Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton
AIMS OF THE STUDY: Vaccination is regarded as the most promising response to the COVID-19 pandemic. We assessed opinions about COVID-19 vaccination, willingness to be vaccinated, and reasons for vaccination hesitancy among healthcare workers.
METHODS: We conducted a cross-sectional, web-based survey among 3,793 healthcare workers in December 2020 in the Canton of Solothurn, Switzerland, before the start of the national COVID-19 vaccination campaign.
RESULTS: Median age was 43 years (interquartile range [IQR] 31–53), 2,841 were female (74.9%). A total of 1,511 healthcare workers (39.8%) reported willingness to accept vaccination, whereas 1,114 (29.4%) were unsure and 1,168 (30.8%) would decline vaccination. Among medical doctors, 76.1% were willing, whereas only 27.8% of nurses expressed willingness. Among the 1,168 healthcare workers who would decline vaccination, 1,073 (91.9%) expressed concerns about vaccine safety and side effects. The willingness of healthcare workers to be vaccinated was associated with older age (adjusted odds ratio [aOR] 1.97, 95% confidence interval [Cl] 1.71–2.27) and having been vaccinated for influenza this year (aOR 2.70, 95% Cl 2.20–3.31). Healthcare workers who reported a lack of confidence in government were less likely to be willing to be vaccinated (aOR 0.58, 95% Cl 0.40–0.84), and women were less willing to be vaccinated than men (OR 0.33, 95% CI 0.28–0.38).
CONCLUSION: Less than half of healthcare workers reported willingness to be vaccinated before the campaign start, but proportions varied greatly depending on profession and workplace. Strategies with clear and objective messages that particularly address the concerns of healthcare workers are needed if their willingness to be vaccinated against COVID-19 is to be further increased.
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al.; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb;382(8):727–33. https://doi.org/10.1056/NEJMoa2001017
- World Health Organization. Coronavirus Disease (COVID-19) Dashboard Geneva: World Health Organization; 2021 [cited 2021 13 Reburary]. Available from: https://covid19.who.int/
- Federal Office of Public Health (FOPH). Coronavirus: Situation Schweiz Bern Federal Office of Public Health; 2021 [Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international.html
- Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International journal of surgery (London, England). 2020;78:185-93.
- Kim JH, Marks F, Clemens JD. Looking beyond COVID-19 vaccine phase 3 trials. Nat Med. 2021 Feb;27(2):205–11. https://doi.org/10.1038/s41591-021-01230-y
- Parker EP, Shrotri M, Kampmann B. Keeping track of the SARS-CoV-2 vaccine pipeline. Nat Rev Immunol. 2020 Nov;20(11):650. https://doi.org/10.1038/s41577-020-00455-1
- London School of Hygiene & Tropical Medicine. COVID-19 vaccine tracker London: London School of Hygiene & Tropical Medicine; 2020 [Available from: https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/
- So AD, Woo J. Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis. BMJ. 2020 Dec;371:m4750. https://doi.org/10.1136/bmj.m4750
- Swissmedic. Swissmedic grants authorisation for the first COVID-19 vaccine in Switzerland Bern: Swissmedic; 2020 [Available from: https://www.swissmedic.ch/swissmedic/en/home/news/coronavirus-covid-19/covid-19-impfstoff_erstzulassung.html
- Swissmedic. Swissmedic grants authorisation for the COVID-19 vaccine from Moderna: Second COVID-19 vaccine authorised in Switzerland Bern: Swissmedic; 2021 [Available from: https://www.swissmedic.ch/swissmedic/en/home/news/coronavirus-covid-19/zulassung-covid-19-impfstoff-moderna.html
- Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020 Apr;395(10231):1225–8. https://doi.org/10.1016/S0140-6736(20)30627-9
- International Council of Nurses. International Council of Nurses High proportion of healthcare workers with COVID-19 in Italy is a stark warning to the world: protecting nurses and their colleagues must be the number one priority. 20 March, 2020. Geneva: International Council of Nurses; 2020 [Available from: https://www.icn.ch/news/high-proportion-healthcare-workers-covid-19-italy-stark-warning-world-protecting-nurses-and
- Garcia-Basteiro AL, Moncunill G, Tortajada M, Vidal M, Guinovart C, Jiménez A, et al. Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital. Nat Commun. 2020 Jul;11(1):3500. https://doi.org/10.1038/s41467-020-17318-x
- Folgueira MD, Muñoz-Ruipérez C, Alonso-López MÁ, Delgado R. SARS-CoV-2 infection in Health Care Workers in a large public hospital in Madrid, Spain, during March 2020. medRxiv. 2020:2020.04.07.20055723.
