Vaccine Hesitancy: Wariness Is Rare, But There’s a Wider Worry About COVID Vaccines’ Efficacy in Some Populations

Rheumatologists may find that some patients have misconceptions about the vaccines’ contents or safety that are impossible to alter, says Dr. Kim.

“At the end of the day, if my patient isn’t ready to get the vaccine yet, I do not force it,” Dr. Kim says. “Vaccine readiness takes time for some, so I want to make sure we all respect this.”

Dr. Prahalad

Pediatric Patients & Parents

On May 10, the U.S. Food & Drug Administration expanded the emergency use authorization for the Pfizer-BioNTech COVID-19 vaccine to include adolescents from ages 12 to 15.³ Almost immediately, many of newly eligible patients with autoimmune diseases and their parents expressed interest in vaccination, says Sampath Prahalad, MD, chief of pediatric rheumatology at Children’s Healthcare of Atlanta.

“They want to know more about the different types of vaccines and whether they are safe,” says Dr. Prahalad, who has encountered some vaccine hesitancy as well. “Some have concerns about how quickly the vaccine was developed. Others feel not enough time has passed to know about long-term side effects. Some feel that COVID-19 is a mild disease and wonder if a vaccine is necessary.”

To respond to these concerns, he explains that while children generally experience milder disease than adults with COVID-19, some pediatric patients experience serious disease and even require hospitalization, including 3,700 in the U.S. with multisystem inflammatory syndrome in children (MIS-C) caused by an abnormal immune response to the coronavirus infection.

“For these reasons, vaccination with the mRNA vaccines is recommended. We explain that the trials of these vaccines involved a large number of subjects, and we have experience with over 200 million doses of the mRNA vaccines being administered in the U.S.,” he says.

Dr. Prahalad allays the fears of patients or parents worried about vaccine side effects, explaining that most after-effects are mild, such as injection site pain and swelling. “We also explain that the best way to protect your children younger than 12 is for the parents and other eligible family members to get vaccinated, forming a ring of protection for vulnerable children,” he says.

When Dr. Navarro-Millan talks with vaccine-hesitant patients, she explains the vaccine provides peace of mind. Patients can safely visit their family and friends again, she says, framing the conversation in personal terms rather than stressing efficacy data.

“I tell my patients, ‘That is what I want for you—that human connection that we have all been missing,’” she says. “Patients just want to have a connection with a real person when they talk to their doctor. They don’t want to talk about statistics.”

Efficacy

When Dr. Navarro-Millan’s hospital recently conducted vaccine education webinars in both English and Spanish, patients asked if they would have a lesser response to the COVID vaccine because of their rheumatic disease therapies. She told her patients on B cell therapies, such as rituximab, that they may have a lesser response and could require a booster vaccine dose in the future to achieve optimal protection against COVID.