1880: Vaccine Hesitancy Among Patients with Idiopathic Inflammatory Myopathies and Rheumatic Diseases in 2021-2022: A Comparative Analysis of COVID-19 Vaccination in Autoimmune Diseases Surveys

Naveen R¹, Mrudula Joshi², Parikshit Sen³, Vishwesh Agarwal⁴, Samuel Shinjo⁵, Sinan Kardes⁶, James B. Lilleker⁷, Hector Chinoy⁸, Ashima Makol⁹, Oliver Distler¹⁰, Minchul Kim¹¹, Elena Nikiphorou¹², Ai Lyn Tan¹³, Babur Salim¹⁴, Tamer A Gheita¹⁵, Nelly Ziade¹⁶, Tsvetelina Velikova¹⁷, Tulika Chatterjee¹¹, Arvind Nune¹⁸, Marcin Milchert¹⁹, Ioannis Parodis²⁰, Abraham Edgar Gracia-Ramos²¹, Albert Selva O’Callaghan²², Miguel Angel Saavedra Salinas²³, Lorenzo Cavagna²⁴, Masataka Kuwana²⁵, Johannes Knitza²⁶, Jessica Day²⁷, Carlos Enrique Toro Gutiérrez²⁸, Carlo Caballero²⁹, Dzifa Dey³⁰, Erick Zamora Tehozol³¹, Jorge Rojas Serrano³², Ignacio Garcia-De La Torre³³, Iris Colunga³⁴, Javier Merayo-Chalico³⁵, John Pauling³⁶, Chris Wincup³⁷, Armen Yuri Gasparyan³⁸, Vikas Agarwal¹, Rohit Aggarwal³⁹ and Latika Gupta⁴⁰, ¹Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, ²Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India, ³Maulana Azad Medical College, New Delhi, India, ⁴Mahatma Gandhi Missions Medical College, Lucknow, India, ⁵Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil, ⁶Istanbul University, Istanbul, Turkey, ⁷The University of Manchester, Manchester, United Kingdom, ⁸The University of Manchester, Sale, United Kingdom, ⁹Mayo Clinic, Rochester, MN, Rochester, MN, ¹⁰Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland, ¹¹University of Illinois College of Medicine Peoria, Peoria, IL, ¹²Leiden University Medical Center & King's College London, London, United Kingdom, ¹³University of Leeds, Leeds, United Kingdom, ¹⁴Fauji foundation hospital Rawalpindi, Rawalpindi, Pakistan, ¹⁵Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt, ¹⁶Saint-Joseph University, Beirut, Lebanon, ¹⁷Sofia University St. Kliment Ohridski, Sofia, Bulgaria, ¹⁸Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom, ¹⁹Pomeranian Medical University in Szczecin, Szczecin, Poland, ²⁰Karolinska Institutet, Stockholm, Sweden, ²¹Instituto Mexicano del Seguro Social, Ciudad de México, Mexico, ²²Hospital Universitari Vall d'Hebron, Barcelona, Spain, ²³IMSS, Ciudad de México, Mexico, ²⁴Università di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Pavia, Italy, ²⁵Nippon Medical School Graduate School of Medicine, Tokyo, Japan, ²⁶Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander-UniversityErlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany, ²⁷Walter and Eliza Hall Institute, Melbourne, Australia, ²⁸Internal Medicine and Rheumatology, Reference Center for Osteoporosis, Rheumatology & Dermatology. Pontificia Javeriana University, Calí, Colombia, ²⁹Universidad del Norte, Barranquilla, Colombia, ³⁰University of Ghana School of Medicine and Dentistry, Accra, Ghana, ³¹Centro Medico Pensiones, Merida, Mexico, ³²Hospital Angeles Villahermosa, Ciudad de México, Mexico, ³³Centro de Est. de Inv. Bas. y Clinica, S.C., Guadalajara, Mexico, ³⁴Hospital Universitario UANL, Monterrey, Mexico, ³⁵Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Ciudad de México, Mexico, ³⁶North Bristol NHS Trust, Bristol, United Kingdom, ³⁷Rayne Institute, University College London, London, United Kingdom, ³⁸Dudley Group NHS Foundation Trust, Dudley, United Kingdom, ³⁹Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, ⁴⁰Royal Wolverhampton Trust, Wolverhampton/University of Manchester, United Kingdom

Background/Purpose: Patients with comorbidities and active rheumatic disease have increased morbidity and hospitalization following SARS-CoV-2 infection. While vaccination has decreased this, many unknown factors still influence COVID-19 vaccine hesitancy. The data on predictors of vaccine hesitancy is regional and scarce. We aimed to analyze the factors influencing vaccine hesitancy in 2022 and compare them with those in 2021 through multicentre international e-surveys (The COVID-19 Vaccination in Autoimmune Diseases Studies - COVAD study 1 and 2).

Methods: COVAD 1 and 2 are multi-centre international e-survey with 152 collaborators in 106 countries including patients with idiopathic inflammatory myopathies (IIM), autoimmune rheumatic diseases (AIRDs), other autoimmune diseases (AIDs), and healthy controls (HCs) conducted in March-December 2021 and February-June 2022 (ongoing), respectively. Descriptive and multivariable regression adjusting for age, gender, ethnicity, and stratified by country of residence was performed.

