Healthcare Personnel (HCP) Attitudes About Coronavirus Disease 2019 (COVID-19) Vaccination After Emergency Use Authorization

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.

COVID-19 Booster Vaccination Adverse Effects and Willingness to Receive a Yearly Booster Dose among Members of Health Sciences Faculties: A Descriptive Cross-Sectional Study

Background

New severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and waning vaccine efficacy led to the administration of booster doses. Healthcare workers (HCWs) are vulnerable to contract the infection, and vaccination hesitancy in this group may have an impact on vaccine uptake among the general public.

Aims

This study aimed to (1) assess the prevalence of self-reported adverse effects (AEs) after the first booster dose vaccine, (2) evaluate the AEs between the homologous and heterologous booster vaccines, and (3) evaluate the willingness to receive a hypothetical yearly booster dose.

Materials and Methods

An online, cross-sectional, self-administered, structured questionnaire was distributed to members of the health sciences faculties (HSFs), XXXX University, Malaysia. Convenience sampling was adopted, and descriptive statistics was used to interpret the results.

Results

About 67.1% of participants experienced systemic or local AEs. The common AEs were pain at the site of injection (60.2%), fatigue (45.7%), headache (31.6%), and fever (24.7%). About 64% of our participants believed that the booster dose provided extra immunity against the coronavirus disease 2019 (COVID-19) infection and 57.7% of participants expressed concern over the "mix-match" of vaccination. About 78% of the participants were keen to receive the hypothetical yearly booster dose. The severity of AEs between the booster dose and the primary dose was statistically insignificant (P < 0.159).

Conclusion

Booster vaccination AEs were similar to the primary dose. However, a higher severity of AEs occurring in heterologous vaccine receivers was noted in our study.

A Scoping Review on Gender/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States

OBJECTIVE

To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic.

DATA SOURCE

Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake.

DATA EXTRACTION

Three authors screened studies and extracted data.

DATA SYNTHESIS

Univariate and multivariate results are summarized.

RESULTS

A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men's greater intentions to vaccinate compared to women, and men's greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses.

CONCLUSION

Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.

Occupational Health Providers' Perceptions of Employee Vaccine Hesitancy

OBJECTIVE

This study examined the perspectives of occupational health providers (OHPs) on the most frequently encountered clinically relevant reasons for employee vaccine hesitancy.

METHODS

We conducted an anonymous, online, cross-sectional survey of US OHPs ( N = 217). The survey asked OHPs about the major reasons that employees cite for being unwilling to receive the following three categories of vaccines: COVID-19, annual influenza, and others relevant to the workplace.

RESULTS

Concern about adverse effects was the most frequently reported reason for employee vaccine hesitancy for each vaccine category. Mistrust was reported more frequently for COVID-19 than for the influenza vaccine or other vaccines (χ 2P < 0.05). Targets of employee mistrust included government and researchers or scientists, but mistrust of healthcare providers was uncommon.

CONCLUSIONS

These results can be used to inform interventions to address vaccine hesitancy in the occupational health setting.

Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries

Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.

COVID-19 Vaccine Uptake and Factors Affecting Hesitancy Among US Nurses, March-June 2021

Objectives. To characterize COVID-19 vaccine uptake and hesitancy among US nurses. Methods. We surveyed nurses in 3 national cohorts during spring 2021. Participants who indicated that they did not plan to receive or were unsure whether they planned to receive the vaccine were considered vaccine hesitant. Results. Among 32 426 female current and former nurses, 93% had been or planned to be vaccinated. After adjustment for age, race/ethnicity, and occupational variables, vaccine hesitancy was associated with lower education, living in the South, and working in a group care or home health setting. Those who experienced COVID-19 deaths and those reporting personal or household vulnerability to COVID-19 were less likely to be hesitant. Having contracted COVID-19 doubled the risk of vaccine hesitancy (95% confidence interval [CI] = 1.85, 2.53). Reasons for hesitancy that were common among nurses who did not plan to receive the vaccine were religion/ethics, belief that the vaccine was ineffective, and lack of concern about COVID-19; those who were unsure often cited concerns regarding side effects or medical reasons or reported that they had had COVID-19. Conclusions. Vaccine hesitancy was unusual and stemmed from specific concerns. Public Health Implications. Targeted messaging and outreach might reduce vaccine hesitancy. (Am J Public Health. 2022;112(11):1620-1629. https://doi.org/10.2105/AJPH.2022.307050).

