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Sir, we read with interest the recent communication by Priori et al. (2021) reporting that patients with rheumatic musculoskeletal diseases (RMDs) in Italy are less willing to receive the COVID-19 vaccination than healthy controls and that they are more likely to perceive themselves at higher risk of becoming infected with SARS-CoV-2 and developing severe COVID-19 . These data are somehow at odds with our observations from patients with RMDs from other seven European countries who took part in the REUMAVID study .
REUMAVID is an international cross-sectional study using an online survey of unselected patients with 15 RMDs from seven European countries (United Kingdom, Spain, Italy, France, Portugal, Greece, and Cyprus). A total of 2,002 patients participated in the second phase between February and April 2021. At that time, the European Medicines Agency (EMA) had approved four COVID-19 vaccines: BioNTech Pfizer, Moderna, Oxford AstraZeneca, and Janssen . Significant differences in the roll out speed and vaccine availability between countries contributed to global anxiety created by the rapid development of the vaccines. Like our Italian colleagues, we were keen to explore patients’ willingness to get the vaccination and factors associated with possible unwillingness to do so.
Contrary to the report by Priori et al. (2021), our results show that the majority of survey respondents were either willing to be (82.8%, n= 1,657) or had already been vaccinat...
Contrary to the report by Priori et al. (2021), our results show that the majority of survey respondents were either willing to be (82.8%, n= 1,657) or had already been vaccinated against SARS-CoV-2 (8.4%, n= 168), compared to only 8.8% (n= 177) who were unwilling. This is consistent with previous evidence showing that the risk of contracting the SARS-CoV-2 virus or developing the COVID-19 infection is similar in patients with RMDs in comparison to the general population . Reasons for unwillingness to undergo vaccination included the fear of adverse effects (60.5%, n= 92), waiting for a new vaccine with reported greater efficacy (56.6%, n= 86), self-perception of having a compromised immune system (30.3%, n= 46), not being afraid of the virus (7.9%, n= 12) or being an anti-vaxxer (2.6%, n=4). Interestingly, those in younger age categories (OR= 0.98) and females (OR= 1.66) were associated with unwillingness to be vaccinated as demonstrated by Priori et al. (2021). In addition, having greater fears about possible adverse effects of the vaccine (OR= 1.77) or less fear that there will be enough vaccines (OR= 0.85), having less hope about the availability of an effective vaccine (OR= 0.51) or of achieving protection against COVID-19 (OR= 0.43) were also associated with unwillingness to be vaccinated. Importantly, patients expressed a fear that clinical trials of these vaccines may not have included patients with RMDs on immunosuppressive therapies . Surprisingly, patients who had never taken biologics were less willing to be vaccinated (OR= 1.56) as opposed to those who had, who were overall younger (53.6 vs 56.5 years, p<0.001) and more likely to be members of patient organisations (34.4% vs 29.5%, p=0.023), receiving a higher quality of information on COVID-19 (3.0 vs 2.8 of 5, p=0.025), and being more likely to contact their rheumatologist during the pandemic (74.5% vs 55.5%, p<0.001). A multivariable logistic regression model showed that having a higher fear of adverse effects (OR= 1.96) and a lower hope of being vaccinated and protected against the virus (OR= 0.50) were associated with an unwillingness to be vaccinated in patients with non-inflammatory RMDs (OR= 2.03).
Finally, we found interesting the observation by Priori et al. (2021) that, compared to healthy controls, patients with RMDs who refused vaccination were more willing to reconsider their decision if they received more medical information. Indeed, in the REUMAVID cohort, not belonging to a patient organisation (OR= 1.44) or receiving poorer quality information (OR= 0.81) were associated with unwillingness to vaccinate. This was seen primarily in the sub-group of patients with non-inflammatory RMDs, whereas a higher proportion of patients with inflammatory articular RMDs (i.e., Axial Spondyloarthritis/Ankylosing Spondylitis, Gout, Peripheral Spondyloarthritis, Psoriatic Arthritis and Rheumatoid Arthritis) received information from patient organisations (58.9% vs 50.3% p=0.003) and reported themselves to be more likely to get vaccinated.
In conclusion, the results from phase 2 of the REUMAVID study show that the type of RMD, available treatments, source of information, and individual fears and hopes may condition the willingness to be vaccinated against COVID-19 among European patients with RMDs. Scientific societies and patient organisations have promoted the importance of vaccination in people with RMDs . Therefore, patient organisations can play a crucial role as advocates and reliable sources of information for patients, especially in uncertain situations such as the current pandemic.
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