Results: Among the 18882 (2021) and 7666 complete responses (2022), and 3109 (16.5%) and 387 (5.1%) did not receive any COVID-19 vaccine, respectively. The prevalence of vaccine hesitancy has decreased [OR 0.26 (0.24-0.3), p< 0.001]. Among the 387 vaccine non-recipients in 2022, numbers were as follows: IIM 69 (17%), AIRDs 179 (46%), other AIDs 80 (20.6%), and HC 59 (15%). The reasons for vaccine hesitancy in 2022 included: doctor advising against it 47 (12%), don't believe in the science behind the vaccine 79 (21%), long-term safety concerns 152 (39%), awaiting more safety data 105 (27%), and not recommended due to recent infection 30 (7%).

Compared to AIRDs and HCs, IIM patients were more disbelievers of the science behind the vaccine [OR 1.8 (1.08-3.2), p=0.023 AIRDs, OR 4 (1.9-8.1), p< 0.001 HC], had more long-term safety concerns [OR 1.9 (1.2-2.9), p=0.001 AIRDs, OR 5.4 (3-9.6), p< 0.001 HC] and had more doctors recommending against the vaccine [OR 12.9 (2.8-59), p< 0.001 HC] (Figure 1).

Vaccine non-recipients had higher pain visual analog score (VAS) (p< 0.001), lower fatigue VAS (p=0.003), lower PROMIS10a physical health (p< 0.001), and mental health scores (p=0.015) (Table 1).

The factors predicting vaccine hesitancy in regression were lower PROMIS10a global physical health score [OR 0.9 (0.8-0.97), p=0.014] and Caucasian ethnicity [OR 4.2 (1.7-10.3), p=0.001].

Compared to 2021, doctor's advising against vaccination [OR 2.5 (1.8-3.6), p< 0.001] and long-term safety concerns [OR 3.6 (2.9-4.6), p< 0.001] were more frequent causes of vaccine hesitancy overall whereas vaccine non-availability [OR 0.05 (0.02-0.11), p< 0.001] and have scheduled the vaccination but not received [OR 0.1 (0.06-0.3), p< 0.001] were less frequent causes in 2022 (Figure 2).

Conclusion: Overall, the prevalence of COVID-19 vaccine hesitancy has decreased. Long-term safety concerns and the need for more safety data are now the major reasons for vaccine hesitancy. Caucasian ethnicity and lower physical health scores are predictors of vaccine hesitancy. The increase in physicians recommending against vaccination calls for more physician awareness to mitigate vaccine hesitancy.

Table 1. Comparison of baseline characteristics of vaccine recipients and non-recipients (COVAD 2 survey)

Figure 1. Various causes of vaccine hesitancy

Figure 2. Comparison of causes of vaccine hesitancy among COVAD 1 and 2 surveys
Disclosures: N. R, None; M. Joshi, None; P. Sen, None; V. Agarwal, None; S. Shinjo, None; S. Kardes, None; J. Lilleker, None; H. Chinoy, Eli Lilly, UCB; A. Makol, Boehringer-Ingelheim; O. Distler, AbbVie/Abbott, Amgen, GlaxoSmithKlein(GSK), Novartis, Roche, UCB, Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, 4P-Pharma, Acceleron, Alcimed, Altavant Sciences, AnaMar, Arxx, AstraZeneca, Blade Therapeutics, Bayer, Corbus Pharmaceuticals, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Lupin, Miltenyi Biotec, Merck/MSD, Prometheus Biosciences, Redx Pharma, Roivant, Sanofi, Topadur, Pfizer, Janssen, Medscape, Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143), FOREUM Foundation, ERS/EULAR Guidelines, EUSTAR, SCQM (Swiss Clinical Quality Management in Rheumatic Diseases), Swiss Academy of Medical Sciences (SAMW), Hartmann Müller Foundation; M. Kim, None; E. Nikiphorou, Pfizer, Celltrion, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius; A. Tan, None; B. Salim, None; T. Gheita, None; N. Ziade, Pfizer, Roche, AbbVie/Abbott, Eli Lilly, Boehringer-Ingelheim, Janssen; T. Velikova, None; T. Chatterjee, None; A. Nune, None; M. Milchert, None; I. Parodis, GlaxoSmithKlein(GSK), Amgen, AstraZeneca, Aurinia Pharmaceuticals, Eli Lilly, Gilead, Janssen, Novartis, Roche; A. Gracia-Ramos, None; A. O’Callaghan, None; M. Saavedra Salinas, GlaxoSmithKlein(GSK), AbbVie/Abbott; L. Cavagna, None; M. Kuwana, Boehringer-Ingelheim, Ono pharmaceuticals, Mochida, AbbVie/Abbott, Astellas, Janssen, Bayer, Corbus, Horizon; J. Knitza, AbbVie, Novartis, ThermoFisher, UCB, ABATON, Sanofi, Medac, Lilly, BMS, Gilead, GSK, Werfen, Vila Health, Böhringer Ingelheim, Janssen, Galapagos, Chugai; J. Day, CSL; C. Toro Gutiérrez, AbbVie, Amgen, Biopas, Bristol-Myers Squibb(BMS), Boehringer-Ingelheim, Janssen, Pfizer, Roche, Novartis; C. Caballero, None; D. Dey, None; E. Zamora Tehozol, None; J. Rojas Serrano, None; I. Garcia-De La Torre, None; I. Colunga, None; J. Merayo-Chalico, Janssen, Sanofi; J. Pauling, None; C. Wincup, None; A. Gasparyan, None; V. Agarwal, None; R. Aggarwal, Mallinckrodt, Bristol Myers Squibb, EMD Serono, Pfizer, Octapharma, CSL Behring, Q32, Kezar, AstraZeneca, Alexion, Argenx, Boehringer Ingelheim, Corbus, Janssen, Kyverna, Roivant, AbbVie, Jubilant, Orphazyme, Genentech; L. Gupta, None.