Longitudinal assessment of COVID-19 vaccine acceptance and uptake among frontline medical workers in Los Angeles, California

Nurses' COVID-19-related fear and anxiety and their attitudes to the COVID-19 vaccine: A descriptive and correlational study

BACKGROUND

The novel coronavirus disease 2019 has caused psychological distress such as anxiety and fear among nurses worldwide. Nurses are a creditable source of vaccine-related information and have a primary role in building confidence regarding vaccines.

AIM

The present study was designed to investigate the fear and anxiety of nurses regarding novel coronavirus disease 2019 (COVID-19) and their attitudes towards the COVID-19 vaccine. The predictors of fear, anxiety and attitudes towards the vaccine were also investigated.

METHODS

A descriptive and correlational design was used. The study was conducted in three public hospitals from different parts of the Turkey, and 405 nurses from the three hospitals were recruited by stratified sampling.

RESULTS

Anxiety and negative attitudes towards the vaccine were positively related to fear of COVID-19. Age and fear were also positively associated with anxiety related to COVID-19. Nurses who had received the vaccine and those who were fearful had a positive attitude towards the vaccine.

CONCLUSION

Psychosocial support programmes should be implemented to improve psychological resilience and coping strategies in nurses and organized education programmes are needed to increase positive attitudes towards vaccination.

Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children

IMPORTANCE

Healthcare personnel (HCP) are important messengers for promoting vaccines, for both adults and children. Our investigation describes perceptions of fully vaccinated HCP about COVID-19 vaccine for themselves and primary series for their children.

OBJECTIVE

To determine associations between sociodemographic, employment characteristics and perceptions of COVID-19 vaccines among HCP overall and the subset of HCP with children, who were all mandated to receive a COVID-19 vaccine, in a large US metropolitan region.

DESIGN

Cross-sectional survey of fully vaccinated HCP from a large integrated health system.

SETTING

Participants were electronically enrolled within a multi-site NYS healthcare system from December 21, 2021, to January 21, 2022.

PARTICIPANTS

Of 78,000 employees, approximately one-third accessed promotional emails; 6,537 employees started surveys and 4165 completed them. Immunocompromised HCP (self-reported) were excluded.

EXPOSURE(S) (FOR OBSERVATIONAL STUDIES)

We conducted a survey with measures including demographic variables, employment history, booster status, child vaccination status; vaccine recommendation, confidence, and knowledge.

MAIN OUTCOME(S) AND MEASURES

The primary outcome was COVID-19 vaccine hesitancy for all dose types - primary series or booster doses - among HCP.

RESULTS

Findings from 4,165 completed surveys indicated that almost 17.2 % of all HCP, including administrative and clinical staff, were hesitant or unsure about receiving a COVID-19 vaccine booster, despite the NYS recommendation to do so. Depending on age group, between 20 % and 40 % of HCP were hesitant about having their children vaccinated for COVID-19, regardless of clinical versus non-clinical duties. In multivariable regression analyses, lack of booster dose, unvaccinated children, females, income less than $50,000, and residence in Manhattan remained significantly associated with vaccine hesitancy.

CONCLUSIONS AND RELEVANCE

Despite mandated COVID-19 vaccination, a substantial proportion of HCP remained vaccine hesitant towards adult booster doses and pediatric COVID-19 vaccination. While provider recommendation has been the mainstay of combatting COVID-19 vaccine hesitancy, a gap exists between HCP-despite clinical or administrative status-and the ability to communicate the need for vaccination in a healthcare setting. While previous studies describe the HCP vaccine mandate as a positive force to overcome vaccine hesitancy, we have found that despite a mandate, there is still substantial COVID-19 vaccine hesitancy, misinformation, and reluctance to vaccinate children.

