Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys
Authors: Sen Parikshit , R Naveen , Houshmand Nazanin , Moghadam Kia Siamak , Joshi Mrudula , Saha Sreoshy , Jagtap Kshitij , Agarwal Vishwesh , Nune Arvind , Nikiphorou Elena , Tan Ai Lyn , Shinjo Samuel Katsuyuki , Ziade Nelly , Velikova Tsvetelina , Milchert Marcin , Parodis Ioannis , Gracia-Ramos Abraham Edgar , Cavagna Lorenzo , Kuwana Masataka , Knitza Johannes , Makol Ashima , Patel Aarat , Pauling John D , Wincup Chris , Barman Bhupen , Zamora Tehozol Erick Adrian , Rojas Serrano Jorge , García-De La Torre Ignacio , Colunga-Pedraza Iris J , Merayo-Chalico Javier , Chibuzo Okwara Celestine , Katchamart Wanruchada , Akawatcharangura Goo Phonpen , Shumnalieva Russka , Chen Yi-Ming , Hoff Leonardo Santos , El Kibbi Lina , Halabi Hussein , Vaidya Binit , Sazliyana Shaharir Syahrul , Hasan A T M Tanveer , Dey Dzifa , Gutiérrez Carlos Enrique Toro , Caballero-Uribe Carlo Vinicio , Lilleker James B , Salim Babur , Gheita Tamer , Chatterjee Tulika , Distler Oliver , Saavedra Miguel A , Day Jessica , Chinoy Hector ,   COVAD Study Group, Kardes Sinan , Andreoli Laura , Lini Daniele , Screiber Karen , Vince Melinda Nagy , Singh Yogesh Preet , Ranjan Rajiv , Jain Avinash , Pandya Sapan C , Pilania Rakesh Kumar , Sharma Aman , Manesh Manoj M , Gupta Vikas , Kavadichanda Chengappa G , Patro Pradeepta Sekhar , Ajmani Sajal , Phatak Sanat , Goswami Rudra Prosad , Chowdhury Abhra Chandra , Mathew Ashish Jacob , Shenoy Padnamabha , Asranna Ajay , Bommakanti Keerthi Talari , Shukla Anuj , Pande Arunkumar R , Chandwar Kunal , Ghodke Akanksha , Boro Hiya , Fazal Zoha Zahid , Cansu Döndü Üsküdar , Yıldırım Reşit , Gasparyan Armen Yuri , Del Papa Nicoletta , Sambataro Gianluca , Fabiola Atzeni , Govoni Marcello , Parisi Simone , Bocci Elena Bartoloni , Sebastiani Gian Domenico , Fusaro Enrico , Sebastiani Marco , Quartuccio Luca , Franceschini Franco , Sainaghi Pier Paolo , Orsolini Giovanni , De Angelis Rossella , Danielli Maria Giovanna , Venerito Vincenzo , Grignaschi Silvia , Giollo Alessandro , Alluno Alessia , Ioannone Florenzo , Fornaro Marco , Traboco Lisa S , Wibowo Suryo Anggoro Kusumo , Loarce-Martos Jesús , Prieto-González Sergio , Gonzalez Raquel Aranega , Yoshida Akira , Nakashima Ran , Sato Shinji , Kimura Naoki , Kaneko Yuko , Gono Takahisa , Tomaras Stylianos , Proft Fabian Nikolai , Holzer Marie-Therese , Gromova Margarita Aleksandrovna , Aharonov Or , Griger Zoltán , Hmamouchi Ihsane , El bouchti Imane , Baba Zineb , Giannini Margherita , Maurier François , Campagne Julien , Meyer Alain , Langguth Daman , Limaye Vidya , Needham Merrilee , Srivastav Nilesh , Hudson Marie , Landon-Cardinal Océane , Zuleta Wilmer Gerardo Rojas , Arbeláez Álvaro , Cajas Javier , Silva José António Pereira , Fonseca João Eurico , Zimba Olena , Bohdana Doskaliuk , Ima-Edomwonyi Uyi , Dedeke Ibukunoluwa , Airenakho Emorinken , Madu Nwankwo Henry , Yerima Abubakar , Olaosebikan Hakeem , Becky A , Koussougbo Oruma Devi , Palalane Elisa , So Ho , Ugarte-Gil Manuel Francisco , Chinchay Lyn , Bernaola José Proaño , Pimentel Victorio , Fathi Hanan Mohammed , Mohammed Reem Hamdy A , Harifi Ghita , Fuentes-Silva Yurilís , Cabriza Karoll , Losanto Jonathan , Colaman Nelly , Cachafeiro-Vilar Antonio , Bautista Generoso Guerra , Ho Enrique Julio Giraldo , González Raúl , Nunez Lilith Stange , Cristian Vergara M , Báez Jossiell Then , Alonzo Hugo , Pastelin Carlos Benito Santiago , Salinas Rodrigo García , Obiols Alejandro Quiñónez , Chávez Nilmo , Ordóñez Andrea Bran , Argueta Sandra , Llerena Gil Alberto Reyes , Sierra-Zorita Radames , Arrieta Dina , Hidalgo Eduardo Romero , Saenz Ricardo , Idania Escalante M , Morales Roberto , Calapaqui Wendy , Quezada Ivonne , Arredondo Gabriela , Gasparyan Armen Yuri , Agarwal Vikas , Aggarwal Rohit , Gupta Latika 
Published: February 2023

Abstract

Objective
COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs); however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys.

Methods
The first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups.

Results
We analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26; 95% CI: 0.24, 0.30, P &lt; 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6; 95% CI: 2.9, 4.6, P &lt; 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8; 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4; 95% CI: 1.9, 8.1, P &lt; 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs – OR: 1.9; 95% CI: 1.2, 2.9, P = 0.001; IIMs vs HCs – OR: 5.4 95% CI: 3, 9.6, P &lt; 0.001). Caucasians [OR 4.2 (1.7–10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8–0.97)].

Conclusion
Vaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.