This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health) based on information provided by members of the COVID-19 Evidence Synthesis Network. Please refer to the Methods section for further information.
This note provides a summary of Canadian and international experiences with vaccination hesitancy among health care workers (HCW) during the novel coronavirus disease (COVID-19) pandemic, and interventions used to increase vaccination uptake.
*The full version of the Briefing Note including the Appendix can be accessed in the PDF file at the top of the page*
- An emerging body of evidence from across the globe (e.g., United States, France, Egypt, Saudi Arabia, China, Hong Kong) has begun to document HCWs’ willingness to receive a COVID-19 vaccine, and the factors underlying their willingness. Emerging research suggests that the proportion of HCWs positively inclined toward receiving a COVID-19 vaccine ranges from 27.7% to 81.5%.
- Differences in vaccine acceptance were associated with individual and group characteristics, which should be addressed to avoid exacerbating health inequities.
- Barriers: Female gender; Black, Latinx, Conservative/Republican HCWs; rural work settings; concerns about COVID-19 vaccine safety; concerns about vaccine effectiveness; and concerns about expedited development/approval process; experience with racial discrimination.
- Enablers: Male gender; older age; physician profession; presence of comorbidities or chronic diseases; fear of COVID-19; perceived risk; stronger vaccine confidence; belief that COVID-19 vaccine will likely to stop the pandemic; social contacts’ decisions to have vaccine; and use of CDC updates.
- Interventions to Increase Uptake: Multi-faceted vaccine campaigns (i.e., influenza, hepatitis B, other vaccines) have reached an absolute vaccination coverage among HCWs of over 90%; campaigns solely based on education and promotion or on-site-vaccination did not regularly exceed an absolute vaccination coverage of 40%.
- No identified studies reported specific interventions to increase COVID-19 vaccination uptake among HCWs. Since the distribution of vaccinations began in early December 2020, there likely has not been an opportunity to examine interventions to address COVID-19 vaccine hesitancy.
Analysis for Ontario
- Since a large proportion of HCWs reported plans to delay vaccine uptake due to concerns about expedited development, forthcoming vaccination campaigns could address this aspect of COVID-19 vaccine hesitancy.
- Communication strategies may consider various behaviour change techniques to address determinants of individuals’ willingness to receive a COVID-19 vaccine, including information about health consequences, social support or encouragement, prompts/cues, among others.
- COVID 19 vaccination campaigns must be sensitive to individuals’ past-experiences of discrimination by identifying appropriate channels of communication and sites for vaccine distribution to reach those who may mistrust the vaccination campaign.
This section below summarizes published and grey literature on vaccine hesitancy among health care workers (HCWs) during the COVID-19 pandemic, and interventions to increase vaccination uptake.
COVID-19 Vaccination Acceptance
- An emerging body of evidence has begun to document HCWs’ willingness to receive a COVID-19 vaccine and the factors underlying their willingness.
- Nine single studies conducted across the globe (United States, France, Egypt, Saudi Arabia, China, Hong Kong) and two systematic reviews (international) reported HCWs willingness to receive a COVID-19 vaccine varied greatly; one systematic review suggested the overall proportion of HCWs positively inclined towards receiving a COVID-19 vaccine ranged from 27.7% to 81.5%.
Barriers and Enablers of Vaccine Uptake
- Overall, knowledge of the factors that affect intention of HWCs to accept COVID-19 vaccination is limited. Overall attitudes toward vaccination were positive but specific concerns regarding the COVID-19 vaccine are prevalent. Differences in vaccine acceptance were noted between individual and group characteristics.
- Barriers: Selected barriers include: female gender; Black, Latinx, Conservative/ Republican HCWs; rural work setting; concerns regarding COVID-19 vaccine safety (e.g., unknown risks, insufficient data, known side effects); concerns about vaccine effectiveness; and concerns about expedited development/approval process; experience with racial discrimination.
- Enablers: Selected enablers include: male gender; older age; physician profession; presence of comorbidities or chronic diseases; fear of COVID-19; perceived risk; stronger vaccine confidence; belief that COVID-19 vaccine will likely to stop the pandemic; social contacts’ decisions to have vaccine; and reliance on CDC website for COVID 19 updates.
- After an FDA advisory committee voted to recommend an emergency use authorization, the proportion of HCWs in a Pennsylvania health system intending to receive a COVID-19 vaccine increased (i.e., 79% of HCWs [n = 1,155].
Interventions to Increase COVID-19 Uptake
- No identified studies reported interventions for increasing COVID-19 vaccination uptake among HCWs. Since the distribution of vaccinations began in early December 2020, there likely has been little opportunity to examine interventions to address COVID-19 vaccine hesitancy.
- Key interventions to increase HCW uptake of other vaccines (i.e., influenza, hepatitis B, other vaccines) included: Provision of free vaccine; easy access to the vaccine; educational activities and/or reminders and/or incentives; management or organizational changes; and long-term implementation of the strategy, such as mandatory vaccination policies
Recommendations to Increase COVID-19 Vaccine Confidence
- The US Centers for Disease Control and Prevention (CDC) outlined six steps to build COVID-19 vaccine confidence among HCWs: 1) encourage senior leaders to be vaccine champions; 2) host discussions where personnel at different levels can provide input and ask questions; 3) share key messages with staff through emails, breakroom posters, and other channels; 4) educate health care teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to other about the vaccines; 5) educate non-medical staff about the importance of getting vaccinated; and, 6) make the decision to get vaccinated visible, and celebrate it.
- Recent preliminary survey data of a long-term care home staff from British Columbia found that 57% intended to get the COVID-19 vaccine when it became available.
The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:
- Ontario Health
- McMaster Health Forum