LAUSR

We appreciate the comments by Smerilli et al in response to our letter about the willingness to vaccination among patients with rheumatic and musculoskeletal diseases (RMDs). By the time we had performed our survey, only the Pfizer– BioNTech vaccine was available for the administration to healthcare personnel, therefore we could not assess whether, among the reasons for refusal, the kind of vaccine might have affected willingness to vaccinate. After some months, once other vaccines became available, Smerilli et al, confirming a rate of acceptance to COVID-19 vaccination similar to ours, had the opportunity to observe that the decision of accepting or declining vaccination is heavily influenced by the type of vaccine. We can now corroborate Smerilli’s results. In fact, during the last few weeks, our tertiary referral centre has organised the vaccination campaign by starting to contact our extremely vulnerable patients by telephone call (according to the definition of our Minister of Health those subjects with autoimmune diseases and an immunodeficiency secondary to treatments or with severe lung involvement) (https://www. salutelazio. it/ documents/ 10182/ 59078875/ allegato+ 1_ COV19_ 12032021. pdf/ 5a4f445b31d864262dd5ffe53ea6c8f3 (accessed 25 April 2021)) to make an appointment for vaccination with the Pfizer– BioNTech product. Only 54 (5.2%) out of the 1027 subjects contacted so far have declined, which is a lower percentage than that previously reported in January when vaccination was only a still far possibility and not a real opportunity, in line with those observed in the USA by Nguyen et al. Other kinds of vaccines were not available for such prioritised category of patients, so we could not check if proposing Vaxzevria or others would have increased refusals. Across all countries, vaccines and population groups, the leading cause of concerns for vaccinations is vaccine safety, in the peculiar case of COVID-19 it appears that safety concerns linked to the type of vaccine, more than to vaccination itself, outweigh the perceived disease risks. This type of concern is probably unprecedented in the history of vaccination campaigns and is possibly linked to an overabundance of information concerning this topic, some of which are potentially harmful because untrue. Vaccine acceptance is a complex decisionmaking process influenced by a wide spectrum of factors among which communication and media environments play an important role. We, as physicians, have the responsibility and the duty to increase our patients’ willingness to vaccinate on the ground of solid scientific evidence about risk and benefits, trying to fight this unique and overwhelming COVID-19 infodemic. In this context, we are planning calls between specialists and their patients with RMDs who had refused vaccination to verify if a personal contact might increase awareness and willingness to vaccinate.