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. 2022 Sep 9;17(9):e0267769.
doi: 10.1371/journal.pone.0267769. eCollection 2022.

Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic

Amy Fuller  1 , Jennie Hancox  2 , Kavita Vedhara  2 , Tim Card  3 , Christian Mallen  4 , Jonathan S Nguyen Van-Tam  3 , Abhishek Abhishek  1
Affiliations

Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic

Amy Fuller et al. PLoS One. .

Abstract

Objectives: To explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases (IMIDs).

Methods: Recruiting through national patient charities and a local hospital, participants were invited to take part in an in-depth, one-to-one, semi-structured interview with a trained qualitative researcher between November 2021 and January 2022. Data were analysed thematically in NVivo, cross-validated by a second coder and mapped to the SAGE vaccine hesitancy matrix.

Results: Twenty participants (75% female, 20% non-white) were recruited. Barriers and facilitators spanned contextual, individual/group and vaccine/vaccination-specific factors. Key facilitators to all vaccines were higher perceived infection risk and belief that vaccination is beneficial. Key barriers to all vaccines were belief that vaccination could trigger IMID flare, and active IMID. Key facilitators specific to COVID-19 vaccines included media focus, high incidence, mass-vaccination programme with visible impact, social responsibility, and healthcare professionals' (HCP) confirmation of the new vaccines' suitability for their IMID. Novel vaccine technology was a concern, not a barrier. Key facilitators of influenza/pneumococcal vaccines were awareness of eligibility, direct invitation, and, clear recommendation from trusted HCP. Key barriers of influenza/pneumococcal vaccines were unaware of eligibility, no direct invitation or recommendation from HCP, low perceived infection risk, and no perceived benefit from vaccination.

Conclusions: Numerous barriers and facilitators to vaccination, varying by vaccine-type, exist for immunosuppressed-IMID patients. Addressing vaccine benefits and safety for IMID-patients in clinical practice, direct invitation, and public-health messaging highlighting immunosuppression as key vaccination-eligibility criteria may optimise uptake, although further research should assess this.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: AF, JH, KV, TC and JSN-V-T declare no competing interests. CM declares grants awarded from MRC, AHRC BMS and Versus Arthritis, and is Director of the NIHR SPCR. AA declares grants from AstraZeneca and Oxford Immunotec, personal payments from UpToDate, Springer, Menarini and Cadilla pharmaceuticals, consulting fees from Inflazome and NGM Biopharmaceuticals, meeting attendance/travel payments from Pfizer, and is co-chair for the OMERACT CPPD classification criteria and ACR/EULAR CPPD classification criteria working groups. JSN-V-T was seconded to the Department of Health and Social Care, England (DHSC) until 31st March 2022. The views expressed in this manuscript are those of its authors and not necessarily those of DHSC or the Joint Committee on Vaccination and Immunisation (JCVI). These do not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Diagrammatic summary of the barriers and facilitators of vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases.
See this image and copyright information in PMC

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