key: cord-1020570-7o55ld3e
authors: Ali, Zahid; Sarwar, Musharraf; Ansar, Sheraz; Awan, Usman Ayub; Ahmed, Haroon; Aftab, Nauman; Afzal, Muhammad Sohail
title: COVID‐19 vaccination hesitancy in patients with autoimmune diseases: A mystery that needs an immediate solution!
date: 2021-04-23
journal: J Med Virol
DOI: 10.1002/jmv.27014
sha: 4e8b56432ad441b34e4746635258de5f74bde266
doc_id: 1020570
cord_uid: 7o55ld3e

The broader spectrum of interactions between autoimmune disorders and SARS-CoV-2 is uncertain; additionally, the mechanism underlying this relationship is still poorly understood. According to the EULAR COVID-19 database, approximately 3590 patients with rheumatic diseases were infected with SARS-CoV-2 until December 1st, 2020, escalating rapidly. The onset of multiple co-morbidities and persistent immuno-suppressive treatments is exceptional in these patients. In the last few decades, biological and modern synthetic drugs have boosted the therapeutic approach and dramatically enhance disease outcomes. However, the response to certain immunosuppression vaccines, which may result in immunogenicity and B cell depletion therapies, has become unpredictable. A recent survey was conducted about vaccine hesitancy on 2887 patients who had different autoimmune disorders, as shown in Fig. 2. Curiously, people with inflammatory rheumatoid arthritis were 54.2 percent eager to get vaccinated, although 13.6 percent were reluctant to get vaccinated against SARS-CoV-2. In autoimmune disease patients, the major reasons for vaccine reluctance are fears regarding adverse effects and the worsening of the underlying autoimmune disease, as reported by other studies. To reduce the catastrophic effect of COVID-19 in autoimmune patients, their treatment and management should be prioritized, and SARS-CoV-2 vaccination is considered one of the most effective solutions. Conversely, their safety and effectiveness should first be analyzed, and large-scale studies are carried out considering emerging data. Furthermore, physicians should also strongly advise their patients underlying any autoimmune disorder to endure SARS-CoV-2 vaccines, as this can substantially help to minimize associated morbidity and death in COVID-19. This article is protected by copyright. All rights reserved.

Dreadfully, most robust healthcare systems are finding it hard to cope with the pandemic of COVID-19. [4] [5] [6] [7] The only way to reduce the socioeconomic burden of COVID-19 and the strain on healthcare systems is to achieve herd immunity against SARS-CoV-2. 1 Vaccine, one of the most promising public health measures, seems to offer a ray of expectation of ending the pandemic through herd immunity.

To achieve herd immunity, it was projected that about 60%-100% of the worldwide population should be vaccinated, depending on the efficacy of the vaccines used. 8 In autoimmune disorders, the body's immune system is already hyperactive, and damages own body cells comprising more than eighty inflammatory disorders, as shown in Figure 1 The broader spectrum of interactions between autoimmune disorders and SARS-CoV-2 is uncertain; in addition, the mechanism underlying this relationship is still poorly understood. According to the EULAR COVID-19 database, approximately 3590 patients with rheumatic diseases were infected with SARS-CoV-2 until December 1, 2020, escalating rapidly. 14 The onset of multiple comorbidities and persistent immunosuppressive treatments is exceptional in these patients. 15 In the last few decades, biological and modern synthetic drugs have boosted the F I G U R E 1 Geographical distribution of autoimmune diseases worldwide 9 therapeutic approach and dramatically enhance disease outcomes.

However, the response to certain immunosuppression vaccines, which may result in immunogenicity and B-cell depletion therapies, has become unpredictable. 16 A recent survey was conducted about vaccine hesitancy on 2887 patients who had different autoimmune disorders, as shown in Figure 2 . Muhammad Sohail Afzal 7

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