Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic

Amy Fuller; Jennie Hancox; Kavita Vedhara; Tim Card; Christian Mallen; Jonathan S. Nguyen Van-Tam; Abhishek Abhishek

doi:10.1371/journal.pone.0267769

Peer Review History

Original SubmissionApril 13, 2022
16 Jun 2022 Decision Letter - Latika Gupta, Editor PONE-D-22-10935Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: a qualitative interview study during the COVID-19 pandemicPLOS ONE Dear Dr. Fuller, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 31 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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CM declares grants awarded from MRC, AHRC BMS and Versus Arthritis, and is Director of the NIHR SPCR. AA declares grants from AstraZeneca and Oxford Immunotec, personal payments from UpToDate, Springer, Menarini and Cadilla pharmaceuticals, consulting fees from Inflazome and NGM Biopharmaceuticals, meeting attendance/travel payments from Pfizer, and is co-chair for the OMERACT CPPD classification criteria and ACR/EULAR CPPD classification criteria working groups. JSN-V-T was seconded to the Department of Health and Social Care, England (DHSC) until 31st March 2022. The views expressed in this manuscript are those of its authors and not necessarily those of DHSC or the Joint Committee on Vaccination and Immunisation (JCVI)." 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: There manuscript is well written and timely. Minor edits may be considered. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors conducted a qualitative study to explore barriers and facilitators to vaccination against COVID-19 among immunosuppressed adults with IMIDs in UK. It found that determinants of engagement with vaccination are similar between people with different IMIDs with barriers and facilitators spanning contextual, individual/group and vaccine/vaccination specific influences. The authors could redesign the data visualization of the facilitator/barrier tables to make them more impactful. Reviewer #2: The manuscript is well written and well-timed as even in the midst of the pandemic vaccine refusals have been rampant and unfortunately so even in the immunocompromised group. Multiple quantitative studies have been published on the topic of vaccine hesitancy but qualitative studies are rarer, especially in the patient population with inflammatory immune-mediated diseases. Gives more insight in the thought process of the actual patients. It is interesting that patients actually prefer using patient resource centers and dedicated websites for vaccine information over social media websites. At the same time advertisements at GP offices actually encouraged vaccination uptake. So it’s the different type of media that is viewed differently by patients when it comes to making informed health decisions. This study brings out a fact that patients with chronic disease tend to rely on their specialists even for basic primary care like vaccination and there appears to be an underlying bias that specialists’ opinion about vaccination is more trustworthy. While in clinical practice primary care physicians can play an important role in increasing vaccine awareness and receptiveness. Yearly checklists of things to be done for health maintenance are one of the major work areas of primary care. It is interesting to note that there is a difference from the Canadian study where there was mistrust about pharmaceutical companies which was not seen in this UK-based study. It opens an arena about are their differences in vaccine uptake and vaccine hesitancy. Discussing the above points in a little more detail might improve the manuscript even more. Overall, a well written and thought about paper ****** 6. 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Revision 1
27 Jul 2022 Author Response Reviewer 1 Comment: The authors could redesign the data visualization of the facilitator/barrier tables to make them more impactful. Action: We agree that an impactful visual of the data would benefit this manuscript. We feel that it is important to retain Table 1 as it shows how the data maps to sub-categories of the SAGE matrix by vaccine-type, so have kept this within the manuscript. We have created a diagrammatic summary (Fig 1) of the barriers and facilitators, providing the reader with a quick and impactful overview of the data. The figure caption can be found on page 10, lines 151 – 152. We made a few minor amendments in Table 1 to make the data included within it clearer. Reviewer 2 Reviewer 2 noted that discussing the following points in a little more detail might improve the manuscript even more. Comment: Multiple quantitative studies have been published on the topic of vaccine hesitancy but qualitative studies are rarer, especially in the patient population with inflammatory immune-mediated diseases. Gives more insight in the thought process of the actual patients. Action: Thank you, we agree and have added comment to this point on page 20, lines 305 – 307 and lines 315 – 323. Comment: It is interesting that patients actually prefer using patient resource centers and dedicated websites for vaccine information over social media websites. At the same time advertisements at GP offices actually encouraged vaccination uptake. So it’s the different type of media that is viewed differently by patients when it comes to making informed health decisions. Action: This is a great point, especially when social media has been found to be a source of information and