COVID-19 Vaccine Hesitancy among Healthcare Workers

By October 2021, 244 million known COVID-19 infections were recorded worldwide, with 45 million cases in the United States (U.S.) and resulting in over 736,000 deaths.¹ Unprecedented global research efforts produced effective COVID-19 vaccines in record time, with the first doses becoming available in December 2020.² Healthcare workers (HCWs) were the first group in the U.S. to be offered COVID-19 vaccinations. However, several months into the vaccination effort, many remain hesitant and unvaccinated despite increasingly stringent vaccination policies.

Vaccine hesitancy, the leading threat to global health,³ is the refusal of vaccination despite availability and accessibility. HCW vaccine hesitancy can be rooted in many factors including fears about safety and efficacy,⁴ preference for physiological herd immunity (i.e., natural inoculation),⁵ distrust in government,⁶ maintaining a sense of personal freedom,⁷ sociodemographic characteristics, and broader external or organizational factors.⁸

A recent scoping review of 35 studies published after vaccine authorizations found a hesitancy rate of 22.5% among 76,471 HCWs.⁹ Hesitancy rates among HCWs are occupation and context dependent. For instance, 96% of the practicing physicians in that study had been fully vaccinated.¹⁰ In contrast, only about a third (37.5%) of HCWs in skilled nursing facilities had been vaccinated.¹¹

HCWs are a critical partner in moving vaccine-hesitant populations toward vaccination. HCWs are more trusted and viewed more positively than elected officials or government agencies.¹² Therefore, addressing COVID-19 vaccine hesitancy among HCWs is a complex but important task in reaching herd immunity.

In our recent study published in the Vaccines journal, we evaluated the status of and attitudes toward COVID-19 vaccination of HCWs at Loma Linda University Health and Eisenhower Medical Center.¹³ Responses were collected via an anonymous online survey from a total of 2,491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2,103 (84%) were vaccinated. The bulk of the participants were middle-aged, college-educated White (73%) non-Hispanic women (75%), with nursing as the most represented medical occupation (35%).

We found four distinct clusters among 304 vaccine-hesitant HCWs, suggesting that the dichotomous 'anti-vaccine vs. pro-vaccine’ separation of HCWs may not be adequate in informing interventions.

Respondents grouped in cluster 1 ‘misinformed’ (38 participants) were slightly older and leaned Republican. They strongly opposed the COVID-19 vaccine, refusing to receive and/or recommend the COVID-19 vaccine. This group underestimated both the COVID-19 vaccine efficacy and COVID-19 mortality. Members of this cluster were more likely to believe several COVID-19 conspiracies (e.g., COVID-19 is a hoax). They were more likely to be subjects of disinformation from politically leaning news media.

Respondents in cluster 2 ‘uninformed’ (94 participants) tended to be the sub-group of HCWs with the greatest need for accurate and easy-to-understand vaccine information. This cluster was the second least willing to receive the COVID-19 vaccine. This group underestimated the impact of the pandemic and the efficacy of the vaccine. They tended to be less educated (60% lacking undergraduate degree), were more likely Hispanic/Latinx (47%), and worked in outpatient areas (33%) as allied health providers (60%).

Cluster 3 ‘undecided’ (86 participants) members were more open to receiving the COVID-19 vaccine, with half of the respondents unsure about vaccine receipt. Members of this cluster were predominantly White nurses and respiratory therapists working in an ICU. They understood the personal risk of exposure to the virus and knew the severity of COVID-19 disease, correctly assuming it is deadlier than seasonal flu. Participants in this cluster strongly leaned Republican.

Cluster 4 ‘unconcerned’ (86 participants) members were younger and racially diverse. This cluster is the most educated and leaned Democrat. Members of this cluster had an accurate knowledge of the vaccine efficacy and the lowest support of COVID-19 conspiracies. While hesitating to receive the vaccine themselves, respondents in this cluster were willing to recommend it to others.

Our study found diversity in vaccine hesitancy among HCWs and highlights the need for unique and targeted interventions depending on degrees, types, and causes of hesitancy. Consequently, messaging should be tailored to specific subgroups to increase the understanding of the science behind vaccines. Interventions should elicit HCWs’ concerns with empathy, and policymaking should be inclusive of vaccine-hesitant subgroups.

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References:

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