Hesitancy and Refusal of the COVID-19 Vaccine Among Healthcare Professionals: A Cross-Sectional Study in a Portuguese Hospital
DOI:
https://doi.org/10.20344/amp.22540Keywords:
Attitude of Health Personnel, COVID-19 Vaccines, Vaccination Hesitancy, Vaccination RefusalAbstract
Introduction: Vaccine hesitancy is recognized by the World Health Organization as a major global health threat. In the context of the COVID-19 pandemic, this issue has taken on unique dimensions. Healthcare professionals are considered one of the most reliable sources of information regarding vaccination. Their stance on immunization is a determining factor in their likelihood to recommend it to others, with potential repercussions for vaccination uptake rates in the general population. This study aimed to characterize the sociodemographic profile of healthcare professionals at a Portuguese tertiary hospital who declined COVID-19 vaccination and to analyze the reasons for hesitancy/refusal and future vaccination intentions.
Methods: A cross-sectional study was conducted in 2021, targeting healthcare professionals eligible for the completion of the primary COVID-19 vaccination schedule. Those who refused vaccination were asked to complete the “COVID-19 Non-Vaccination Questionnaire”, which included a multiplechoice question and an open response field regarding reasons for hesitancy/refusal and future vaccination intentions. Variables analyzed included gender, age, and professional category.
Results: Among the 6648 healthcare professionals in the sample, 2.3% (n = 153) declined to complete the vaccination schedule. The average age was 46 years (SD = 11), with the proportion in each age group being 1.2% aged ≤ 35 years, 2.5% aged 36 - 45 years, and 3.1% aged > 45 years. The vaccine refusal rate among all professionals of each gender was 2.3% for females and 2.4% for males. A higher proportion of refusals was observed among healthcare assistants (n = 53, 4.0%) and technical assistants (n = 13, 3.0%). Sixteen reasons for vaccine hesitancy/refusal were identified, with the most frequently reported being fear of adverse reactions (n = 31), insufficient research on vaccines (n = 22), and distrust in vaccine efficacy (n = 25). Only 28.1% (n = 43) expressed an intention to be vaccinated in the future.
Conclusion: A high acceptance rate for the primary COVID-19 vaccination schedule was observed. The likelihood of vaccine refusal was similar between genders but higher among individuals over 45 years and operational support staff. The reasons for vaccine refusal that implied concerns about the vaccine’s safety stood out. Further studies are needed to better understand the dynamics underlying vaccine hesitancy/refusal.
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References
World Health Organization. Fact sheet: immunization coverage. [consultado 2023 nov 30]. Disponível em: http://www.who.int/mediacentre/factsheets/fs378/en/.
The World Health Organization. Ten threats to global health in 2019. [consultado 2023 nov 30]. Disponível em: https://www.who.int/newsroom/spotlight/ten-threats-to-global-health-in-2019.
MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33:4161-4.
Smith MJ. Promoting vaccine confidence. Infect Dis Clin North Am. 2015;29:759-69.
Karafillakis E, Larson HJ, ADVANCE Consortium. The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations. Vaccine. 2017;35:4840-50.
Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine. 2014;32:2150-9.
Chirico F, Teixeira da Silva JA. Evidence-based policies in public health to address COVID-19 vaccine hesitancy. Future Virol. 2023;18:261-73.
Shrestha S, Khatri J, Shakya S, Danekhu K, Khatiwada AP, Sah R, et al. Adverse events related to COVID-19 vaccines: the need to strengthen pharmacovigilance monitoring systems. Drugs Ther Perspect. 2021;37:376-82.
Patel SK, Pathak M, Tiwari R, Yatoo MI, Malik YS, Sah R, et al. A vaccine is not too far for COVID-19. J Infect Dev Ctries;14:450-3.
Kim JH, Hotez P, Batista C, Ergonul O, Figueroa JP, Gilbert S, et al. Operation warp speed: implications for global vaccine security. Lancet Glob Health. 2021;9:e1017-21.
Paudyal V, Al-Hamid A, Bowen M, Hadi MA, Hasan SS, Jalal Z, et al. Interventions to improve spontaneous adverse drug reaction reporting by healthcare professionals and patients: systematic review and metaanalysis. Expert Opin Drug Saf. 2020;19:1173-91.
