Study Explores Which Healthcare Workers Are Apprehensive of a COVID-19 Vaccine

While states have made different choices regarding who’s considered high priority for the coronavirus vaccine, everyone seems to agree that healthcare workers should be at the top of the list. However, a new medRxiv study preprint—meaning a study that hasn’t gone through peer review—suggests that not every healthcare worker is willing to get the shot. The decision could be dangerous for healthcare workers who come into regular contact with people at high risk of developing severe COVID-19 infection.

Sam Sun, MD, director of a COVID-19 data management non-profit called the inDemic Foundation, tells Verywell that vaccine confidence among physicians is vital in promoting public vaccine confidence. He adds that healthcare workers being vaccine hesitant is a misleading statement because healthcare workers are a broad category. Sun was not involved with the study.

“Healthcare workers who are hesitant about getting vaccinated are not positioned in a healthcare setting in assessing the data or assessing the data from population studies or clinical trials to decide on how to handle public health emergencies such as the COVID-19 pandemic,” Sun tells Verywell.

He argues that physicians are very confident of the vaccine, which should show others that the vaccine is safe and effective. Other factors such as safety concerns, education level, and racism in medicine play major roles in vaccine hesitancy among healthcare workers.

Most Healthcare Workers Are Waiting To Review Safety Data

From October 7 through November 9—weeks before the first COVID-19 shot was administered in the U.S. on December 14—the research team behind the medRxiv study created an online survey posted on social media that collected anonymous information from healthcare workers.

Beyond collecting demographic information, survey questions gleaned information regarding everything from previous exposure to COVID-19 and self-perceived risk to acceptance of a COVID-19 vaccine and vaccine attitudes in general. Of the 4,080 responses collected, 3,479 were deemed complete enough to be used in the researchers’ analysis.

Results show that 36% of healthcare workers planned on getting the COVID-19 vaccine when it became available to them. Some healthcare workers showed vaccine hesitancy. About 56% of healthcare workers said they would consider getting the vaccine after reviewing the safety data. Ten to 11% of healthcare workers would prefer to schedule their vaccines after a few months, and 20% prefer to wait after a year.

Only 8% of survey respondents said they would not get the vaccine.

Educational Level and Patient Exposure Drastically Influence Vaccine Attitudes

Vaccine acceptance was highest among older healthcare workers; 47% of respondents in the 70+ age group responded positively to the idea of getting the COVID-19 vaccine. The researchers suggest this may be because older adults are at high risk for severe COVID-19 infection and mortality.

Healthcare workers with higher education levels and income were also more likely to agree to get vaccinated.

Sun tells Verywell that education makes a difference in whether a healthcare worker can assess the risk of a COVID-19 vaccine. “Healthcare workers are such a broad population now. It’s a wide range of educational levels and educational attainment,” he says. “Grouping people as ‘healthcare workers’ means you have some people working in healthcare whose education doesn’t go past high school and so they may not have the most scientific take on whether they should get the COVID-19 vaccine.”

Healthcare workers who did not have direct contact with patients were more likely to say they’d refuse the vaccine.

Sun says this is why grouping all healthcare workers together is misleading and may encourage vaccine hesitancy with the public, even though the healthcare workers opposed to vaccination aren’t necessarily the ones working with patients.

“I haven’t really seen many physicians refusing a vaccine,” Sun says, expressing concern that grouping all healthcare workers together is misleading and may encourage vaccine hesitancy among the public. “I think physicians are a good population to look at because [doctors] have the highest educational attainment in medicine among healthcare workers. We are on the frontlines of care, interacting with patients, and have the highest risk of contracting COVID-19.”

Let’s use the Yale New Haven Health System (YNHHS) as an example. After reviewing data from the first phase of the vaccine rollout, the Yale School of Medicine found vaccine acceptance was highest among YNHHS medical residents at 90%, followed by 70% of physicians. Healthcare workers with environmental or food service roles showed the highest rates of vaccine hesitancy; only 20% to 25% responded to the YNHHS invitation to be vaccinated.

“The fact that over 90% of medical residents would take the vaccine tells me that this population wants to get the vaccine right away,” Sun says. “That says there’s a lot of confidence behind the COVID-19 vaccine.”

Racial Inequalities in Health Lead To Vaccine Mistrust

According to the medRxiv study, unlike Asian healthcare workers who had a high degree of vaccine acceptance, Black and Latinx healthcare workers were most hesitant to take a vaccine. About 65% of Black healthcare workers said they preferred to wait to review safety and efficacy data before deciding on vaccination. Eighty percent of Native Americans and 100% of Native Hawaiian or Pacific Islanders said they would delay their decision and first review the data.

Historically, the healthcare system has failed communities of color through unethical experimentation and creating barriers to treatment. And throughout the current pandemic, people of color have experienced a disproportionate number of infections and deaths. As of November, of the roughly 300,000 who had died of COVID-19 in the U.S., more than half were Black, Latinx, and Indigenous.

As a result, there’s a high degree of mistrust among these communities regarding whether the healthcare system will care for them. To address vaccine hesitancy, Sun says vaccine manufacturers are making strides to reduce disparities beginning in the clinical trial phase.

“Pfizer and Moderna have made significant efforts to address this by enrolling people of color in more clinical trials,” Sun says. “So I think it is still a concern, but they have done a reasonable job addressing the concerns.”

Safety Concerns Are Unique To the COVID-19 Vaccine

Sun says any type of vaccine comes with its fair share of vaccine hesitancy, but that hesitancy is usually relatively low for healthcare workers. Sun says it also helps that some vaccines, such as the yearly flu shot, can be mandatory for some people in the healthcare field. The survey results reflect this, with healthcare workers viewing vaccinations as safe overall.

But for the COVID-19 vaccine, 74% of healthcare workers reported concerns about the speed of development. Sun says this is most likely because mRNA—the vaccine platform used by both Pfizer and Moderna—is a new technology being used for the first time in human vaccines.

About 69% of healthcare workers were concerned about safety.

“Another reason people may be hesitant in getting the vaccine is that people are not good at discussing risks and the likelihood of rare events,” Sun says. “Some of the side effects people are concerned about—such as Bell’s palsy or anaphylaxis—[are] so rare; about 1 in 100,000 or less. I don’t think it should be a barrier for people to get vaccinated.”

Improving Vaccine Confidence Among the Public

Based on survey results, doctors are viewed as more trustworthy than the government, with a third of respondents mistrustful of the Federal Drug and Food Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Among healthcare workers, 73% trusted their doctors’ vaccine recommendations.

To encourage public vaccination, Sun suggests more transparent messaging regarding the fact the currently-authorized vaccines are nearly 95% effective in preventing COVID-19. He says that messaging should make clear physicians have high levels of confidence for the vaccine, even though not all healthcare workers share the feeling.

“Physicians are the most qualified people to make that determination within healthcare workers or the general population, and they’re taking the vaccine at very high rates,” Sun says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.