Coronavirus disease 2019 (COVID-19) vaccine hesitancy among physicians, physician assistants, nurse practitioners, and nurses in two academic hospitals in Philadelphia

OBJECTIVE

To evaluate coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel (HCP) with significant clinical exposure to COVID-19 at 2 large, academic hospitals in Philadelphia, Pennsylvania.

DESIGN, SETTING, AND PARTICIPANTS

HCP were surveyed in November-December 2020 about their intention to receive the COVID-19 vaccine.

METHODS

The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (medical doctor, nurse practitioner or physician assistant, and registered nurse) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines.

RESULTS

Among 5,929 HCP (2,253 medical doctors [MDs] and doctors of osteopathy [DOs], 582 nurse practitioners [NPs], 158 physician assistants [PAs], and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs and NPs and 13.1% of MDs and DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (odds ratio [OR], ∼5) and females were more hesitant than males (OR, ∼2).

CONCLUSIONS

Although most clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race or ethnicity across all positions. These results highlight the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.

'Why Should I Take the COVID-19 Vaccine after Recovering from the Disease?' A Mixed-methods Study of Correlates of COVID-19 Vaccine Acceptability among Health Workers in Northern Nigeria

We assessed the acceptability of COVID-19 vaccine, predictors, and reasons for vaccine hesitancy among clinical and non-clinical staff at a tertiary hospital in Kano, northern Nigeria.Using a mixed-methods design, structured questionnaires were administered to 284 hospital staff, followed by 20 in-depth interviews with a purposive sub-sample. Logistic regression and the framework approach were used to analyze the data.Only 24.3% (n = 69) of the respondents were willing to accept the COVID-19 vaccine. Acceptance was lower among females (Adjusted Odds Ratio (aOR) = 0.37, 95% Confidence Interval (95%CI): 0.18-0.77 (male vs. female), nurses/midwives (aOR = 0.41, 95%CI:0.13-0.60, physicians vs. nurses/midwives), persons not tested for COVID-19 (aOR = 0.32, 95%CI 0.13-0.79) (no vs. yes) and those who perceived themselves to be at low risk of COVID-19 (aOR = 0.47, 95%CI,0.21-0.89, low vs. high). In contrast, vaccine acceptance was higher among more experienced workers (aOR = 2.28, 95%CI:1.16-8.55, ≥10 vs. <5 years). Vaccine acceptance was also higher among persons who did not worry about vaccine efficacy (aOR = 2.35, 95%CI:1.18-6.54, no vs. yes), or about vaccine safety (aOR = 1.76, 95%CI: 1.16-5.09, no vs. yes), side effects (aOR = 1.85, 95%CI:1.17-5.04, no vs. yes), or rumors (aOR = 2.55, 95%CI:1.25-5.20, no vs. yes). The top four reasons for vaccine hesitancy included distrust, inadequate information, fear of long-term effects, and infertility-related rumors.Concerted efforts are required to build COVID-19 vaccine confidence among health workers in Kano, Nigeria.Our findings can help guide implementation of COVID-19 vaccination in similar settings.

Predictors of COVID-19 Vaccine Uptake in Healthcare Workers: A Cross-Sectional Study in Greece

OBJECTIVE

We assessed the uptake of a COVID-19 vaccine and associated factors in a sample of healthcare workers (HCWs).

