“Still on the Fence”: A Mixed Methods Investigation of COVID-19 Vaccine Confidence Among Health Care Providers

Abstract

Background: There is evidence of disparities in COVID-19 vaccine acceptance among health care providers. The purpose of this study was to examine confidence receiving and recommending COVID-19 vaccines by health care provider type and race/ethnicity. Methods: This mixed methods study involved a cross-sectional survey and qualitative, semi-structured interviews from March to May 2021 among a sample of physicians, advanced practice providers, nurses, and pharmacists. These workers were recruited through voluntary response sampling from an integrated health system in Southern California. The primary dependent variables were (a) confidence in vaccine safety, (b) confidence in vaccine effectiveness, and (c) intent to recommend the vaccine to others. The primary independent variables were health care provider type and race/ethnicity. Findings: A total of 2,948 providers completed the survey. Nurses relative to physicians were 15% less likely to perceive the COVID-19 vaccine to be safe (risk ratio [RR] = 0.85; 95% confidence interval [CI] = 0.83–0.87); 27% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.73; 95% CI = 0.69–0.76); and 11% less likely to recommend the vaccine to others (RR = 0.89; 95% CI = 0.87–0.91). Hispanic/Latinx providers were 10% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.90; 95% CI = 0.83–0.98) relative to White providers. Qualitative themes included: No need for vaccine; distrusting vaccine research and roll-out; caretaking barriers; uncertainty and potential to change one’s mind; framing vaccine decisions around personal beliefs. Conclusions & Application to Practice: Health care workplaces should consider interventions to increase COVID-19 vaccination among their workers, including education and mandatory vaccination policies.

COVID-19 Vaccination Hesitancy among Healthcare Workers—A Review

“…Some contend that natural immunity is preferable to immunization [82,198]. Others contend that vaccination should not be required or is not necessary for those who have already contracted COVID-19 [110,142]. This may be due to feeling protected from COVID-19 due to previous illness or because those who are more likely to contract COVID-19 had fewer health-protective behaviors in the first place [157].…”

“…One study of over 65,000 US HCWs noted a lower vaccination rate among those who had previously been infected with COVID-19 (OR, 0.55; 95% CI, 0.51-0.58, p < 0.0001) [227]. Still, others claim that they do not feel at risk for COVID-19 [102] or that COVID-19 is less serious than depicted [142]. Furthermore, continued public health measures, such as masking requirements, make unvaccinated HCWs skeptical of the vaccine's effectiveness or the personal utility of vaccinating given some personal protective requirements remained the same [142].…”

“…One HCW reported feeling disheartened by people who once praised their efforts now treating them as a "dangerous person" because of their vaccination status [218]. Another HCW felt selfish about getting the vaccine before family members were able to do so, saying she would be vaccinated once the vaccine was more widely available [142]. Some feel that vaccination programs are being overemphasized and at the expense of other effective public health measures [235].…”

Is resisting Covid-19 vaccination a “problem”? A critical policy inquiry of vaccine mandates for healthcare workers

“…By way of example, having dismissed fertility concerns with vaccination, Hoffman et al proffered that "it would be valuable for [HCWs] to counter misinformation […] including concerns about vaccine safety while pregnant or breastfeeding" (Hoffman et al, 2022) (p.756), while Shaw et al recommended that "misperceptions, such as lack of research data, rushed vaccine development, and misinformation about the vaccine's impact on fertility and reproduction" be corrected through "education" (Shaw J et al, 2021)(p.e820). Some authors acknowledged that racialized HCWs were less accepting of COVID-19 vaccines (Choi et al, 2022;Evans et al, 2022;Oberleitner et al, 2022). However, while this "mistrust" was deemed excusable on grounds of its roots in negative, historical or current, experiences with medical institutions (Wirpsa et al, 2023;Woodhead et al, 2022), it was still presented as misinformed, i.e., not grounded on real evidence of harm but rather a misapplication of this mistrust to the COVID-19 case.…”

“…However, while this "mistrust" was deemed excusable on grounds of its roots in negative, historical or current, experiences with medical institutions (Wirpsa et al, 2023;Woodhead et al, 2022), it was still presented as misinformed, i.e., not grounded on real evidence of harm but rather a misapplication of this mistrust to the COVID-19 case. It was also presented as problematic given its potential to "exacerbate racial/ethnic disparities in COVID-19 outcomes" (p.286) when these HCWs served patient populations in their own communities (Choi et al, 2022). For example, in their study of HCWs in Nigeria, Iwu et al stated that: "despite their knowledge and training [vaccine hesitant] HCWs continue to be at risk of being trapped within the cycle of misinformation and vaccination fear" (p.7).…”