Many Healthcare Workers Are Still Hesitant Toward COVID-19 Vaccines

More than one-fifth of healthcare workers globally are hesitant about receiving a COVID-19 vaccine, according to a recent study. Researchers found that vaccine safety, efficacy, and potential side effects were the top reasons for concern, along with a host of misinformation about COVID-19 vaccines. 

The researchers also discovered that younger female healthcare workers with a lower education level are more likely to be vaccine-hesitant. The April study was published in the Journal of Community Health.

“Most people spend eight waking hours in a full-time job,” co-study author Jagdish Khubchandani, PhD, professor of public health at New Mexico State University, tells Verywell. “Beyond that, they are a part of the society for 16 hours. So, the time spent around family and community is more, and the influence could be greater from community and family norms, perceptions, and misinformation.”

Healthcare Worker Vaccine Hesitancy by the Numbers

In a scoping review, Khubchandani and fellow researchers looked at a pool of 35 studies on healthcare worker vaccine hesitancy worldwide. The studies encompassed more than 76,000 participants.

For the sake of the review, researchers considered participants hesitant if they declined or refused a COVID-19 vaccine, said they were unlikely to get one, or if indicated disagreement with vaccinating against the virus. Undecided participants were not counted. The researchers found that the prevalence of vaccine hesitancy worldwide ranged from about 4% to 72%, with an average of 22%.

“We have a misperception that healthcare workers practice better health behaviors and engage in healthier lifestyles,” Khubchandani says.

Khubchandani and colleagues looked at healthcare worker vaccine hesitancy globally, but the prevalence is potentially higher in the U.S. Frontline healthcare workers were among the first groups of people in the nation to be offered a vaccine last December, with rollout beginning at the end of 2020. But not all jumped at the chance when their turn came.

According to a Kaiser Family Foundation (KFF) and Washington Post survey of 1,327 frontline healthcare workers, as of early March, only 52% said they had received at least one dose. Of those surveyed, 18% said they didn't plan to get a vaccine, while another 12% said they were undecided. 

Factors That Correlate With Hesitancy

In their study, Khubchandani and fellow researchers found three factors among healthcare workers that correlated with more hesitancy toward the COVID-19 vaccines: being female, having a lower education level, and being young.

Gender

“Gender-related findings were initially surprising to me, as I have always written that women practice better health behaviors," Khubchandani says. "But the case of COVID vaccines is unique.” 

In another preprint study part of the COVID States Project, researchers surveyed more than 21,000 individuals across the U.S. about their COVID-19 vaccine attitudes. The researchers also found that vaccine resistance was higher in female healthcare workers than in males in the industry. For those surveyed in February 2021, 27% of female and 18% of male healthcare workers said they would not get a COVID-19 vaccine.

Khubchandani says some women express concerns about vaccine side effects leaving them unable to care for their families or causing infertility. However, COVID-19 vaccine side effects tend to resolve within a few days, and experts have widely debunked concerns about the shots causing infertility.

Education

Khubchandani and his colleagues found a correlation between higher vaccine uptake among healthcare workers if they were doctoral degree holders or involved in patient-facing care. Those with lower education levels were more likely to be hesitant.  Not all healthcare workers are doctors or have extensive training in medicine or research and not all have waded through the vaccine data, which may be inaccessible to some people, he explains. 

Healthcare workers with lower levels of education may also be more vulnerable to misinformation on social media and elsewhere. Some participants expressed doubts on whether COVID-19 exists or didn't believe it is a serious disease. Others cited false conspiracy theories about the vaccines actually serving as an “injection of microchips.”

“For many people, it is a lack of knowledge that feeds into vaccine fear,” Nichole Cumby, PhD, an assistant professor of microbiology at University of Medicine and Health Sciences St. Kitts, tells Verywell. "The science behind these topics can be complex. The amount of information available—both true and false—is overwhelming.”

The COVID States Project survey as well as the KFF and Washington Post survey both found that healthcare workers with higher education levels resisted the vaccine at lower rates.

