Barriers and facilitators to influenza and pneumococcal vaccine hesitancy in rheumatoid arthritis: a qualitative study

Abstract

Objective Immunization is an essential component of rheumatoid arthritis (RA) care. Nevertheless, vaccine coverage in RA is suboptimal. Contextual, individual, and vaccine-related factors influence vaccine acceptance. However, barriers and facilitators of vaccination in RA are not well defined. The aim of this study was to assess perspectives of RA patients and health care professionals (HCPs) involved in RA care of barriers and facilitators regarding influenza and pneumococcal vaccines. Methods Eight focus groups (4 with RA patients and 4 with HCPs), and eight semi-structured open-ended individual interviews with vaccine hesitant RA patients were conducted. Data were audio-recorded, transcribed verbatim, and imported to the MAXQDA software. Analysis using the framework of vaccine hesitancy proposed by the Strategic Advisory Group of Experts (SAGE) on Immunization was conducted. Results RA patients and HCPs reported common and specific barriers and facilitators to influenza vaccination that included contextual, individual and/or group, and vaccine and/or vaccination specific factors. A key contextual influence on vaccination was patients’ perception of the media, pharmaceutical industry, authorities, scientists, and the medical community at large. Among the individual-related influences, experiences with vaccination, knowledge/awareness, and beliefs about health and disease prevention were considered to impact vaccine-acceptance. Vaccine-related factors including concerns of vaccine side effects such as RA flares, safety of new formulations, mechanism of action, access to vaccines and costs associated with vaccination were identified as actionable barriers. Conclusion Acknowledging RA patients' perceived barriers to influenza and pneumococcal vaccination and implementing specific strategies to address them might increase vaccination coverage in this population.

Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic

“…It found that determinants of engagement with vaccination are similar between people with different IMIDs, and among those treated with conventional or biologic immune-suppressing drugs. Our findings align with the SAGE working group vaccine hesitancy matrix and a previous qualitative research study on vaccine hesitancy about vaccination against pneumococcal and seasonal flu vaccination in people with RA [21], with barriers and facilitators spanning contextual, individual/ group and vaccine/vaccination specific influences. Similar to other studies qualitatively exploring vaccine hesitancy in select population groups [22,23], we identified additional factors influencing the decision to be vaccinated that were specific to this patient group, such as concerns of vaccination inducing IMID-flare, as well as those specific to the COVID-19 pandemic, such as vaccination as an opportunity to end social restrictions.…”

“…Participants' understanding of increased risk of infection and complications from infections was an important reason for getting vaccinated in our study as reported previously [21,[24][25][26][27]. Similarly, lack of awareness about eligibility for getting vaccinated has been reported as a barrier to vaccination [21], but was particularly prominent for pneumococcal vaccine uptake in our study.…”

“…As reported elsewhere, we found concern regarding vaccination-associated IMID flares emerged as a potential barrier to vaccination [21,30,32]. This dissipated following reassurance from a trusted HCP.…”

“…Before the COVID-19 pandemic, a Canadian study explored factors influencing influenza and pneumococcal pneumonia vaccine uptake among RA patients [21]. It highlighted multiple barriers identified in the present work, but also reported distrust of health systems and pharmaceuticals as key barriers.…”

Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis

“…It has to be acknowledged though that the context of vaccination uptake in high-risk populations is quite complex and it is not influenced only by patient and disease characteristics, but by other factors as well ( 32 ). In a recent review, Boucher et al identified several factors that could lead to vaccine hesitancy, such as healthcare policies, access to care, social and media influence, the understanding of vaccines’ benefits and risks, the role of healthcare professionals and the implementation of vaccination schedules ( 33 ).…”