One-Year Follow-Up of Seroprevalence of SARS-CoV-2 Infection and Anxiety among Health Workers of a French Cancer Center: The PRO-SERO-COV Study

Infection of SARS-CoV-2 among health workers (HWs) in contact with cancer patients has been a major issue since the beginning of the pandemic. We aimed to assess the serological immune status of SARS-CoV-2 infection among these HWs. A prospective cohort study was initiated in the comprehensive cancer center of the Nouvelle-Aquitaine region (NA, France). Volunteer HWs working on March 2020 without active infection or symptoms of COVID-19 completed a self-questionnaire and had a blood test at inclusion, at 3 and 12 months. Positive serological status of SARS-CoV-2 infection was defined by anti-nucleocapsid antibodies and/or IgG anti-spike antibodies, except at 12 months due to vaccine. Half of the HWs were included (N = 517) and 89% were followed for three months (N = 500) and one year (N = 462). Seroprevalence of SARS-CoV-2 infection was 3.5% (95% CI: 1.9-5.1), 6.2% (95% CI: 4.1-8.3), and 10% (95% CI: 7.2-12.7) on June-September 2020, September 2020-January 2021, and June-October 2021, respectively. At 12 months, 93.3% had detectable antibodies with 80% vaccinated in the first three months of vaccine availability. The COVID-19-free policy of the institution, respect for barrier gestures, high and early vaccination of HWs, and low prevalence of SARS-CoV-2 in NA may explain the low rate of seropositivity among the HWs of the Institut Bergonié.

Marcotte A, M. Kaufman E, Moscovici Z, R. Adams O, Lovins S, R. Garcia J, N. Gesselman A. American Singles' Attitudes Toward Future Romantic/Sexual Partners' COVID-19 Vaccination Status: Evidence for both Vigilance and Indifference in a National Sample

Around 142 million American adults are currently single; at least half of these singles want to pursue a romantic partner. Romantic dating can involve exposure to numerous people. Thus, dating can significantly impact pathogen exposure risk. In a demographically-representative cross-sectional survey conducted in 2021 (N = 5,000), we examined U.S. American singles' COVID-19 vaccination status, assessed their preferences around a potential partner's COVID-19 vaccination status, and identified demographic subgroups of singles particularly opposed to or indifferent to a partner being vaccinated against COVID-19. Our results showed 65% of participants were fully vaccinated, 10% were partially vaccinated, and 26% were unvaccinated against COVID-19. With regards to partner preferences, half wanted a vaccinated partner; 18.9% wanted a vaccinated partner but would make exceptions; 6.1% wanted an unvaccinated partner; and 25% reported that they did not care about their dating partner's vaccination status. Partner preferences were largely aligned with participants' own vaccination status, such that vaccinated participants preferred vaccinated partners. However, those preferring unvaccinated partners-or those willing to make exceptions for a partner-were most likely to identify as men, younger in age, a political affiliation outside of the two-party political system, a gender or sexual minority, or as a racial minority (i.e., Black/African-American or South Asian). Additionally, participants who were employed (vs. unemployed) were more likely to make exceptions for or prefer an unvaccinated partner. These results suggest that singles prefer homophily in COVID-19 vaccine status, and that minoritized subgroups of singles are more likely to maintain a social network including unvaccinated close others.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12119-023-10097-9.

Current Evidence for Infection Prevention and Control Interventions in Emergency Medical Services: A Scoping Review

OBJECTIVES

The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians.

REPORT AND METHODS

PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics.

CONCLUSIONS

Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.

COVID-19 vaccine acceptance and associated factors among health workers in West Guji zone, Southern Ethiopia: Cross-sectional study

Background

Currently, different COVID-19 vaccines are being developed and distributed worldwide to increase the proportion of the vaccinated people and as a result to halt the pandemic. However, the vaccination progress is different from place to place even among health care workers due to variation in vaccine acceptance. Therefore, this study aimed to assess the acceptance of COVID-19 vaccine and determinant factors among healthcare workers in west Guji zone, southern Ethiopia.

Method and materials

An institutional-based cross-sectional study design was employed to assess COVID-19 vaccine acceptance and associated factors among health care workers from July to August 2021. A simple random sampling technique was used to choose 421 representative healthcare workers from three hospitals in the west Guji Zone. The self-administrated questionnaire was used to collect data. Bivariate and multivariable logistic regression analyses were computed to identify factors associated with the acceptance of the COVID-19 vaccine. P < 0.05 was considered for significantly associated factors.

