|Year : 2022 | Volume
| Issue : 4 | Page : 820-824
Willingness for COVID-19 vaccination among health-care workers: During initial days of vaccination in a tertiary care hospital of Odisha
Smaranita Sabat1, Sambedana Mohanty1, Lipilekha Patnaik1, Sumitra Pattanaik1, Pusparaj Samantsinghar2
1 Department of Community Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Forensic Medicine and Toxicology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
|Date of Submission||17-Oct-2022|
|Date of Decision||29-Nov-2022|
|Date of Acceptance||30-Nov-2022|
|Date of Web Publication||10-Feb-2023|
Dr. Smaranita Sabat
Department of Community Medicine, IMS and SUM Hospital, K8 Kalinga Nagar, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
Background: COVID-19 vaccine was launched in India on 16 January 2021, prioritizing health care workers. There is lot of apprehensions and anxiety regarding uptake of the vaccine among them. So, determining the acceptability of a COVID-19 vaccine by healthcare professionals will also guide future vaccination studies. Objective: To know the willingness for COVID-19 vaccination among healthcare workers in a tertiary care hospital and to explore the factors responsible for unwillingness of COVID-19 vaccination. Methods: A cross-sectional study was conducted among health care workers of a tertiary care hospital of Odisha. Those who refused to participate in the study, pregnant & lactating mothers and those who participated in COVID 19 vaccine clinical trial were excluded from the study. Data was collected from 746 HCWs for a period of three months i.e., from January 2021 to April 2021. Results: 78.8% HCWs were willing to get vaccinated with COVID 19 vaccine. Also 78.6% HCWs were willing to get their family members vaccinated with COVID 19 vaccine. But 53.6% study participants were not willing for COVID 19 vaccination if they do not get the option of free vaccine. Major reasons for COVID-19 vaccine hesitancy were concerns about the safety (60.8%) and efficacy of the vaccine (58.8%). Vaccine acceptance was more in older age group, Hindus, rural residents and those who have already suffered from COVID 19. Conclusion: Effort should be made to eliminate the doubts and concerns regarding the COVID 19 vaccine.
Keywords: COVID-19, health-care workers, vaccine hesitancy, vaccine
|How to cite this article:|
Sabat S, Mohanty S, Patnaik L, Pattanaik S, Samantsinghar P. Willingness for COVID-19 vaccination among health-care workers: During initial days of vaccination in a tertiary care hospital of Odisha. J Datta Meghe Inst Med Sci Univ 2022;17:820-4
|How to cite this URL:|
Sabat S, Mohanty S, Patnaik L, Pattanaik S, Samantsinghar P. Willingness for COVID-19 vaccination among health-care workers: During initial days of vaccination in a tertiary care hospital of Odisha. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Mar 28];17:820-4. Available from: http://www.journaldmims.com/text.asp?2022/17/4/820/369513
| Introduction|| |
The most effective community health initiative known to humankind is immunization. With vaccination, many infectious diseases have been controlled. In addition to protecting those who have received the vaccination, herd immunity through indirect effects may also help to minimize the disease among those who have not received the vaccination. However, herd immunity can be attained when a sufficient part of the population is vaccinated. Hence, vaccination for the development of herd immunity is dependent on each individual's willingness to be vaccinated. The negative impact on this willingness is due to doubts about the safety and effectiveness of a vaccine, vaccine costs and benefits, social considerations, misinformation, and misconceptions about vaccines. If too many people hesitate to vaccinate, we may not get herd immunity.,
Willingness for vaccination is important for the success of an immunization program. Vaccine hesitancy specifies “delays in acceptance or refusal of vaccination despite the availability of vaccination services.” Vaccine hesitation has grown to be one of the main issues in recent years. The lower rate of vaccine acceptance, particularly those that have been produced for a long time, has become a significant challenge to combat infectious illness. In 2019, the WHO ranked vaccine hesitancy among the top 10 threats to global health. The most common reasons for vaccine hesitancy as identified by the WHO Vaccine Advisory Group were difficulty in accessing vaccines, complacency, and a lack of public confidence.
