Vaccination perceptions in inflammatory conditions
Research type
Research Study
Full title
Barriers and facilitators of flu, pneumonia and SARS-CoV-2 vaccination in adults with inflammatory conditions treated with immune-suppressing drugs
IRAS ID
303339
Contact name
A Abhishek
Contact email
Sponsor organisation
University of Nottingham
Clinicaltrials.gov Identifier
000, NA
Duration of Study in the UK
0 years, 11 months, 1 days
Research summary
Research Summary
People with inflammatory diseases are often treated with medications that act to suppress the immune-system, increasing the risk of catching infections. Consequently, vaccination with the pneumonia and seasonal flu vaccines is recommended for them. They were also prioritised to receive the COVID-19 vaccines early in the national rollout.
However, the uptake of the pneumonia and seasonal flu vaccines among this group is lower than ideal. There may be many reasons why they do or do not seek to be vaccinated for these infections, such as the belief it may cause their disease to flare up or lack of knowledge of vaccines effectiveness. Anecdotally there was a high uptake of COVID-19 vaccines in adults with inflammatory conditions, however, concerns about vaccine-induced disease flare-ups and reports of complications deterred some from being vaccinated. A better understanding of why people do and do not seek vaccination may result in more targeted messaging for patients to help overcome vaccine hesitancy for these infectious diseases.
This study aims to explore the drivers and barriers to being vaccinated among adults with common inflammatory conditions and on immune-suppressing medication.
They will be invited to participate in a single, semi-structured interview. Interviews will be face-to-face, by telephone or video-call, last up to one hour, and digitally audio-recorded. They will explore participants’ understanding of pneumonia, seasonal flu and COVID-19 and the risk they pose to their health, their understanding of vaccinations, beliefs of the benefits and risks of vaccinations for these infections, and reasons for seeking or not seeking vaccination.
Findings will inform messaging about being vaccinated for these infections in patient education leaflets, such as those by patient charities regularly provided at speciality clinics. They will also be disseminated to healthcare professionals to help them better understand the drivers and barriers to vaccination.
Summary of Results
Around one in fifty adults in the UK has an inflammatory condition where the immune-system is overactive, mistakenly attacking and damaging parts of the body. These conditions can be treated with medicines that dampen down the immune system, but this increases the chance of getting seriously unwell from flu, pneumonia and COVID-19. These infections can be prevented with vaccines, however, many immune-suppressed people do not get vaccinated. The reasons for this are not well understood. The aim of this study was to understand why some immune-suppressed people with inflammatory conditions choose to get vaccinated for flu, pneumonia and COVID-19 while others do not.
Participants were recruited through national patient charities and a local hospital between November 2021 and January 2022. We recruited twenty participants with different inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease, vasculitis, and lupus. They each took part in a single telephone interview with a trained researcher over the same time period.
We found that there were many reasons for choosing to be vaccinated or not. This varied by the type of vaccine, but not from condition to condition.
For all three vaccines, the key reasons for choosing to be vaccinated were: knowing that they had a high risk of getting seriously unwell if they caught flu, pneumonia or COVID-19; believing that vaccines will keep them well; and, vaccine endorsement from patient charities working on behalf of people with their condition. For all three vaccines, the reasons for not being vaccinated were believing that vaccination could cause their inflammatory condition to flare-up, and, their condition not being stable.
Specific to COVID-19 vaccines, key reasons for being vaccinated included: the focus on COVID-19 and its threat in the news, and seeing how many people were catching it; to help others; the mass vaccination programme with multiple invitations to be vaccinated and good appointment availability; and, a doctor or nurse confirming the new vaccines’ were suitable for their condition.
Specific to flu and pneumonia, key reasons for being vaccinated were knowing they were eligible for these vaccines, and, receiving an invitation to be vaccinated and/or recommendation from a doctor or nurse. Specific to flu and pneumonia, key reasons for not being vaccinated were: not being aware they were eligible for these vaccines; not receiving an invitation or recommendation from a doctor or nurse; and, believing they had a low chance of getting seriously unwell from flu and pneumonia, so there were no benefits to taking these vaccines.
Based on our findings, we recommend that the benefits and safety of vaccination are addressed with patients in hospital and GP appointments. Those on medicines that dampen the immune system are not routinely included in direct invitation for vaccination and so they could be considered for this. People that take these medicines could also be listed in the eligibility criteria for vaccination in television, newspaper and pharmacy adverts.REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
21/PR/1147
Date of REC Opinion
13 Sep 2021
REC opinion
Further Information Favourable Opinion