COVID-19 Vaccine Hesitancy Among Health Care Workers: Why?

Vaccine hesitant health care professionals are most likely to be persuaded by fellow workers. Meanwhile, mandates can backfire.

Perhaps one of the more perplexing developments during the COVID-19 pandemic has been the display of vaccine hesitancy among some health care workers (HCWs). Because infection preventionists (IPs) often lead vaccination drives at hospitals, they’ve found themselves having to encourage their fellow workers to get the COVID-19 vaccine, and it hasn’t always been an easy job.

But just whom among HCWs want to avoid getting the vaccine? Investigators with the University of Illinois at Chicago wanted to address that question and presented their findings in a preprint study in the American Journal of Infection Control (AJIC).

“A surprising proportion of vaccine hesitant respondents cited insufficient evidence for vaccine efficacy, a somewhat concerning finding given the survey population,” the study states.

Politics, it seems, cannot be avoided when discussing vaccine hesitancy and investigators found a divide depending on party affiliation. Nearly half of the HCW participants in the study who said they were Republican said that they had not been vaccinated, nor do they intend to be vaccinated.

However, HCWs who did not get the vaccine also tended to be younger, non-physicians, and Black. Also, some HCWs expressed concerns about adverse side effects having to do with getting pregnant or delivering a baby. Overall, Black and Republican HCWs had lower rates of vaccine uptake.

“Although we acknowledge that COVID-19 and its vaccines have been politicized more than any other disease in recent history, it is equally important to acknowledge there is more to human intersectionality, values, and experience than political affiliation,” the study states.

Investigators surveyed HCWs in 3 large academic medical centers in the Chicago area between March and May 2021 and found that about 3 out of every 20 HCWs self-reported vaccine hesitancy. Of the 1974 respondents, about 85% said that they had gotten or planned to get the COVID-19 vaccine. “Multivariable logistic regression found HCWs were less likely to receive COVID-19 vaccination if they were Black (OR 0.34, 95% CI 0.15-0.80), Republican (OR 0.54, 95% CI 0.31-0.91), or allergic to any vaccine component (OR 0.27, 95% CI 0.10-0.70) and more likely to receive if they believed people close to them thought it was important for them to receive the vaccine (OR 5.2, 95% CI 3-8),” the study states.

They found that—and this is where IPs might come in—HCWs tended to trust information that’s relayed to them by a fellow HCW than by any marketing campaign. Rather than rely on such campaigns, hospitals should instead foster trusting relationships among employees across departments and job roles. Doctors and nurses are principally viewed as trustworthy, the study states.

“It will be especially important to create safe spaces where HCWs, including clinicians, food providers, and environmental service workers can express their questions and concerns in an open and transparent forum due to inherent power structures and hierarchies that frequently serve as barriers to the agency of vulnerable persons,” the study states.

Many hospitals and health care systems across the country have mandated that their workers be vaccinated against COVID-19, sometimes leading to workers either quitting or getting fired.

As authors Mary Jean Ricci, MSN, RNBC, and Frances Amorim, MSN, RN, CCE, recently put it in an article in Infection Control Today®, mandating vaccinations for health care workers is a balancing act. The title of their article: “Ethical and Practical Considerations Surrounding Mandatory Vaccination.” They wrote: “Infection preventionists and the hospital leadership teams need to communicate with all stakeholders to balance the health of the community and protect the current and future workforce.”

The authors of the AJIC study also recognize how tricky vaccine mandates for HCWs can be. “Hospitals, health care systems, and state governments are increasingly mandating vaccination against COVID-19 for health care workers across the United States,” they write. “While we support these efforts, vaccine mandates come with attendant harms and the potential to exacerbate issues of mistrust, hesitancy, communication, and inequities in agency. Although it is likely vaccine mandates for health care workers will increase uptake in the vaccine, it is also possible these mandates may lead to backlash, leaving health care workers fearful of losing their jobs or feeling obliged to receive the vaccine against their personal values or concerns.”