It is expected that health-care workers (HCWs) are aware of the risks of vaccine-preventable diseases and benefits of vaccination. They are also expected to do their best to transmit this information to their patients. Previous research has shown a strong correlation between vaccine knowledge and the attitudes of health-care professionals and immunization recommendations for patients. Health-care providers are thought to provide the most relevant information on vaccines. Hesitancy among HCWs about vaccines may partly undermine trust and lead to vaccine hesitancy among the general population.
Despite influenza becoming a seasonal flu virus in India even during summer, the uptake of flu vaccine in India is poor, due to which 1000 of cases and deaths get reported each year. Vaccine hesitancy is not new as many studies are available regarding HCWs' attitude toward seasonal or pandemic influenza vaccines in particular. The majority of the health-care personnel did not obtain the flu vaccine due to time constraints, low risk of flu, or concerns about safety and efficacy. In India, different states had different aspects and reasons for vaccine and immunization coverage. In previous studies, it was reported that the influenza vaccination uptake was 11% among health-care professionals in India. The barrier to vaccination was due to the belief that they were healthy and they will not contract the disease.
Currently, COVID-19 immunization studies are at the forefront due to the pandemic, especially for frontline workers and those at increased risk. Future research on vaccination will also be guided by determining whether health-care professionals will adopt the COVID-19 vaccine. Hence, the purpose of the study was to determine the willingness for COVID-19 vaccination among HCWs in a tertiary care hospital and to explore the factors responsible for unwillingness of COVID-19 vaccination.
| Materials and Methods|| |
This cross-sectional study was conducted among HCWs of a tertiary care hospital of Odisha. The study was undertaken for 3 months, i.e., from January 2021 to April 2021. The study began just after vaccination for HCW was started (January 16, 2021). The study population consisted of all HCWs of a tertiary care hospital of Odisha. HCW is a person who provides care and services to ill patients either directly as doctors and nurses or indirectly as assistants, helpers, laboratory technicians, or even medical waste handlers. Those who refused to participate in the study, lactating mothers, and those who participated in COVID-19 vaccine clinical trial were excluded from the study.
Ethical clearance was obtained from the Institutional Ethics Committee (DRI/IMS. SH/SOA/2021/038). Data were collected by visiting each and every department of the hospital. Informed consent was obtained from each study participant after explaining to them the study objectives. A predesigned, pretested, semi-structured questionnaire was used to conduct face-to-face interviews. The questionnaire included 17 questions about sociodemographic attributes, status of prior immunization, willingness for COVID-19 vaccination, and reasons for unwillingness.
Statistical software SPSS version 20 (IBM Corp., Armonk, NY, USA) was used to analyze the data that were entered in Excel spreadsheet. Rates and proportions were calculated. The Chi-square test was used for finding the association. A P < 0.05 was considered to be statistically significant.
| Results|| |
The study included 746 HCWs in total. The study participants ranged in age from 21 to 69, with a mean age of 33.05 ± 12.47. Most of the study participants were below 45 years (75%). More than half (57.2%) of the study participants were females. The majority of them were Hindu by religion (94.6%). Among the study participants, 37.5% were physicians, 39.5% were nurses, 13.4% were paramedics, and the rest 9.5% were other staff such as sweeper and attendants. The majority of them resided in urban areas (83.4%) and were from nuclear families (59.2%). Almost 81.2% of participants did not suffer from any chronic medical condition, whereas the rest of them suffered from chronic diseases such as asthma (5.6%), diabetes mellitus (5.8%), hypertension (5.5%), and heart disease (1.9%). Among those interviewed 126 (16.9%) had already suffered from COVID-19 [Table 1].
|Table 1: Sociodemographic characteristics of the study population (n=746)|
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It was found that only 8% HCWs were vaccinated with influenza vaccine within 1 year and only 3.8% HCWs were vaccinated with pneumonia vaccine within 5 years. However, most of them were vaccinated with tetanus vaccine within 5 years (75.6%). Out of 746 HCWs, 78.8% were interested in receiving the COVID-19 vaccine, whereas the remaining 21.2% were not interested in receiving COVID-19 vaccine. Furthermore, 78.6% HCWs were willing to get their family members vaccinated with COVID-19 vaccine. However, 53.6% of study participants were reluctant for COVID-19 vaccination if they do not get the option of free vaccine [Table 2].