Result

From the representative health workers, 57, 47.02, and 57.9% of healthcare workers had good practice of COVID-19 prevention, adequate knowledge, and a positive attitude toward the COVID-19 vaccine consecutively. 38.1% of healthcare workers said they had a willingness to accept the COVI-19 vaccine. Profession (AOR-6, CI: 2.92-8.22), previous history of vaccine side effects (AOR: 3.67, CI: 2.75-11.41), positive attitude toward vaccine acceptance (AOR: 1.38, CI: 1.18-3.29), adequate knowledge toward COVID-19 vaccine (AOR: 3.33, CI: 1.36-8.12), and adequate practice of COVID-19 prevention measure (AOR: 3.45, CI: 1.39-8.61) were significant associated with COVID-19 vaccine acceptance.

Conclusion

The proportion of COVID-19 vaccine acceptance among health workers was found to be low. From the study variables, profession, previous history of vaccine side effects, positive attitude toward vaccine acceptance, adequate knowledge to ward off COVID-19 vaccine, and adequate practice of COVID-19 prevention measures were significantly associated with COVID-19 vaccine acceptance.

From Heroes to Scoundrels: Exploring the effects of online campaigns celebrating frontline workers on COVID-19 outcomes

This paper examines the effects of online campaigns celebrating frontline workers on COVID-19 outcomes regarding new cases, deaths, and vaccinations, using the United Kingdom as a case study. We implement text and sentiment analysis on Twitter data and feed the result into random regression forests and cointegration analysis. Our combined machine learning and econometric approach shows very weak effects of both the volume and the sentiment of Twitter discussions on new cases, deaths, and vaccinations. On the other hand, established relationships (such as between stringency measures and cases/deaths and between vaccinations and deaths) are confirmed. On the contrary, we find adverse lagged effects from negative sentiment to vaccinations and from new cases to negative sentiment posts. As we assess the knowledge acquired from the COVID-19 crisis, our findings can be used by policy makers, particularly in public health, and prepare for the next pandemic.

Characterization of COVID-19 Vaccine Hesitancy Among Essential Workforce Members of a Large Safety Net Urban Medical Center

OBJECTIVES

Vaccine hesitancy among essential workers remains a significant public health challenge. We examined psychological constructs of perceived susceptibility, threat, and self-efficacy and their associations with COVID-19 vaccine hesitancy among a racially and ethnically diverse essential workforce population.

METHODS

We performed a cross-sectional survey of essential workers from September-December 2020 at a large Los Angeles safety-net medical center as part of a program offering free COVID-19 serology testing. Program participants completed a standardized survey at the time of phlebotomy. Hierarchical logistic regression was utilized to determine factors independently associated with vaccine hesitancy.

RESULTS

Among 1327 persons who had serology testing, 1235 (93%) completed the survey. Of these, 958 (78%) were healthcare workers. Based on expressed intent, 22% were vaccine-hesitant 78% were vaccine acceptors. In our multivariate model, vaccine hesitancy was associated with female gender [aOR = 2.09; 95% CI (1.44-3.05)], African American race [aOR = 4.32; (2.16-8.62)], LatinX ethnicity [aOR = 2.47; 95% CI (1.51-4.05)] and history of not/sometimes receiving influenza vaccination [aOR = 4.39; 95% CI (2.98-6.48)]. Compared to nurses, vaccine hesitancy was lower among physicians [aOR = 0.09; 95% CI (0.04-0.23)], non-nursing/non-physician healthcare workers [aOR = 0.55; 95% CI (0.33-0.92)], and non-healthcare care workers [aOR = 0.53; 95% CI (0.36-0.78)].

CONCLUSIONS

Among a racially/ethnically diverse group of safety net medical center essential workers, COVID-19 vaccine hesitancy was associated with racial/ethnic minority groups, employment type, and prior influenza vaccination hesitancy. Interestingly, we found no association with the Health Belief Model construct measures of perceived susceptibility, threat, and self-efficacy. Psychological constructs not assessed may be drivers of vaccine hesitancy in our population.

