Survey: COVID-19 Vaccine Hesitancy Low Among People with Rheumatic Diseases

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Three-quarters of patients said they were worried about the risks associated with SARS-CoV-2 infection.

Patients with rheumatic diseases have highly favorable attitudes toward the COVID-19 vaccine, particularly when their physicians encourage them to take the shot, according to a new survey.

The study, published in ACR Open Rheumatology, also found a high rate of flu-shot uptake among the group.

Corresponding author Sara K. Tedeschi, MD, MPH, of Brigham and Women’s Hospital, and colleagues noted that people with rheumatic diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) can face significant health consequences—and significant health care costs—if they contract vaccine-preventable diseases like COVID-19 and herpes zoster. Yet, the investigators said existing evidence about vaccine uptake in this group is mixed.

In the general population, attitudes toward COVID-19 vaccination have also been mixed, in part because of the quick development timeline of the vaccines, and because 2 of the 3 available vaccines are in a novel class of vaccine, mRNA vaccines. The American College of Rheumatology has recommended COVID-19 vaccination for most patients with rheumatic diseases, and the small amount of available evidence suggests the vaccines are safe for people with rheumatic diseases, though their immunogenicity is sometimes reduced in patients taking certain immunomodulators.

“Because of the paucity of safety and efficacy data on the COVID-19 vaccine in patients with systemic rheumatic disease, as well as the special concerns related to immunomodulator use, there may be important differences in attitudes toward COVID-19 vaccination between patients with systemic rheumatic disease and the general population,” Tedeschi and colleagues wrote.

In order to better understand the issue, the investigators constructed a survey for patients with rheumatic diseases by pulling questions from a nationwide Harris Poll on vaccination attitudes. The survey was delivered to 243 patients at Brigham and Women’s Hospital between December 2020 and April 2021. One in 4 patients who were asked to complete the survey responded. Most (82%) were women, and two-thirds were white. Half of the respondents had RA, and 28% had SLE. The mean age was 56 years.

The survey showed that 84% of respondents wanted a COVID-19 vaccine as soon as it was available to them, and 76% said they worried “a lot” or “somewhat” about getting COVID-19. The vast majority of these patients (92%) said they had received the flu shot in the previous year, and 30% said they had previously been hospitalized for an infection.


The authors noted limitations to their results. Their study included a highly educated, mostly female population who had high rates of preventative health measure use, meaning they may not be representative of the general rheumatic disease population. Tedeschi and colleagues also said people with positive attitudes toward the vaccine may have been more likely than vaccine skeptics to complete the survey, which could have skewed the results.

Still, Tedeschi and colleagues concluded that patients with systemic rheumatic diseases generally had more favorable attitudes toward vaccination compared to the general population. They noted that Harris Poll results found around 30-40% of the general population wanted a COVID-19 vaccination as quickly as possible.

“Physician recommendation to receive a vaccine against COVID-19 or other preventable illnesses is the most important factor influencing vaccine uptake in this population, followed by the desire to avoid infection,” they wrote.


Tedeschi SK, Ellrodt J, Stratton J, et al. Acceptability of vaccines against preventable infections including coronavirus cisease 2019 among patients with rheumatic disease . ACR Open Rheumatol. Published online October 6, 2021 Oct 6]. doi:10.1002/acr2.11351. doi:10.1002/acr2.11351