News Release

Fear of side effects, including rheumatic disease flares, driving COVID-19 vaccine hesitancy among some patients

Reports and Proceedings

American College of Rheumatology

ATLANTA — New research presented this week at ACR Convergence, the American College of Rheumatology’s annual meeting, shows that in Alabama, one in 10 racial or ethnic minority patients with a rheumatic disease in a large rheumatology clinic said they were unlikely to get vaccinated against COVID-19 (Abstract #0617).

COVID-19 is the disease caused by the novel SARS-CoV-2 coronavirus. Research presented at ACR Convergence 2020 showed that people of color with rheumatic disease have worse health outcomes from COVID-19 infection, are more likely to be hospitalized to treat their coronavirus infection and are more likely to require invasive ventilator treatment. While COVID-19 vaccines are now available in the U.S., hesitancy to receive them persists.

Alabama lags behind other U.S. states in COVID-19 vaccine uptake. According to researchers, people in racial and ethnic minority groups also face disparities in access to the vaccines. In addition, many in Alabama’s large Black population mistrust the medical establishment due to past abuses like the Tuskegee Syphilis study. Researchers at the University of Alabama at Birmingham (UAB) launched this new study to find out more about vaccine hesitancy and uptake among racial and ethnic minority patients at a large academic center’s rheumatology clinic.

“Many patients seen in rheumatology clinics are immunosuppressed or have comorbidities that put them at risk for higher morbidity and mortality due to COVID-19,” says Maria I. Danila, MD, MSc, MSPH, Associate Professor of Medicine, Division of Clinical Immunology and Rheumatology at UAB and the study’s corresponding author. “Early during the rollout of the COVID-19 vaccination program in our region, it became apparent that vaccination among some minority communities was lagging. We conducted this study to take ‘the pulse’ of vaccine uptake in our area and to understand the top reasons why some patients had not been vaccinated. Our goal was to inform the development of communication strategies to ensure equitable access to vaccination among our patients.”

Between April 19 and May 6, 2021, researchers invited patients from racial and ethnic minority communities in Alabama to complete a survey during their in-person visits to the rheumatology clinic. They assessed patients’ vaccination confidence using a standard psychological scale. They analyzed patients’ attitudes and beliefs about COVID-19 vaccines and determined the potential factors associated with getting a vaccine: such as age, sex, education level, vaccine confidence, safety concerns about the vaccine, medical mistrust and receipt of a flu vaccine in the past.

There were 150 patients who agreed to complete the survey. They had a mean age of 54, 86.9% were women, 94% identified as Black or African American, 69% had some college, and 22% said they believed that they would get better medical care if they belonged to a different racial or ethnic group. Although 81% of people who completed the survey had received the flu vaccine in the past, only two-thirds said they had received a COVID-19 vaccine. Of 50 people who remained unvaccinated, only half said they had been offered a COVID-19 shot. One third said they did not plan to be vaccinated.

The participants who did not plan on receiving a vaccine listed several reasons why. More than half said they had concerns about vaccine side effects, 53% feared a rheumatic disease flare, 32% said they knew someone who had a bad experience with the vaccine, 21% said they worried about getting COVID-19 from the vaccine, and 18% were concerned that the vaccine would “modify my DNA.” Unvaccinated patients also expressed their desire to have more information about the safety and efficacy of the vaccine in people with a rheumatic disease.

After multivariable adjustment, researchers found that patients of an older age, not having safety concerns about the new vaccine, having gotten a flu shot in the past, and having higher vaccine confidence overall were associated with receipt of a COVID-19 vaccine. There was no association between reporting medical mistrust and vaccine receipt.

“Our findings suggest that a one-size-fits-all approach is not a viable solution to help inform COVID-19 vaccine decisions among people with rheumatic disease,” says Dr. Danila. “To build trust, it is important to listen to understand why people may be reluctant to become vaccinated, and to address their specific concerns in an empathic and non-judgmental fashion. This may result in more people participating in COVID-19 vaccination.”


About ACR Convergence

ACR Convergence, the annual meeting of the American College of Rheumatology, is where rheumatology meets to collaborate, celebrate, congregate, and learn. With more than 320 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, business education and interactive discussions to improve patient care. For more information about the meeting, visit, or join the conversation on Twitter by following the official hashtag (#ACR21).

About the American College of Rheumatology

Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves over 7,700 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit

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