A Scoping Review of Three Dimensions for Long-Term COVID-19 Vaccination Models: Hybrid Immunity, Individual Drivers of Vaccinal Choice, and Human Errors

The virus that causes COVID-19 changes over time, occasionally leading to Variants of Interest (VOIs) and Variants of Concern (VOCs) that can behave differently with respect to detection kits, treatments, or vaccines. For instance, two vaccination doses were 61% effective against the BA.1 predominant variant, but only 24% effective when BA.2 became predominant. While doses still confer protection against severe disease outcomes, the BA.5 variant demonstrates the possibility that individuals who have received a few doses built for previous variants can still be infected with newer variants. As previous vaccines become less effective, new ones will be released to target specific variants and the whole process of vaccinating the population will restart. While previous models have detailed logistical aspects and disease progression, there are three additional key elements to model COVID-19 vaccination coverage in the long term. First, the willingness of the population to participate in regular vaccination campaigns is essential for long-term effective COVID-19 vaccination coverage. Previous research has shown that several categories of variables drive vaccination status: sociodemographic, health-related, psychological, and information-related constructs. However, the inclusion of these categories in future models raises questions about the identification of specific factors (e.g., which sociodemographic aspects?) and their operationalization (e.g., how to initialize agents with a plausible combination of factors?). While previous models separately accounted for natural- and vaccine-induced immunity, the reality is that a significant fraction of individuals will be both vaccinated and infected over the coming years. Modeling the decay in immunity with respect to new VOCs will thus need to account for hybrid immunity. Finally, models rarely assume that individuals make mistakes, even though this over-reliance on perfectly rational individuals can miss essential dynamics. Using the U.S. as a guiding example, our scoping review summarizes these aspects (vaccinal choice, immunity, and errors) through ten recommendations to support the modeling community in developing long-term COVID-19 vaccination models.

Factors associated with reversals of COVID-19 vaccination willingness: Results from two longitudinal, national surveys in Japan 2021-2022

BACKGROUND

Research characterizing changes of heart with respect to vaccine intention is scarce, and very little research considers those who were initially vaccine willing but became hesitant. Here, we sought to assess the factors related to reversals of vaccine willingness.

METHODS

We conducted a longitudinal, national survey on vaccination intention among Japanese adults aged 20 years or older, with the first questionnaire performed in February-March 2021 (N = 30,053) and the follow-up in February 2022 (N = 19,195, response rate 63.9%). The study population comprised those who reported vaccine willingness in the first survey, with the outcome variable being development of vaccine hesitancy at follow-up. We performed a regression analysis of vaccination status using sociodemographic, health-related, psychologic/attitudinal, and information-related variables as predictors. We used the sparse group minimax concave penalty (MCP) to select the optimum group of covariates for the logistic regression.

FINDINGS

Of 11,118 (57.9%) respondents who previously expressed interest in vaccination, 10,684 (96.1%) and 434 (3.9%) were in the vaccine willing and hesitant groups, respectively. Several covariates were found to significantly predict vaccine hesitancy, including marital status, influenza vaccine history, COVID-19 infection/testing history, engagement in COVID-19 preventive measures, perceived risks/benefits of the COVID-19 vaccine, and attitudes regarding vaccination policies and norms. The use of certain information sources was also associated with vaccine hesitancy.

INTERPRETATION

Sociodemographic, health-related, psychologic/attitudinal, and information-related variables predicted the development of vaccine hesitancy among those with prior willingness. Most of these predictors were also associated with vaccination status.

FUNDING

The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians' profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs' decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated.

Effects of COVID-19 on Older Adults: Physical, Mental, Emotional, Social, and Financial Problems Seen and Unseen

Older adults are vulnerable to coronavirus disease 2019 (COVID-19) and efforts have been made to protect them. However, one protective mechanism, isolation of older adults, has resulted in unintended physical, mental, emotional, social, and financial consequences. We conducted a comprehensive literature review to understand the effects of COVID-19 and the new COVID-19 vaccine on older adults and the factors affecting vaccine acceptance. A review of the literature was conducted to understand the unique challenges COVID-19 creates for older adults. It was found that older adults are significantly impacted by the COVID-19 pandemic and resulting isolation. Physical health can be improved by increasing contact with healthcare providers and opportunities for physical activity. Mental and emotional health can be improved by addressing fear and uncertainty about the pandemic. Social health interventions should be targeted at ensuring older adults have contact with loved ones both in person and in the virtual format. To ameliorate financial concerns, interventions should be targeted at assistance with food and medications.

Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake

Background

The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19–related events on sentiment and vaccine uptake.

Objective

This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine.

Methods

Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine–related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined.

Results

The majority of collected tweets expressed negative (n=91,052, 66%) rather than positive (n=21,686, 16%) or neutral (n=24,785, 18%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment.

Conclusions

The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning.

Decisions to Choose COVID-19 Vaccination by Health Care Workers in a Southern California Safety Net Medical Center Vary by Sociodemographic Factors

BACKGROUND

Limited information exists regarding COVID-19 vaccine hesitancy among healthcare workers (HCWs). Our previous survey analyzed the reasons for HCWs' decisions to accept vaccination, suggesting that a "one-size fits all" approach may not suffice to increase vaccine uptake.

METHODS

Based on the vaccination acceptance group (acceptor, hesitant, refuser), we examined differences by sociodemographic factors (race/ethnicity, household income, education) from Likert Scale responses to fourteen influences affecting a decision to be vaccinated using the Kruskal-Wallis test and multinomial logistic regression with mutual adjustment for these sociodemographic factors, age, and sex.

RESULTS

Non-Hispanic White vaccine acceptors ranked lower confidence in preventing, withstanding, or treating COVID-19, while Non-Hispanic Blacks more highly regarded the motivation of a religious leader, colleague, or family member. Social media was ranked more influential among Non-Hispanic Asians. Acceptors with lower incomes ranked a job requirement influential; conversely, higher income vaccine hesitant HCWs highly rated this reason. More highly educated acceptors ranked being motivated by colleagues, family, and other HCWs higher. Adjustment weakened some but not all the differences between groups.

CONCLUSIONS

Sociodemographic factors affect HCWs' decisions to be vaccinated against COVID-19. Our findings may help develop more focused and tailored strategies to improve vaccination acceptance.

Acceptance of Booster COVID-19 Vaccine and Its Association with Components of Vaccination Readiness in the General Population: A Cross-Sectional Survey for Starting Booster Dose in Japan

The Japanese government approved COVID-19 vaccine booster doses in November 2021. However, intentions and readiness for booster vaccines among the general population were unknown. This survey measured the intentions for COVID-19 booster vaccination. Among 6172 participants (53.2% female), 4832 (78.3%) accepted booster doses; 415 (6.7%) hesitated. Vaccination intention was associated with higher age, marital status, having children, underlying diseases, and social norms. To evaluate the readiness for vaccination, the seven component (7C) vaccination readiness scale was employed, comprising “Confidence”, “Complacency”, “Constraints”, “Calculation”, “Collective responsibility”, “Compliance”, and “Conspiracy”. Participants with acceptance showed significantly higher 7C scores (p < 0.001) than those who hesitated or were unsure. Multivariable logistic regression analysis revealed that the “social norms” predictor was the strongest predictor of acceptance (adjusted odds ratio (AOR) 4.02, 95% confidence interval (CI): 3.64−4.45). “Constraints” (AOR: 2.27, 95% CI: 2.11−2.45) and “complacency” (AOR: 2.18, 95% CI: 2.03−2.34) were also strongly associated with acceptance, but “compliance” (AOR: 1.24, 95% CI: 1.18−1.31) and “conspiracy” (AOR: 1.42, 95% CI: 1.33−1.52) were weakly associated. The “7C vaccination readiness scale” is useful for measuring vaccine acceptance in the Japanese population. However, “social norms” might be more suitable than “compliance” and “conspiracy” for measuring vaccine acceptance in Japan.