misinformation among vaccine-hesitant individuals in the general population. We have added discussion to this point on page 22, lines 363 – 370. Comment: This study brings out a fact that patients with chronic disease tend to rely on their specialists even for basic primary care like vaccination and there appears to be an underlying bias that specialists’ opinion about vaccination is more trustworthy. While in clinical practice primary care physicians can play an important role in increasing vaccine awareness and receptiveness. Yearly checklists of things to be done for health maintenance are one of the major work areas of primary care. Action: Thank you for raising this. We have added discussion relating to this on page 21, lines 339 – 351. Comment: It is interesting to note that there is a difference from the Canadian study where there was mistrust about pharmaceutical companies which was not seen in this UK-based study. It opens an arena about are their differences in vaccine uptake and vaccine hesitancy. Action: We have added further discussion to this point on page 23, lines 383 – 388. Editorial requests from PLOS ONE In addition, we have addressed the following requests from the journal. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Action: The manuscript and supporting information documents have been edited to meet the PLOS ONE style requirements. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). Action: Participants provided their consent using an online consent forms via Microsoft Teams. We have added this detail into the ‘Ethical approval’ statement in the Methods (page 6, lines 87 – 88) and online submission information. 3. Thank you for stating the following in the Competing Interests section. Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. Action: We have added the required statement to our Competing Interests statement which is written in full below: “I have read the journal's policy and the authors of this manuscript have the following competing interests: AF, JH, KV, TC and JSN-V-T declare no competing interests. CM declares grants awarded from MRC, AHRC BMS and Versus Arthritis, and is Director of the NIHR SPCR. AA declares grants from AstraZeneca and Oxford Immunotec, personal payments from UpToDate, Springer, Menarini and Cadilla pharmaceuticals, consulting fees from Inflazome and NGM Biopharmaceuticals, meeting attendance/travel payments from Pfizer, and is co-chair for the OMERACT CPPD classification criteria and ACR/EULAR CPPD classification criteria working groups. JSN-V-T was seconded to the Department of Health and Social Care, England (DHSC) until 31st March 2022. The views expressed in this manuscript are those of its authors and not necessarily those of DHSC or the Joint Committee on Vaccination and Immunisation (JCVI). This does not alter our adherence to PLOS ONE policies on sharing data and materials.” 4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. We will update your Data Availability statement to reflect the information you provide in your cover letter. Action: We apologise that our previous Data Availability statement did not set out where the minimal dataset can be found. As per the guidance on your website for qualitative data https://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions, transcript excerpts relevant to the study are included within the paper. The interview guide has been included as a supplementary file. Additional qualitative data and audio recordings are archived in the University of Nottingham servers using password protection. For requests to access this additional data the Chief Investigator can be contacted abhishek.abhishek@nottingham.ac.uk. 5. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. Action: The ORCID ID for the corresponding author has now been added and validated in Editorial Manager. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Action: Captions for the Supporting Information files have now been provided at the end of the manuscript with in-text citations to match. 7. Please review your reference list to ensure that it is complete and correct. Action: We can confirm the reference list is complete and correct, and we have ensured it meets the PLOS ONE reference formatting requirements. Attachments Attachment Submitted filename: Approval of data availability statement.docx https://doi.org/10.1371/journal.pone.0267769.r002
12 Aug 2022 Decision Letter - Latika Gupta, Editor Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: a qualitative interview study during the COVID-19 pandemic PONE-D-22-10935R1 Dear Dr. Fuller We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. 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Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The aim of this study is to explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases. The method used a qualitative analysis of a semi-structured interview between November 2021 and January 2022. The authors have responded fully to the reviewers' comments. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** https://doi.org/10.1371/journal.pone.0267769.r003
Formally Accepted
30 Aug 2022 Acceptance Letter - Latika Gupta, Editor PONE-D-22-10935R1 Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: a qualitative interview study during the COVID-19 pandemic Dear Dr. Fuller: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Latika Gupta Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0267769.r004

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