Kutasi K, Koltai J, Szabó-Morvai Á, Röst G, Karsai M, Biró P, et al. Understanding hesitancy with revealed preferences across COVID-19 vaccine types. Sci Rep. 2022;12:13293.
Leigh JP, Moss SJ, White TM, Picchio CA, Rabin KH, Ratzan SC, et al. Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries. Vaccine. 2022;40:4081-9.
Dzieciolowska S, Hamel D, Gadio S, Dionne M, Gagnon D, Robitaille L, et al. Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian health care workers: A multicenter survey. Am J Infect Control. 2021;49:1152-7.
McClendon S, Proctor K. American nurses association underscores nurses’ role in successful mass vaccination campaigns: ‘most trusted’ profession key to building public confidence. 2020. [consultado 2024 jan 10]. Disponível em: https://www.nursingworld.org/news/newsreleases/2020/american-nurses-association-underscores-nurses-role---in-successful-mass-vaccination-campaigns---most-trusted--professionkey-to-building-public-confidence/.
Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34:6700- 6.
Biswas N, Mustapha T, Khubchandani J, Price JH. The nature and extent of covid-19 vaccination hesitancy in healthcare workers. J Community Health. 2021:46;1244-51.
Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9:1763-73.
Piraveenan M, Sawleshwarkar S, Walsh M, Zablotska I, Bhattacharyya S, Farooqui HH, et al. Optimal governance and implementation of vaccination programmes to contain the COVID-19 pandemic. R Soc Open Sci. 2021;8:210429.
Fieselmann J, Annac K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany. BMC Public Health. 2022;22:846.
Gu F, Lin H, Chen Z, Ambler G, Chen X, Chen X, et al. Future covid-19 booster vaccine refusal in healthcare workers after a massive breakthrough infection wave, a nationwide survey-based study. Vaccines. 2023;11:987.
Dong Y, He Z, Liu T, Huang J, Zhang CJ, Akinwunmi B, et al. Acceptance of and preference for covid-19 vaccination in India, the United Kingdom, Germany, Italy, and Spain: an international cross-sectional study. Vaccines. 2022;10:832.
Sallam M. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines. 2021;9:160.
Khubchandani J, Bustos E, Chowdhury S, Biswas N, Keller T. COVID-19 vaccine refusal among nurses worldwide: review of trends and predictors. Vaccines. 2022;10:230.
Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35:775-9.
Arshad MS, Masood I, Imran I, Saeed H, Ahmad I, Ishaq I, et al. COVID-19 vaccine booster hesitancy (VBH) among healthcare professionals of Pakistan, a nationwide survey. Vaccines. 2022;10:1736.
Koh SW, Liow Y, Loh VW, Liew SJ, Chan YH, Young D. COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore. BMC Prim Care. 2022;23:81.
Guidry JP, Laestadius LI, Vraga EK, Miller CA, Perrin PB, Burton CW, et al. Willingness to get the COVID-19 vaccine with and without emergency use authorization. Am J Infect Control. 2021;49:137-42.
Wang K, Wong EL, Ho KF, Cheung AW, Chan EY, Yeoh EK, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: a cross-sectional survey. Vaccine. 2020;38:7049-56.
Kricorian K, Civen R, Equils O. COVID-19 vaccine hesitancy: misinformation and perceptions of vaccine safety. Hum Vaccin Immunother. 2022;18:1950504.
Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes toward a potential sars-cov-2 vaccine: a survey of U.S. adults. Ann Intern Med. 2020;173:964-73.
Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: how many people would get vaccinated? Vaccine. 2020;38:6500-7.
Gu M, Taylor B, Pollack HA, Schneider JA, Zaller N. A pilot study on COVID-19 vaccine hesitancy among healthcare workers in the US. PLoS One. 2022;17:e0269320.
Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines. 2017;16:1107-18.
Anello P, Cestari L, Baldovin T, Simonato L, Frasca G, Caranci N, et al. Socioeconomic factors influencing childhood vaccination in two northern Italian regions. Vaccine. 2017;35:4673-80.
