“…Probably most important, the initial period of good compliance towards COVID-19 vaccines, during which the majority of scleroderma patients have taken the first three doses, was followed by lower adherence to the vaccination campaign either by the general population and by the patients themselves. To date, just over a third of patients received the fourth dose of vaccine; this finding in combination with the impaired immunoreactivity to vaccines [ 19 , 20 , [22] , [23] , [24] ], could be responsible for the overall toll of vaccination campaign in SSc patients. The resulting scenario, especially in the last 6–12 months of pandemic, was most likely characterized by an increasing number of patients with a peculiar combination of some adverse factors, namely SSc multiple organ involvement, mainly ILD, ongoing immune suppressor treatments, and impaired humoral/cellular anti-COVID-19 response, all in the context of weakened pandemic containment measures.…”