Australian research has revealed factors associated with changing vaccine hesitancy in rheumatology patients.
Australian research has revealed factors associated with changing vaccine hesitancy among rheumatology patients.
Those who were vaccine hesitant before the pandemic had very different behaviours to those who became vaccine hesitant during the pandemic, the researchers found, highlighting the need for varying approaches in counselling different patients.
“Within our cohort of inflammatory arthritis patients, a group vulnerable largely because of their prescribed medications, we found that while persistent vaccine hesitancy strongly correlates with wider views on medication overuse and harm, more fluid beliefs correlate strongly with different sources of information,” wrote the authors, led by rheumatologist Dr Chris McMaster of Austin Health in Melbourne.
“Importantly, for the rheumatologist seeing vaccine-hesitant patients in the clinic, it is vaccine information from health professionals that is correlated with fluid vaccine hesitancy.”
Patients enrolled in the Australian Rheumatology Association Database (ARAD) were fortuitously surveyed in January 2020, before the covid pandemic hit Australian shores, and May 2021. The surveys covered a range of questions relating to medical therapy, vaccine beliefs and experiences and the patient’s disease.
The 2021 survey also included questions specifically about covid vaccines, with the survey taking place about two months after the first covid vaccines were administered and one month after government advice to limit Vaxzevria (AstraZeneca) vaccine use due to concerns about thrombotic adverse events.
Almost 1000 people responded to the first survey and another 1000 to the second, with a total 594 responding to both, allowing analysis of changing beliefs over time. Findings were published in Rheumatology.
Among the patients who responded to both surveys, 12% were identified as covid-vaccine hesitant in 2021. There were shifts over time, with some patients vaccine hesitant in 2020 but not 2021 and some who were non-hesitant in 2020 becoming newly hesitant in 2021.
There were no sociodemographic differences between hesitant and non-hesitant participants other than age, with vaccine hesitant patients slightly younger than non-hesitant patients.
What they did find was that newly hesitant patients were different to those who were vaccine hesitant prior to the pandemic in terms of beliefs and behaviours.
People who were vaccine hesitant before the pandemic were more suspicious of medicine harm and overuse, and these beliefs were even stronger among those who remained hesitant.
Meanwhile, patients who were newly hesitant had gone to their peers and online for vaccine information, rather than healthcare professionals.
Indeed, sources of vaccine information were key to vaccine acceptance, with patients who changed from vaccine hesitant to non-hesitant having the highest rate of seeking vaccine advice from health professionals.
“As rheumatologists, we must acknowledge the central role we play and make effective, individualised communication with vaccine-hesitant patients a priority in practice,” wrote the authors.
Investigators also looked at influenza vaccine hesitancy and found that overall rates were low, decreasing slightly from 2020 to 2021.
“Attitudes to flu vax thankfully didn’t change with covid vaccination, allaying fears that covid vaccination mandates might make our patients turn away from vaccination in general,” said Melbourne rheumatologist and co-author, Dr David Liew.
Analysis comparing vaccine hesitancy among Victorians and the rest of the country found no differences, despite the large differences in covid incidence and government response between states.
The real advantage of this survey was having done a vaccine hesitancy survey immediately before the pandemic, said Dr Liew, who is also deputy editor of Rheumatology Republic.
“It really was very lucky and gave us the chance to understand rheumatology patient attitudes to vaccine hesitancy in a way that would otherwise be very hard to do,” he said.
“The pandemic changed lots of things for people, including some people’s attitudes towards covid vaccination. Given the real benefit our patients can get from covid vaccination, it’s so important to help our patients get boosters, but the key going forward is to knowing that vaccine discussions need to be personalised to why patients are hesitant in the first place.”
Dr Liew added that the team was following these patients up, with more data to be released in the near future.
