Summer 2021 (Volume 31, Number 2)

Survey Results: Vaccine Inequity

On behalf of the CRA Quality Care Committee

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The pandemic has presented challenges to virtually every human on the planet. These have often been amplified in individuals with underlying health conditions. With COVID-19 vaccination underway across Canada, the focus of this issue’s Joint Count survey is vaccine inequity. In February 2021, we reached out to CRA members to find out about their perspectives on vaccine inequity in Canada. There were a total of 102 responses received out of a possible 578. Many thanks to those who shared their experiences.

The primary question asked was the following: “To your knowledge, have any of your patients who have otherwise met provincial criteria for COVID-19 vaccination been denied it on the basis of their autoimmune disease and/or the medications used to treat it?” About 20% of respondents replied that they were aware of at least one instance of a patient being turned away. Of these, in most cases (90%), it was 1 to 5 patients, but 10% responded that they knew of 6-10 patients who were turned away.

Most of the patients turned away were women with rheumatoid arthritis on some form of disease-modifying anti-rheumatic drug (DMARD). Most rheumatologists were involved in some advocacy in this context. A recurrent theme which emerged from narratives provided was that patients were turned away because the vaccine was “not recommended” and “un-studied” in patients with rheumatic diseases, and that they must then provide documentation of their rheumatologist’s support in order to obtain the vaccine. This, in turn, bred hesitancy among patients, not to mention material delay in receiving the vaccine at a time when cases were rising and variants of concern were proliferating.

Furthermore, a similar survey was also sent out to rheumatology patients, in collaboration with the Canadian Arthritis Patient Alliance (CAPA) and the Arthritis Society, to ask about their opinions (in March and April 2021). Of the 112 responses, the majority (96%) were from women from Ontario (54%). Only half of respondents were eligible to receive vaccines at the time they responded. Only a few (~3%) reported being denied the vaccine. Evidently, with the self-selected group of respondents and a small sample size this reflects a sliver rather than a swath of the rheumatology patient experience.

As COVID-19 vaccination is currently gaining momentum across Canada, and the criteria and news surrounding it are rapidly evolving, it is important to note that the observations from this survey may only reflect a specific slice in time.

These real-time observations can inform ongoing COVID-19 vaccine advocacy as we navigate the roll-out’s twists and turns, and the impact it has had on patients with rheumatic diseases. More generally, these observations serve as a reminder of the role for continued timely and nuanced advocacy, such as the excellent work of the CRA Guidelines and Therapeutics committees, in collaboration with patient groups, through the pandemic and beyond

If you have any additional feedback for the CRA, please contact Sue Ranta at sranta@rheum.ca.

CHART 1: Percentage (%) of rheumatologists who have had a patient denied the COVID-19 vaccination based on their autoimmune disease and/or the medications used to treat it (who otherwise met provincial criteria)

CHART 2: Percentage (%) of patients who intended to get COVID-19 vaccine as of April 2021