COVID-19 Vaccine Uptake Among Health Care Workers Hits Wall

Health care professionals were getting vaccinated at a steady clip. Then came the drop-off. Now, only about 70% are fully vaccinated. Infection preventionists to the rescue?

On September 24, Rochelle Walensky, MD, the director of the Centers for Disease Control and Prevention (CDC) took the highly unusual step of overruling the CDC’s Advisory Committee on Immunization Practices and made COVID-19 booster shots available for health care professionals (HCPs) on the frontlines of the pandemic. The move garnered headlines and speculation as to why Walensky took that action, but perhaps a new study on vaccine uptake among HCPs might shed some light. By mid-September vaccine uptake among HCPs had stalled significantly, according to a huge study by CDC investigators published in the American Journal of Infection Control (AJIC).

In what’s being touted as the most comprehensive examination of the problem of vaccine hesitancy among HCPs, investigators with the CDC COVID-19 Rapid Response Team collected data from 2086 health care facilities with about 3.3 million HCPs. Vaccine uptake among this population seemed to be going well, rising from 36% to 60% between January 2021 (when the rollout began with a somewhat bumpy start) and April 2021 (after the initial rollout problems were fixed).

And then the slowdown.

The study states that “as of September 15, 2021, among 3,357,348 HCP in 2,086 hospitals included in this analysis, 70% were fully vaccinated. Additional efforts are needed to improve COVID-19 vaccine coverage among HCP.”

In any effort to increase HCP vaccine uptake, infection preventionists (IPs) will most likely play a major role. IPs often take the lead in vaccination efforts in hospitals and other health care settings—not only for COVID-19, but also for influenza.

The AJIC study arrives as medical experts and the mainstream media focus on the waning of the COVID-19 vaccines that brings both the CDC and the Food and Drug Administration (FDA) close to authorizing that COVID-19 booster shots be approved for all adults, not just those 65 or older or those with compromised immune systems. It also comes as the holiday season fast approaches and both the CDC and FDA face criticism about muddled messaging when it comes to the importance of COVID-19 booster shots that would help fuel a 5th wave of the pandemic that seems to have already begun.

Hannah Reses, MPH, the lead author of the AJIC study, says in a press release that “our analysis revealed that vaccine coverage among U.S. hospital-based HCP stalled significantly after initial uptake. Additional efforts are needed now to improve HCP vaccine coverage and reduce the risk of SARS-CoV-2 transmission to patients and other hospital staff.”

To underscore that IPs will most likely play a crucial role in those efforts, the press release also contains a statement by Ann Marie Pettis, BSN, RN, CIC, FAPIC, the president of the Association for Professionals in Infection Control and Epidemiology (APIC), the lobbying organization representing IPs. (AJIC is an APIC publication.)

“Hospital-based HCP play a critical role in influencing community uptake of vaccines and are also at increased risk of both acquiring and transmitting COVID-19 in health care settings,” Pettis says in the press release. She adds that “the findings from this analysis suggest that vaccine mandates as well as investment in additional educational and promotional activities could help increase vaccine coverage among HCP to better protect public health.”

But vaccine mandates must be handled with care. As Infection Control Today® reported in its October issue, there are ethical and practical considerations. Mandates might force the resignation or firing of HCPs at a time when there’s already a critical shortage.

CDC investigators looked at HCP vaccine uptake at children’s hospitals, short-term acute care hospitals, long-term acute-care hospitals, and critical access hospitals.

Vaccine uptake for HCPs was highest at children’s hospitals with a confidence interval (CI) of 95% between 75.8 and 77.3, followed by short-term acute care hospitals (95% CI: 70.1, 70.2) long-term acute care hospitals (CI: 68.2, 69.3) and critical access hospitals (95% CI: 63.8, 64.3). Uptake was highest in health care facilities in metropolitan counties (95% CI: 70.9, 71.0), followed by rural counties (95% CI: 64.8, 65.3), and non-metropolitan urban counties (CI: 63.1, 63.5).

“HCP who did not want to be vaccinated often reported low trust in regulatory authorities and the government; notably, trust in information received from medical professionals was higher, suggesting an important role of professional societies and medical organizations in enhancing vaccine uptake among HCP and combating misinformation that might impact uptake,” the study states.

Another study published recently in AJIC relates that peer education was one of the methods used in a large hospital system to bring HCP vaccination rates up to 90%. In that study, investigators with Narayana Health in Bengaluru, India, used role models. First in line to get vaccinated were senior physicians, and health care facilities administrators. They also relied on the adage that when it comes to battling vaccine hesitancy, a picture might be worth a thousand words.

“Photo booths were erected where everyone getting vaccinated was encouraged to take themselves photographed and use it as their display profile in different social media platforms,” the study states. “This seemed to reassure the other HCWs and may have played an important role in the high uptake seen in all these institutions.”

The AJIC study by the CDC investigators notes that the ramifications of strong COVID-19 vaccine uptake among HCPs can extend far beyond the walls of a hospital.

“HCP play a critical role in advising patients and communities and influencing vaccine decisions,” the study states. “Several studies have found that vaccinated HCP were more likely to recommend vaccination to patients, friends, and family, suggesting that broader uptake of the COVID-19 vaccine among HCP might lead to improved coverage in the general population. HCP are also at increased risk for acquiring and transmitting COVID-19 in health care settings.”