COVID-19 Vaccine Uptake among US Adults According to Standard Occupational Groups

This cross-sectional ecological study examined the relationship between neighborhood-level standard occupational groups in the USA and COVID-19 vaccine uptake using 774 census tract data, each consisting of approximately 1600 housing units. The neighborhood-level COVID-19 vaccination uptake data were retrieved from Harris County Public Health, Harris County, Texas. The standard occupational group data were from the US Census Bureau. We calculated the incidence rate ratios (IRRs) for vaccine uptake using bivariate and multivariable Poisson regression models. In the adjusted models, we found that the healthcare practitioner/technician (IRR: 1.008; 95% CI: 1.003−1.014; p = 0.001), business/management/legal (IRR: 1.011; 95% CI: 1.008−1.013; p < 0.001), computer/engineering/life/physical/social science (IRR: 1.018; 95% CI: 1.013−1.023; p < 0.001), and arts/design/entertainment/sports/media (IRR: 1.031; 95% CI: 1.018−1.044; p < 0.001) occupational groups were more likely to have received the full regimen of a COVID-19 vaccine. On the contrary, the building/installation/maintenance/repair (IRR: 0.991; 95% CI: 0.987−0.995; p < 0.001), construction/extraction/production (IRR: 0.991; 95% CI: 0.988−0.995; p < 0.001), transportation/material moving (IRR: 0.992; 95% CI: 0.987−0.997; p = 0.002), food preparation/serving related (IRR: 0.995; 95% CI: 0.990−0.999; p = 0.023), and personal care/services (IRR: 0.991; 95% CI: 0.985−0.998; p = 0.017) groups were less likely to have received the complete dose of a COVID-19 vaccine. White-collar workers were more likely to be vaccinated than blue-collar workers. We adjusted for age, sex, and race/ethnicity in the multivariable analysis. The low vaccine uptake among certain occupational groups remains a barrier to pandemic control. Engaging labor-centered stakeholders in the development of vaccination interventions may increase uptake.

Vaccine hesitancy in American healthcare workers during the COVID-19 vaccine roll out: an integrative review

OBJECTIVE

The purpose of this integrative review is to examine the literature on vaccine hesitancy among American healthcare workers during the COVID-19 vaccine rollout.

METHODS

A review of quantitative literature on acceptance, intention, refusal, or hesitation to accept the COVID-19 vaccine was conducted, searching in PubMed, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and Web of Science. Because of the immediacy of the topic, research letters were included in addition to articles. The 18 publications were appraised for quality using the Critical Appraisal Checklist for Cross-Sectional Studies by the Center for Evidence-Based Management.

RESULTS

Estimates of vaccine hesitancy among healthcare workers were similar to the general population. The literature indicates demographic characteristics associated with vaccine hesitancy, including being younger, female, Black, Hispanic, or Latinx. However, examination of the demographic data also points to gaps in the understanding and implications of those characteristics. The newness or perceived rush of vaccine development and implementation were the most cited sources for hesitancy.

CONCLUSION

The studies in this review give clear areas of need for translational research on dissemination and implementation relating to the correlational data, including in areas of comorbid, diasporic, and reproductive health concerns. However, with the gravity of the pandemic and quick arrival of the COVID-19 vaccine happening in the midst of an infodemic, adjunctive interventions could be warranted to combat hesitancy.

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.

COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers

INTRODUCTION

In a multi-center prospective cohort of essential workers, we assessed knowledge, attitudes, and practices (KAP) by vaccine intention, prior SARS-CoV-2 positivity, and occupation, and their impact on vaccine uptake over time.

METHODS

Initiated in July 2020, the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. Using two follow-up surveys approximately three months apart, COVID-19 vaccine KAP, intention, and receipt was collected; the first survey categorized participants as reluctant, reachable, or endorser.

RESULTS

A total of 4,803 participants were included in the analysis. Most (70%) were vaccine endorsers, 16% were reachable, and 14% were reluctant. By May 2021, 77% had received at least one vaccine dose. KAP responses strongly predicted vaccine uptake, particularly positive attitudes about safety (aOR = 5.46, 95% CI: 1.4-20.8) and effectiveness (aOR = 5.0, 95% CI: 1.3-19.1). Participants' with prior SARS-CoV-2 infection were 22% less likely to believe the COVID-19 vaccine was effective compared with uninfected participants (aOR 0.78, 95% CI: 0.64-0.96). This was even more pronounced in first responders compared with other occupations, with first responders 42% less likely to believe in COVID-19 vaccine effectiveness (aOR = 0.58, 95% CI 0.40-0.84). Between administrations of the two surveys, 25% of reluctant, 56% reachable, and 83% of endorser groups received the COVID-19 vaccine. The reachable group had large increases in positive responses for questions about vaccine safety (10% of vaccinated, 34% of unvaccinated), and vaccine effectiveness (12% of vaccinated, 27% of unvaccinated).