METHODS

An on-line cross-sectional study with 885 HCWs was conducted in Greece during August 2021. We measured socio-demographic data of HCWs and attitudes towards vaccination and the COVID-19 pandemic. A convenience sample was used since the questionnaire was distributed through social media and emails.

RESULTS

The majority of HCWs were vaccinated against the COVID-19 (91.5%). Females and HCWs with a history of seasonal influenza vaccination had a greater probability to get a COVID-19 vaccine. Also, increased self-perceived knowledge regarding the COVID-19 pandemic and increased trust in COVID-19 vaccines were associated with COVID-19 vaccine uptake.

CONCLUSIONS

Policymakers and scientists should develop novel strategies to improve COVID-19 vaccine uptake among HCWs.

Coronavirus disease 2019 (COVID-19) vaccination uptake among healthcare workers

Objective:

To assess reasons for noncompliance with COVID-19 vaccination among healthcare workers (HCWs).

Design:

Cohort observational and surveillance study.

Setting:

Sheba Medical Center, a 1,600-bed tertiary-care medical center in Israel.

Participants:

The study included 10,888 HCWs including all employees, students, and volunteers.

Intervention:

The BNT162b2 mRNA COVID-19 vaccine was offered to all HCWs of the hospital. Noncompliance was assessed, and pre-rollout and post-rollout surveys were conducted. Data regarding uptake of the vaccine as well as demographic data and compliance with prior influenza vaccination were collected, and 2 surveys were distributed. The survey before the rollout pertained to the intention to receive the vaccine, and the survey after the rollout pertained to all unvaccinated HCWs regarding causes of hesitancy.

Results:

In the pre-rollout survey, 1,673 (47%) of 3,563 HCWs declared their intent to receive the vaccine. Overall, 8,108 (79%) HCWs received the COVID-19 vaccine within 40 days of rollout. In a multivariate logistic regression model, the factors that were significant predictors of vaccine uptake were male sex, age 40–59 years, occupation (paramedical professionals and doctors), high socioeconomic level, and compliance with flu vaccine. Among 425 unvaccinated HCWs who answered the second survey, the most common cause for hesitancy was the risk during pregnancy (31%).

Conclusions:

Although vaccine uptake among HCWs was higher than expected, relatively low uptake was observed among young women and those from lower socioeconomic levels and educational backgrounds. Concerns regarding vaccine safety during pregnancy were common and more data about vaccine safety, especially during pregnancy, might improve compliance.

Hesitancy toward COVID-19 vaccines among medical students in Southwest China: a cross-sectional study

Vaccine hesitancy is an obstacle to COVID-19 vaccination. This study aims to inform the vaccine hesitancy and analyze related factors toward COVID-19 vaccination among medical students in China, so as to provide suggestions for increasing vaccines uptake. An online cross-sectional survey was conducted among medical students in a medical university and a health school. A total of 2,196 valid questionnaires were received. 41.2% vaccine hesitancy was reported among medical students in total. Female (OR = 1.336) and individuals with higher education (OR = 1.724) reported slightly higher vaccine hesitancy. Being in low-risk areas and no need to get vaccinated (OR = 2.285), fear of serious consequences of vaccination (OR = 1.929), being in good health and no need to be vaccinated (OR = 1.891), being concerned about short-term side effects (OR = 1.793) and being concerned that the vaccine was ineffective (OR = 1.694) had higher prevalence of vaccine hesitancy. Those who were believing the specialty of study or work environment made vaccination necessary (OR = 0.378), believing they were susceptible to COVID-19 (OR = 0.411) and the vaccine was free (OR = 0.519) were more willing to get vaccinated. Confidence in vaccines and perceptions of benefits and risk are associated with vaccine hesitancy. It is important to strengthen vaccine health literacy education for medical students and enhance vaccine confidence. Countries need to supervise the public opinions in social media, television broadcasting and other media, so as to ensure the correct orientation of public opinion. Open and transparent evidence-based information is also needed which can help improve the vaccination coverage rate of the public.