Table 1. Barriers and facilitators to vaccination among immunosuppressed adults with immune-mediated inflammatory diseases (IMID) by vaccine type, mapped to the SAGE working group matrix.
| Facilitators | Barriers | |
|---|---|---|
| Contextual influences | ||
| Communication and media | News on threat and seriousness of infection, importance and impact of vaccination on hospitalisation and deaths (C). Advertisement (F). | No news on importance of vaccination (F, P). Little to no advertising (P), or no mention of immunosuppressed being eligible (F, P). |
| Influential leaders | Encouragement from government, HCPs, notable scientists (C). Endorsement by patient organisations (C, F, P). | None |
| Covid-19 pandemic restrictions a | To return to normal (C). Categorised as Clinically Extremely Vulnerable (C, F, P). | None |
| Individual and group influences | ||
| Personal, family or community experience | Positive experience with previous vaccination (C, F, P). | Negative reports from friends and family (F) |
| Risk/benefit (perceived, heuristic) | High incidence of infection and few treatments (C). Higher risk of infection and complications (C, F, P). Confirmation by HCP of no interaction with IMID or its treatment (C, F, P). | Low perceived risk of infection (F, P). Belief that vaccination can or did trigger IMID flare up (C, F, P). |
| Beliefs, attitudes about health and prevention | Belief in benefit from vaccination (C, F, P). Social responsibility to protect others and minimise NHS burdena (C). Often in environment with high chance of catching infection (F, P). | Belief of no tangible benefit from vaccination (F, P). Shielding or in environments with low chance of catching infection (F, P). |
| Health system and providers—trust and personal experience | Trusted HCP familiar with IMID recommending vaccination (C, F, P) | |
| Immunisation as social norm | Has always accepted vaccinations (C, F, P) | None |
| Knowledge, awareness | Aware of eligibility (F, P). | Unaware of eligibility (F, P). |
| Prioritya | None | Other medical appointments for IMID lowers priority of vaccination (F, P). |
| Disease statea | Stable IMID (C, F, P) | Unstable IMID (C, F, P) |
| Vaccine or vaccination specific issues | ||
| Design of vaccination programme or mode of delivery | Mass vaccination programme with ample appointments, prompts and HCP enquiry on vaccination status (C). Invitation from GP (F, P). Ease of booking (F, P). | No invitation from GP (F, P). Not recorded as immunosuppressed in primary-care medical records (F, P). Difficulty booking appointment (F). |
| Introduction of a new vaccine | Confirmation from HCP of novel vaccine technology safety. No reports of side-effects in immunosuppressed (C). | Rapid development of vaccine (C). Type of vaccine (e.g. mRNA) and suitability for IMID (C). |
| Mode of administration | None | Needle phobia |
| Reliability and source of vaccine supply | Good availability of appointments (F) | Limited supply during COVID-19 pandemic (F) |
| Risk benefit | Confidence in vaccine safety (C, F, P). Benefits outweigh risk of vaccination-specific side effects (C, F, P). | Risk of side-effects considered greater burden than benefit of vaccination (F). Safety of taking another vaccine close to COVID-19 (F, P). |
| Strength of recommendation | HCP advising vaccination due to IMID treatment (F, P). | No advice from HCP to be vaccinated (F, P). |
C = COVID-19, F = seasonal-flu, P = pneumonia. aNewly identified from interviews.