Assessment of hesitancy to COVID-19 vaccine in patients with rheumatic arthritis

The COVID-19 pandemic caused by SARS-CoV-2 in 2019 has greatly impacted global health, leading to high morbidity and mortality rates. Rheumatoid arthritis (RA) patients have faced numerous challenges during the pandemic, including concerns about infection, limited medical resources, and shortages of medication. While vaccination is a crucial strategy against COVID-19, the reasons behind vaccine hesitancy (VH) among people with RA remain largely unexplored.

We conducted a cross-sectional, single-arm study in China from July 18 to August 18, 2021. Using a self-administered questionnaire and a convenient sampling method, we investigated vaccine attitudes and VH among RA patients. The questionnaire developed by the investigators was validated by two public health experts and one senior rheumatologist. It covered sociodemographics, disease-related variables, vaccination attitudes, and willingness, etc. We employed Chi-squared and regression analyses to identify factors associated with VH toward COVID-19 vaccination.

A total of 184 RA patients were enrolled in the survey, with 113 (61.41%) expressing unwillingness to be vaccinated. The Chi-squared test revealed significant differences in employment status and related systemic damage (p < 0.05). Among the unvaccinated RA patients, 71.68% believed COVID-19 vaccination might impact their disease. Binary and multicollinearity logistic regression analyses showed that the acute stage of RA (p < 0.001, OR = -3.165, 95% CI: 0.035 - 0.164) and fear of disease development caused by drug discontinuation during vaccination (p < 0.001, OR = -3.591, 95% CI: 0.005 - 0.157) were the restricting factors influencing the COVID-19 vaccine inoculation rate in RA patients.

The COVID-19 vaccination rate among RA patients in China is low due to limited knowledge, misconceptions, and insufficient promotion. Boosting confidence and understanding of the vaccine's effectiveness and safety is crucial to improve vaccination success.