportion of patients (60%) had more than one reason for vaccine hesitancy. Almost 60% of the respondents feared disease flare post-vaccination, while almost half (44.4%) feared vaccine side effects and more than one-third (35%) doubted vaccine efficacy while on immunosuppressive medications. Other causes were the inability to get vaccinated (18%), doubts about vaccine efficacy (15%), and fear of injections (10%). Most patients (91%) expressed vaccine acceptance after specialist counselling. Conclusions: Vaccine hesitancy is multifactorial. Addressing reasons for vaccine hesitancy in patients with AIRD like fear of flare of disease post-vaccination, fear of vaccine side effects and doubts over vaccine efficacy while taking immunosuppressive medications are necessary. Most patients were willing to take vaccine after counselling by a rheumatologist.