Table 1.

Foundational principles, assumptions, and considerations for the guidance statements^*

ACR guidance statements are not intended to supersede the judgment of rheumatology care providers nor override the values and perspectives of their patients. Guidance was, in some cases, based on weak and/or indirect evidence and required substantial extrapolation by an expert task force. All statements, therefore, should be considered conditional or provisional. The ACR is committed to updating this guidance document as new evidence emerges.

The rheumatology community lacks important knowledge on how to best maximize vaccine‐related benefits. RMD patients exhibit high variability with respect to their underlying health condition, disease severity, treatments, degree of multimorbidity, and relationship with their specialist provider. These considerations must be considered when individualizing care.

There is limited direct evidence about mRNA COVID‐19 vaccine safety and efficacy in RMD patients. There is no reason to expect vaccine harms will trump expected COVID‐19 vaccine benefits in RMD patients.

Evidence about the mRNA COVID‐19 vaccine suggests that the benefits outweigh the risks in RMD patients.

The risk of deferring vaccination and thus failing to mitigate COVID‐19 risk should be weighed against a possible blunted response to the vaccine if given under suboptimal circumstances. As a practical matter, this tension must be resolved in the context of imperfect prediction as to whether those circumstances may be transient as well as a paucity of scientific evidence.

Both individual and societal considerations should be considered in issuing vaccine guidance and making policy decisions. Given that context, simplicity should be the touchstone: to avoid confusion, improve implementation, and maintain scientific credibility.

Any vaccination strategy is a reasonable starting point, and decisions about implementation details reflect tradeoffs in the allocation of scarce vaccine resources.

^*ACR = American College of Rheumatology; RMD = rheumatic and musculoskeletal disease.