COVID vaccine: even healthcare workers may be hesitant – but new evidence can be reassuring

Both in the UK and around the world, healthcare workers will be among the first to be offered a vaccine against coronavirus. But research suggests that some staff are hesitant about accepting one. Why might there be a level of vaccine hesitancy among health workers, and how can we address their concerns?

Vaccination behaviour varies between people who accept all vaccines, to those who have uncertainties over accepting or refusing them (the fence sitters), through to people who will refuse all vaccines. The uncertainties that can cause people to be hesitant can range from minor reservations through to more significant vaccine concerns, but are often focused on issues such as safety, and so are different from the more outlandish conspiracy theories expressed by staunch anti-vaxxers.

Research conducted in Israel suggests that, while the majority of healthcare workers there intend to accept a coronavirus vaccine, around 22% of doctors and 39% of nurses are hesitant, meaning they are either undecided or unlikely to accept a vaccine.

Similarly, a recent study of healthcare workers in the US suggests that only one-third would get a vaccine as soon as it were made available to them. However, the vast majority of healthcare workers in the US do plan to get the vaccine at some stage, suggesting that it will be possible to overcome their initial hesitancy.

The surveys also suggest that vaccine hesitancy may vary by profession. As well as showing that doctors are more likely to accept a vaccine than nurses, research suggests that acceptance rates will be higher among healthcare staff who have been directly involved in caring for coronavirus patients. Of these staff, 94% indicated that they would accept a vaccine.

Hesitancy not unexpected

Reluctance among healthcare workers may be surprising given that they are among those most at risk of contracting the virus, but this hesitancy isn’t new. In England around a quarter of healthworkers every year do not get a flu vaccination, despite being offered it.

But promisingly, data recently released by Public Health England shows that flu vaccine uptake among healthcare staff is currently higher than it was at this stage last year. By the end of October 2020, 52% had been vaccinated against the flu, compared with 44% at this point in 2019. This suggests the pandemic has had a positive effect on uptake of the flu vaccine, which could bode well for the coronavirus vaccines about to be rolled out.

One limitation of the surveys on coronavirus vaccines is that they asked people about their intention to accept a hypothetical vaccine. When they were conducted, information was not available on important factors like vaccine effectiveness, side-effects and number of doses required. These are all likely to influence uptake. The positive news regarding the effectiveness and safety of the emerging coronavirus vaccines could mean that acceptance levels will be higher than those suggested by the surveys conducted so far.

What makes health workers hesitant?

There are a number of factors that can cause vaccine hesitancy. One of the most important is lack of trust and confidence. Even among healthcare workers, the most common reason for hesitancy is fear of vaccine side-effects, particularly for new vaccines. Most healthcare workers are not experts in vaccination and share many of the same concerns about vaccines that the wider public have.

The main concern expressed by the public is whether the new coronavirus vaccines are safe. People are worried about potential side-effects and the speed with which the vaccines have been developed.

We need to understand and combat these concerns that healthcare workers and the public have about coronavirus vaccines in order to build trust and confidence in them. And we need to do this in a number of ways – one of the most important being through transparent communication.

This communication should be clear about what the vaccines are made of, how they work, how they have been tested, and how it has been possible to get to the stage of having an approved vaccine so quickly. It should also acknowledge any areas of uncertainty and be transparent about possible side-effects. As part of the approach to building confidence, we also need to target misinformation, which can trigger hesitancy and negative emotions about vaccines, particularly if other sources of information are not available.

In this context, addressing the vaccine hesitancy of healthcare workers is particularly important. Not only will they be among the first to be offered a vaccine, but they will also play an important role in addressing vaccine hesitancy among the public, as they are seen as trusted providers of information. Health workers themselves need to feel confident in coronavirus vaccines so that they are able to communicate effectively about them with the public, listening to and addressing any concerns they have.

Lynn Williams has received funding from the Scottish Government's Chief Scientist Office.