Health workers think COVID, flu vaccines safe and effective, but many remain hesitant, global survey shows

A survey of more than 7,700 healthcare workers (HCWs) in 12 countries in 2022 and 2023 finds that respondents agreed that COVID-19 and influenza vaccines are safe, effective, and useful, yet 1 in 5 reported moderate or strong COVID vaccine hesitation.

For the study, published in Public Health, a team led by researchers from the World Federation of Public Health Associations in Geneva surveyed 7,793 HCWs through the web platform SurveyMonkey from October 2022 to April 2023. Participants had a median age of 44 years, and 68% were women. The 12 countries were Australia, Brazil, Canada, China, France, Germany, India, Italy, New Zealand, Spain, the United States, and the United Kingdom.

The study authors noted that vaccine reluctance was detected worldwide before the pandemic, but the introduction of COVID-19 vaccines has significantly worsened the issue. “Reluctant HCWs not only put their own well-being and that of their patients at risk, but also undermine confidence in vaccines, leading to lower vaccination coverage among patients and communities,” they wrote.

84% say COVID vaccine benefits outweigh risks

While HCWs agreed that the COVID-19 and flu vaccines were safe (89%), effective (92%), and useful (92%), 21% said they were moderately or strongly reluctant to receive COVID vaccination. Differences by nation accounted for 6% of global variance in change in vaccine sentiment (ChVS) and hesitation to receive COVID-19 vaccines (CoVH). Many participants believed that pharmaceutical firms (67%) and public health officials (64%) minimized the vaccines’ side effects. 

In terms of COVID-19 vaccines, 89% of respondents had received three or four doses of COVID-19 vaccine, and 72% wanted another dose, if recommended by health officials. 

In total, 84% agreed that the benefits of the COVID-19 vaccine outweigh the risks, and 88% said the vaccine is effective in reducing severe disease. While 80% indicated that children and adolescents should be vaccinated against COVID-19, only 61% agreed with giving the vaccination to pregnant women, and 66% would support mandatory COVID-19 vaccination for HCWs. 

Overall, 84% of participants said that it was important for community/religious/cultural leaders and traditional healers to reinforce positive messages about COVID-19 vaccination, and 92% believed that easy access to the vaccination is key to increasing COVID-19 vaccination.

Regarding flu vaccination, 42% of HCWs were vaccinated before the pandemic, while 23% were vaccinated some years, 55% were vaccinated in the winter season before the survey, and 57% planned to be vaccinated the next winter. 

In cross-tabulations of flu, 94% of HCWs were vaccinated before the pandemic and 90% of those vaccinated in the last winter also planned to be vaccinated the next winter. 

Factors such as educational attainment, fear of COVID-19 infection, knowledge of COVID-19 vaccines, CoVH level, flu vaccination behavior, and general confidence in vaccines were significant influences on ChVS. Profession, flu vaccination behavior, fear of COVID-19, and main information sources influenced CoVH.

Fear of side effects, waiting for more data

“In general, the COVID-19 pandemic seems not having influenced attitudes towards vaccination (76%); moreover, it increased confidence in the health system of the country of origin (64%) and in vaccine safety (66%), with 73% stating that from now on they would pay more attention to updating their vaccination schedule in general,” the researchers wrote.

There is a need for tailored, nation-specific strategies to address vaccine hesitancy and enhance vaccine confidence among HCWs.

Asked about COVID-19 vaccine reluctance, 79% of HCWs considered themselves not hesitant, 9% moderately hesitant, and 12% strongly hesitant. The most common reasons for COVID-19 uptake included the belief that they prevented infection, wanting to protect themselves or family, working in a profession with a high risk of infection, and social responsibility toward high-risk people. 

The most common reasons for COVID-19 refusal included were fear of side effects, having had COVID-19 in the past and considering vaccination not necessary, waiting for further efficacy and safety trial data, believing they weren’t at risk for severe COVID-19, and believing that COVID-19 was not a serious disease. 

“Individual factors played a major role in determining change in vaccine sentiment and COVID-19 vaccine hesitancy, but they can be modulated by other contextual elements at the country level,” the study authors wrote. “There is a need for tailored, nation-specific strategies to address vaccine hesitancy and enhance vaccine confidence among HCWs.”