DISCUSSION

Our study demonstrates attitudes associated with COVID-19 vaccine uptake and a positive shift in attitudes over time. First responders, despite potential high exposure to SARS-CoV-2, and participants with a history of SARS-CoV-2 infection were more vaccine reluctant.

CONCLUSIONS

Perceptions of the COVID-19 vaccine can shift over time. Targeting messages about the vaccine's safety and effectiveness in reducing SARS-CoV-2 virus infection and illness severity may increase vaccine uptake for reluctant and reachable participants.

Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers

OBJECTIVES

To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination.

DESIGN

Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers.

SETTING

Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine.

PARTICIPANTS

1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff.

PRIMARY OUTCOME MEASURES

The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers.

RESULTS

Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients.

CONCLUSIONS

Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers' decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

COVID-19 Vaccinations in EMS Professionals: Prevalence and Predictors

Background:

Immunizations for emergency medical services (EMS) professionals during pandemics are an important tool to increase the safety of the workforce as well as their patients. The purpose of this study was to better understand EMS professionals’ decisions to receive or decline a COVID-19 vaccine.

Methods:

We conducted a cross-sectional analysis of nationally certified EMS professionals (18–85 years) in April 2021. Participants received an electronic survey asking whether they received a vaccine, why or why not, and their associated beliefs using three validated scales: perceived risk of COVID-19, medical mistrust, and confidence in the COVID-19 vaccine. Data were merged with National Registry dataset demographics. Analyses included descriptive analysis and multivariable logistic regression (OR, 95% CI). Multivariate imputation by chained equations was used for missingness.

Results:

A total of 2,584 respondents satisfied inclusion criteria (response rate = 14%). Overall, 70% of EMS professionals were vaccinated. Common reasons for vaccination among vaccinated respondents were to protect oneself (76%) and others (73%). Common reasons for non-vaccination among non-vaccinated respondents included concerns about vaccine safety (53%) and beliefs that vaccination was not necessary (39%). Most who had not received the vaccine did not plan to get it in the future (84%). Hesitation was most frequently related to wanting to see how the vaccine was working for others (55%). Odds of COVID-19 vaccination were associated with demographics including age (referent <28 years; 39–50 years: 1.56, 1.17–2.08; >51 years: 2.22, 1.64–3.01), male sex (1.26, 1.01–1.58), residing in an urban/suburban area (referent rural; 1.36, 1.08–1.70), advanced education (referent GED/high school and below; bachelor’s and above: 1.72, 1.19–2.47), and working at a hospital (referent fire-based agency; 1.53, 1.04–2.24). Additionally, vaccination odds were significantly higher with greater perceived risk of COVID-19 (2.05, 1.68–2.50), and higher vaccine confidence (2.84, 2.40–3.36). Odds of vaccination were significantly lower with higher medical mistrust (0.54, 0.46–0.63).

Conclusion:

Despite vaccine availability, not all EMS professionals had been vaccinated. The decision to receive a COVID-19 vaccine was associated with demographics, beliefs regarding COVID-19 and the vaccine, and medical mistrust. Efforts to increase COVID-19 vaccination rates should emphasize the safety and efficacy of vaccines.

Correlates of COVID-19 Vaccine Acceptance, Hesitancy and Refusal among Employees of a Safety Net California County Health System with an Early and Aggressive Vaccination Program: Results from a Cross-Sectional Survey

Since health professionals provide frontline care to COVID-19 patients, information on vaccine acceptance among healthcare workers is needed. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbach’s alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy, and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. The appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates amongst healthcare workers.