“Healthcare workers around the world are not a monolithic group and have a variety of roles, types of training, and experiences in the field,” Khubchandani explains. “Those who are in patient care, know someone who died, or know infected or hospitalized clients are more likely to take the vaccine—as they understand the severity of the disease, have a higher perceived risk of getting infected or perceive greater benefits of the vaccine.”

Age

Younger healthcare workers were also more likely to be vaccine-hesitant. The researchers attribute this finding to a few possibilities. Older healthcare workers may have higher education levels and more experience in the field, and age may impact a person’s perceived vulnerability to a severe case of COVID-19.

This aligns with a Verywell Health survey that found young people, in general, were more likely to reject the vaccines. Young respondents—individuals under 30—were more than twice as likely as older respondents to not want the vaccine. 

Unvaccinated Healthcare Workers Pose a Risk

Public health experts say COVID-19 vaccine hesitancy among healthcare workers poses a health threat to patients and the community at large. In their study, Khubchandani and fellow researchers write, “Healthcare workers regularly work with vulnerable populations and cannot rely solely on wearing masks or personal protective equipment to fulfill their professional obligations to their patients."

An unvaccinated healthcare worker can unknowingly transmit SARS-CoV-2, the virus that causes COVID-19, to a patient or even cause an outbreak—as was the case at one Kentucky nursing home. The Centers for Disease Control and Prevention (CDC) confirms that an unvaccinated healthcare worker—who was offered a vaccine but turned it down—caused a COVID-19 outbreak in a skilled nursing facility that infected 26 residents (18 of whom were fully vaccinated) and 20 staff members (4 of whom were vaccinated). Three residents died from the outbreak. The unvaccinated healthcare worker transmitted a more infectious variant of the virus.

“One unvaccinated person infecting everyone around in a healthcare setting can have a major financial and social impact, apart from the toll on health, well-being, and life,” Khubchandani says. 

Experts also express concerns about how vaccine hesitancy among healthcare workers sways the general public opinion. “Making serious medical decisions, like whether to get a new vaccine, is challenging for many people,” Cumby says. “When faced with this sort of decision, it makes sense to look to see what the people who are more knowledgeable regarding health sciences are doing and factor this information into decisions.”

Naturally, people look to those in healthcare to be their guides. “So whether intentional or not, healthcare workers are serving as influencers for other’s decision," Cumby adds. "For this reason, it is critical that healthcare workers support the drive to vaccinate the population against COVID-19, and that begins with overcoming their own hesitancy.”

Vaccine Mandates for Healthcare Workers

Some hospitals, like Houston Methodist, are beginning to implement COVID-19 vaccine mandates for healthcare workers—with certain exceptions in place. Employees who refuse will be terminated from staff.

Other hospitals may follow suit, especially if the Pfizer-BioNTech vaccine receives full approval from the Food and Drug Administration (FDA) soon. All three vaccines are currently under emergency use authorization, but Pfizer is now under review for full approval. Legal experts are still trying to decipher what the EUA provision means for COVID-19 vaccine mandates.

If a COVID-19 vaccine reaches full FDA approval, however, that means the agency vetted extensive research for the drug’s “safety, purity, potency, and effectiveness.” And such a classification places a vaccine squarely in the camp of other FDA-approved inoculations. Currently, 15 states mandate measles, mumps, and rubella (MMR) vaccines for healthcare workers. And states have varying laws on healthcare worker flu shot requirements.

Some experts, like Cumby, champion education campaigns over COVID-19 vaccine mandates. "Encourage, rather than command the person to examine the information provided and let the person decide ultimately what is best for them and their families,” she says. “Nothing makes people shut down faster than being insulted or being forced. Once that happens, the battle lines are drawn, and instead of fighting together against the virus, we are now actively fighting each other.”

But Khubchandani says patients’ and others’ lives are at stake. “As long as we have the exemptions and freedom guaranteed by law, I see no harm in mandates and requirements," he sats. "If an employee can be a risk to coworkers or clients, it is a prudent move to require them to get vaccinated.”

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.