Background/Purpose: Vaccine hesitancy -the reluctance or refusal to vaccinate despite the availability of vaccines- is one of the threats to global health set by the World Health Organization in 2019. Adults with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) have a greater risk of influenza-related morbidity and mortality, however in this population, vaccine uptake remains suboptimal. This study evaluated the underlying reasons for influenza vaccine hesitancy among RA and JIA patients.

Methods: Between 2016 and 2018, 4 focus groups (FG) of RA and JIA patients were conducted at a large Canadian teaching university hospital. In addition, 8 individual telephone-based semi-structured interviews were done with patients who refused to both get the influenza vaccine and participate in the FG. Barriers of influenza vaccination were discussed. All encounters were transcribed verbatim, uploaded into MAXQDA 12, and thematically analyzed.The analytic strategy was guided by an existing theoretical hesitancy model proposed by the Strategic Advisory Group of Experts (SAGE) on immunization.

Results: Participants wereRA (n=23) and adult JIA (n=5) patients, 48±17.3 years-old (mean ± SD, age range= 20-74), English speakers, and mostly women (82%). Identified barriers to vaccination pertained to three main levels, namely: patients, health care-providers and health-care system. At the patient level, limited knowledge about the value and mechanisms of action of inactivated vaccines and the increased risk of infection associated with RA/JIA, as well as poor overall health literacy, were identified as causes of concerns, misconceptions or fears about influenza vaccination. Negative influence from relatives, peers and media, and in some cases the perception that vaccines are promoted to benefit the pharmaceutical industry were also reasons of hesitancy. At the level of health care provider, RA/JIA patients indicated that the limited time to discuss about vaccines is a key cause of vaccine hesitancy. Aspects related to the health-care system mainly revolved around organization, including waiting time and accessibility to vaccines as causes of vaccine hesitancy.

Conclusion: The causes of influenza vaccine hesitancy among RA/JIA patients are multiple. Vaccine specific issues, contextual and individual influences affect RA/JIA patients’ vaccination decisions. Specific multi-level approaches enhancing knowledge-awareness and facilitating communication with health care providers could reduce vaccine hesitancy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/causes-of-influenza-vaccine-hesitancy-in-rheumatoid-arthritis-and-adults-with-juvenile-idiopathic-arthritis/