ATLANTA — Limited knowledge about inactivated vaccines, misconceptions and fears, as well as long wait times and accessibility issues are among the leading drivers of influenza vaccine hesitancy among adults with rheumatoid arthritis and juvenile idiopathic arthritis, according to a presenter at ACR/ARP 2019.
“This is important because patients with rheumatoid arthritis have an increased risk for infection, especially influenza,” Valeria Valerio, a fellow-in-training at the Research Institute of McGill University Health Center, in Montreal, told Healio Rheumatology. “That is one of the leading causes of respiratory infection, so that is why influenza vaccination is recommended. However, vaccination uptake is below what is recommended in Canada — that is, 80% — and one of the main causes of non-vaccination is vaccine hesitancy.”
To analyze the reasons for hesitancy regarding influenza vaccines among adults with JIA or RA, Valerio and colleagues conducted a series of focus groups and telephone-based interviews. The four focus groups were conducted between 2016 and 2018 at a large Canadian teaching university hospital, while the eight semi-structured telephone interviews included people who refused the influenza vaccine and declined to participate in any focus group. During both the focus groups and telephone interviews, the researchers and participants discussed barriers to influenza immunization.
In all, 23 patients with RA and five patients with JIA were included in the study. The researchers transcribed each focus group and interview verbatim and analyzed each transcript thematically. In their analysis, Valerio and colleagues reported that they were guided by an existing theoretical hesitancy model proposed by the Strategic Advisory Group of Experts (SAGE) on vaccines.
According to the researchers, reasons for vaccines hesitancy typically fell into one of three main themes — patient-level, provider-level and systemic-level barriers. At the patient level, barriers included a limited knowledge regarding the benefits and mechanisms of inactivated vaccines, as well as the increased risk for infection involved with RA and JIA. In addition, poor health care literacy led some patients to hold concerns, misconceptions or fears regarding vaccinations. In some cases, bad information received from relatives, peers and certain media contributed to a perception that the pharmaceutical industry promotes vaccines solely to benefit itself.
At the provider level, patients reported that they had limited time to discuss vaccines with their physician, leading to hesitancy. Barriers related to the health care system as a whole included long wait times and accessibility issues.
“Vaccine hesitancy has many causes — there isn’t just one reason patients are not getting their vaccine,” Valerio said. “There is the patient level, which can include even a fear of needles. At the second level, patients do not trust the pharmaceutical industry, and third level is that they do not have enough knowledge and awareness of vaccines.” – by Jason Laday
Pelaez S. Abstract #2258. Causes of influenza vaccine hesitancy in rheumatoid arthritis and adults with juvenile idiopathic arthritis. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Valerio reports no relevant financial disclosures.