- Thompson HA, Mousa A, Dighe A, Fu H, Arnedo-Pena A, Barrett P, et al. SARS-CoV-2 setting-specific transmission rates: a systematic review and meta-analysis. Clin Infect Dis. 2021 Aug;73(3):e754–64. https://doi.org/10.1093/cid/ciab100
- Napolitano F, Bianco A, D’Alessandro A, Papadopoli R, Angelillo IF. Healthcare workers’ knowledge, beliefs, and coverage regarding vaccinations in critical care units in Italy. Vaccine. 2019 Oct;37(46):6900–6. https://doi.org/10.1016/j.vaccine.2019.09.053
- Harrison N, Brand A, Forstner C, Tobudic S, Burgmann K, Burgmann H. Knowledge, risk perception and attitudes toward vaccination among Austrian health care workers: A cross-sectional study. Hum Vaccin Immunother. 2016 Sep;12(9):2459–63. https://doi.org/10.1080/21645515.2016.1168959
- Larson HJ, Schulz WS, Tucker JD, Smith DM. Measuring vaccine confidence: introducing a global vaccine confidence index. PLoS Curr. 2015 Feb;7:7. https://doi.org/10.1371/currents.outbreaks.ce0f6177bc97332602a8e3fe7d7f7cc4
- Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008 Feb;86(2):140–6. https://doi.org/10.2471/BLT.07.040089
- Anderson RM, Vegvari C, Truscott J, Collyer BS. Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination. Lancet. 2020 Nov;396(10263):1614–6. https://doi.org/10.1016/S0140-6736(20)32318-7
- Neumann-Böhme S, Varghese NE, Sabat I, Barros PP, Brouwer W, van Exel J, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ. 2020 Sep;21(7):977–82. https://doi.org/10.1007/s10198-020-01208-6
- Murphy J, Vallières F, Bentall RP, Shevlin M, McBride O, Hartman TK, et al. Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nat Commun. 2021 Jan;12(1):29. https://doi.org/10.1038/s41467-020-20226-9
- Shekhar R, Sheikh AB, Upadhyay S, Singh M, Kottewar S, Mir H, et al. COVID-19 Vaccine Acceptance Among Health Care Workers in the United States. medRxiv. 2021:2021.01.03.21249184.
- Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016 Dec;34(52):6700–6. https://doi.org/10.1016/j.vaccine.2016.10.042
- Bianco A, Pileggi C, Iozzo F, Nobile CG, Pavia M. Vaccination against human papilloma virus infection in male adolescents: knowledge, attitudes, and acceptability among parents in Italy. Hum Vaccin Immunother. 2014;10(9):2536–42. https://doi.org/10.4161/21645515.2014.969614
- Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ. A systematic review of factors affecting vaccine uptake in young children. Vaccine. 2017 Oct;35(45):6059–69. https://doi.org/10.1016/j.vaccine.2017.09.046
- Baicus A. History of polio vaccination. World J Virol. 2012 Aug;1(4):108–14. https://doi.org/10.5501/wjv.v1.i4.108
- A gamble pays off in 'spectacular success': How the leading coronavirus vaccines made it to the finish line [press release]. Washington, United States The Washington Post2020.
- Larson HJ, Clarke RM, Jarrett C, Eckersberger E, Levine Z, Schulz WS, et al. Measuring trust in vaccination: A systematic review. Hum Vaccin Immunother. 2018 Jul;14(7):1599–609. https://doi.org/10.1080/21645515.2018.1459252
- van der Weerd W, Timmermans DR, Beaujean DJ, Oudhoff J, van Steenbergen JE. Monitoring the level of government trust, risk perception and intention of the general public to adopt protective measures during the influenza A (H1N1) pandemic in The Netherlands. BMC Public Health. 2011 Jul;11(1):575. https://doi.org/10.1186/1471-2458-11-575
- Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, et al. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine. 2015 Jun;2(8):891–7. https://doi.org/10.1016/j.ebiom.2015.06.018
- Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2020;1–4.
- Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ. 2009;339(jul02 3):b2651. doi:https://doi.org/https://doi.org/10.1136/bmj.b2651.
- Blair RA, Morse BS, Tsai LL. Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia. Soc Sci Med. 2017 Jan;172:89–97. https://doi.org/10.1016/j.socscimed.2016.11.016
- Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect Dis. 2019 May;19(5):529–36. https://doi.org/10.1016/S1473-3099(19)30063-5
- Moxham-Hall V, Strang L. Public opinion and trust in government during a public health crisis London: King's College London; 2020 [Available from: https://www.kcl.ac.uk/news/public-opinion-and-trust-in-government-during-a-public-health-crisis
- Adam DC, Wu P, Wong JY, Lau EH, Tsang TK, Cauchemez S, et al. Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong. Nat Med. 2020 Nov;26(11):1714–9. https://doi.org/10.1038/s41591-020-1092-0
- Piroth L, Cottenet J, Mariet AS, Bonniaud P, Blot M, Tubert-Bitter P, et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Respir Med. 2020.
- Petersen E. COVID-19 is not influenza. Lancet Respir Med. 2020.
- Zürcher K, Zwahlen M, Berlin C, Egger M, Fenner L. Losing ground at the wrong time: trends in self-reported influenza vaccination uptake in Switzerland, Swiss Health Survey 2007-2017. BMJ Open. 2021 Feb;11(2):e041354. https://doi.org/10.1136/bmjopen-2020-041354
- Sullivan SG, Chilver MB, Carville KS, Deng YM, Grant KA, Higgins G, et al. Low interim influenza vaccine effectiveness, Australia, 1 May to 24 September 2017. Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2017;22(43).
- Sah P, Medlock J, Fitzpatrick MC, Singer BH, Galvani AP. Optimising the impact of low-efficacy influenza vaccines. Proceedings of the National Academy of Sciences of the United States of America. 2018.