Since the coronavirus disease 2019 (COVID-19) vaccines have been available, healthcare workers have been prioritized to receive them and are set to be prioritized to receive boosters. Several studies have noted a disparity in vaccine uptake between healthcare workers based on demographic differences. In a recent paper, the phenomenon of vaccine hesitancy is further explored amongst UK healthcare workers. A preprint version of the study is available on the medRxiv* server while the article undergoes peer review.
Study: “The vaccination is positive; I don’t think it’s the panacea”: A qualitative study on COVID-19 vaccine attitudes among ethnically diverse healthcare workers in the United Kingdom. Image Credit: Southworks/ Shutterstock
How was the study performed?
The study recruited one hundred sixty-four healthcare workers from a diverse pool of ethnicities, ages, migration status, location, and job roles. Interviews or focus group sessions lasting around one hour were conducted to gauge participants' perceptions and concerns regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the COVID-19 vaccine.
Key areas of discussion included the past experiences of each participant with COVID-19 while at work and home, how risky they perceived infection with SARS-CoV-2 to be for themselves or others, their feelings relating to stigma and discrimination already experienced due to race, or that which may be incurred by refusing the vaccine, and what stress relief mechanisms they employ.
Attitudes towards COVID-19 vaccination were scaled against four categories: active acceptance, those that readily accept the vaccine and are optimistic about its effects; passive acceptance, those that had or will receive the vaccine but bore concerns or doubts about the long term effects; passive decline, those that have not yet received the vaccine but may do in the future if their doubts are allayed; and active decline, those that are unlikely ever to accept the vaccine.
Factors relating to vaccine acceptance
Knowledge of the vaccine's mechanism of action was found to be one of the most influential factors in vaccine acceptance, with those demonstrating familiarity with medical, scientific, and public health information being the most likely to be active acceptors of the vaccine. Healthcare workers employed in positions related to virology or similar were, therefore, the most accepting. However, the group noted that several participants with mere proximity to these departments were also more vaccine accepting. A positive attitude to other vaccines also correlated well with COVID-19 vaccine acceptance and knowledge of vaccines.
Participants with more risk-averse behaviors were also more accepting of the vaccine, with some additional concern expressed from those in high-risk roles involving a lot of contact with severely ill patients. Familial risk was also a factor, with those with at-risk close family members being more likely to have sought out early vaccination or eventually accepted. Generally, this factor was rated higher than risk to self.
Social influences were found to play a large role in vaccine hesitancy, with a large proportion of participants being convinced one way or the other by those in their social group. In most cases, conversations with informed family members or trusted healthcare professionals persuaded passive decliners to become passive or active acceptors. However, evidence of receipt of misinformation from a third party was strongly present amongst decliners. The authors comment that a considerable portion of the participants, themselves being healthcare workers, thought they should play an active role in encouraging the hesitant in their community to receive the vaccine.
The possibility that the vaccine could end non-pharmaceutical interventions such as travel restrictions also weighed strongly amongst the vaccine acceptant, particularly for those with family living abroad.
Fig 2: Drivers of vaccine acceptance
Factors relating to vaccine refusal
Factors that weighed most strongly amongst those declining the COVID-19 vaccine included a lack of trust of pharmaceutical companies and the government, lack of communication about vaccine efficacy and future plans, and concerns over vaccine shortage.
The speed at which the vaccines were developed has been a major point of distrust for many of those refusing the vaccine, along with concerns related to long-term effects and damage to fertility. The observation of some individuals experiencing adverse effects from the vaccine in work also motivated some to maintain an anti-vaccination opinion.
Past experience of clinical malpractice relating to discrimination and racism strongly drove distrust in some communities. For example, in 1996, Pfizer gave Nigerian children an experimental anti-meningitis drug resulting in several deaths and many more disabilities, and several participants brought up this particular incident during interviews. The "sudden interest" in Black and Asian ethnic minorities getting vaccinated by the UK government was seen as suspicious by some participants. Many felt that the concerns of minorities as a group are generally disregarded.
Confusing and contradictory information reported by the government and relayed by various media outlets was seen as off-putting for many of the vaccine-hesitant. For example, some questioned the decision to delay the second dose of the vaccine beyond two weeks in 2020 with little public justification. Several participants raised the idea of mandatory vaccination as a key issue, with opinions strongly divided. Many felt that vaccines should be mandatory for healthcare workers, while others felt that this would greatly impinge on their personal freedom.
Fig 3: Barriers to vaccine acceptance
Continued communication and education are important to ensure that passive acceptors do not gradually become passive decliners. Similarly, the government must counter vaccine misinformation promptly in the wider community.
The authors suggest that promoting vaccination amongst the diverse range of job roles encompassed by healthcare workers but not in clinical positions could be an effective strategy, with better communication of the importance of vaccination to porters, domestic and security staff encouraging uptake.
Similarly, better communication and delivery of information to ethnic minorities in a culturally competent manner may alleviate the impression of marginalization and improve feelings of distrust.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.