Hak E, Schönbeck Y, De Melker H, Van Essen GA, Sanders EA. Negative attitude of highly educated parents and health care workers towards future vaccinations in the Dutch childhood vaccination program. Vaccine. 2005;23:3103-7.
Arat A, Burström B, Östberg V, Hjern A. Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review. BMC Publ Health. 2019;19:290.
Gagneux-Brunon A, Detoc M, Bruel S, Tardy B, Rozaire O, Frappe P, et al. Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect. 2021;108:168-73.
Peterson CJ, Lee B, Nugent K. COVID-19 vaccination hesitancy among healthcare workers—a review. Vaccines. 2022;10:948.
Zhou Y, Li R, Shen L. Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies. Vaccine X. 2023;13:100279.
Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-51.
Holzmann-Littig C, Frank T, Schmaderer C, Braunisch MC, Renders L, Kranke P, et al. COVID-19 vaccines: fear of side effects among german health care workers. Vaccines. 2022;10:689.
Torreele E. The rush to create a covid-19 vaccine may do more harm than good. BMJ 2020;370:m3209.
Meyer MN, Gjorgjieva T, Rosica D. Trends in health care worker intentions to receive a covid-19 vaccine and reasons for hesitancy. JAMA Netw Open. 2021;4:e215344.
Vergara RJ, Sarmiento PJ, Lagman JD. Building public trust: a response to COVID-19 vaccine hesitancy predicament. J. Public Health. 2021;43:e291-2.
Rzymski P, Poniedziałek B, Fal A. Willingness to receive the booster covid-19 vaccine dose in Poland. Vaccines. 2021;9:1286.
Day D, Grech L, Nguyen M, Bain N, Kwok A, Harris S, et al. Serious underlying medical conditions and covid-19 vaccine hesitancy: a large cross-sectional analysis from Australia. Vaccines. 2022;10:851.
Smith BA, Ricotta EE, Kwan JL, Evans NG. COVID-19 risk perception and vaccine acceptance in individuals with chronic disease. medRxiv [Preprint]. 2022:2021.03.17.21253760.
Centers for Disease Control and Prevention. COVID-19 vaccines while pregnant or breastfeeding. [consultado 2023 nov 14]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html.
Bianchi F, Stefanizzi P, Gioia M, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines. 2022;21:1443-54.
Del Rio C, Malani P. COVID-19 in 2021—continuing uncertainty. JAMA. 2021;325:1389-90.
Romate J, Rajkumar E, Gopi A, Abraham J, Rages J, Lakshmi R, et al. What contributes to covid-19 vaccine hesitancy? A systematic review of the psychological factors associated with covid-19 vaccine hesitancy. Vaccines. 2022;10:1777.
Dara S, Sharma SK, Kumar A, Goel AD, Jain V, Sharma MC, et al. Awareness, attitude, and acceptability of healthcare workers about covid-19 vaccination in western India. Cureus. 2021;13:e18400.
Dubov A, Distelberg BJ, Abdul-Mutakabbir JC, Beeson WL, Loo LK, Montgomery SB, et al. Predictors of COVID-19 vaccine acceptance and hesitancy among healthcare workers in southern california: not just “anti” vs. “pro” vaccine. Vaccines. 2021;9:1428.
Choi K, Chang J, Luo YX, Lewin B, Munoz-Plaza C, Bronstein D, et al. “Still on the fence:” a mixed methods investigation of covid-19 vaccine confidence among health care providers. Workplace Health Saf. 2022;70:21650799211049811.
Farah W, Breeher L, Shah V, Hainy C, Tommaso CP, Swift MD. Disparities in COVID-19 vaccine uptake among health care workers. Vaccine. 2022;40:2749-54.
Bajos N, Spire A, Silberzan L, Sireyjol A, Jusot F, Meyer L, et al. When lack of trust in the government and in scientists reinforces social inequalities in vaccination against covid-19. Front Public Health. 2022;10:908152.
Hollingsworth H. Unvaccinated medical workers turn to religious exemptions. [consultado 2022 mar 30]. Disponível em:https://www. usnews.com/news/us/articles/2022-02-14/unvaccinated-medicalworkers-turn-to-religious-exemptions.
Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ. Strategies for addressing vaccine hesitancy—a systematic review. Vaccine. 2015;33:4180-90.
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