When asked about their reaction if COVID-19 vaccine is made compulsory by government, 34.6% HCWs were strongly in favor of it, 13.9% were somewhat in favor of it, 27.3% were strongly against it, 4% were somewhat against it, and 20.1% were neutral or had no opinion about it [Figure 1].
|Figure 1: Reaction if COVID-19 vaccine is made compulsory by government (n = 746)|
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Among the hesitant HCWs majority of them had concerns regarding the vaccine's safety (60.8%) and vaccine's efficacy (58.8%). Other reasons for not accepting the COVID-19 vaccines were that they believed in natural remedies for the prevention of COVID-19 (13.3%) and they thought COVID-19 is not dangerous (9.5%) [Figure 2].
[Table 3] lists the variables that influence HCWs willingness to receive the COVID-19 vaccine. Age, religion, residence, and prior COVID-19 infections were significantly associated (P < 0.05) with willingness for COVID-19 vaccination. Older individuals, Hindus, rural residents, and those who have already suffered from COVID-19 mostly desired to receive the COVID-19 vaccine.
|Table 3: Distribution of factors associated with willingness for COVID-19 vaccinations (n=746)|
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| Discussion|| |
This study was undertaken among the health-care providers regarding their willingness for COVID-19 vaccination. The opinions of the HCWs were taken just after the rollout of the COVID-19 vaccine in India and the HCWs were the first subgroup to have access to the vaccine. In this study, it was found that 78.8% HCWs were interested in receiving the COVID-19 vaccine, whereas 21.2% HCWs were hesitant to receive the vaccine. Huge variations were seen in the acceptance and reluctance of COVID-19 immunization among health-care professionals worldwide. In a study by Kose et al., it was found that 68.6% of HCWs in Turkey were ready to accept the vaccine. In another survey by Di Gennaro et al. among Italian HCWs 67% were reported to be willful to accept COVID-19 vaccination, whereas 26% were not sure and 7% refused to accept it. However, only 36% of responders in a study by Shekhar et al. among HCWs in the US were eager to receive the vaccination as soon as it was made accessible. About 13.5% of HCWs in a study by Ar-Aliae Hussein in Egypt totally agreed to accept the vaccine, 32.4% partially agreed, and 40.9% disagreed. Biswas et al. in their study revealed that the average rate of COVID-19 vaccination reluctance among HCWs was 22.5%, with a prevalence range of 4.3% to 72% worldwide.
In our study, the uptake of adult vaccines such as influenza vaccine, pneumonia vaccine, and tetanus vaccine among HCWs was found to be only 8%, 3.8%, and 75.6%, respectively. These findings, when considered collectively, imply that HCWs acceptability of the COVID-19 vaccination is higher than that of other adult vaccines. Similar findings were obtained in a study by Kose et al., who reported that acceptance of the COVID-19 vaccine (68.6%) was higher than that of the influenza vaccine (27.4%) and pneumonia vaccine (10.8%). Although prior vaccination status is a predictor of vaccine uptake, acceptability of the COVID-19 vaccine may be different due to the severity of the disease.
It was also found that those HCWs who were prepared to accept the COVID-19 vaccine were also eager to vaccinate their family members with the vaccine (78.6%). However, only 46.4% HCWs were willing to get vaccinated if they have to pay for it. Contrarily, a study by Shaw et al. among HCWs of the US reported that nearly one-third of HCWs were unsure whether they would take the COVID-19 vaccine if offered free.
Regarding the reaction of the HCWs if the COVID-19 vaccine is made compulsory by government, 34.6% HCWs were strongly in favor of it, 27.3% were strongly against it, and 20.1% were neutral or had no opinion about it. Studies by Qattan et al. and Shaw et al. had similar findings, with 39.6% and 34.1% of HCWs, respectively, believing that the COVID-19 vaccine should be made universally mandatory.,
The current study found that the HCWs reluctance to adopt the COVID-19 vaccines was primarily due to concerns about the adverse effects (60.8%) and efficacy (58.8%) of the vaccines. Other factors for COVID-19 vaccine reluctance included the perception that COVID-19 is not hazardous (9.5%) and the belief in natural therapies for COVID-19 prevention (13.3%). These findings are consistent with other studies. [13,, Concerns regarding the vaccine's safety, efficacy, and side effects were listed by Biswas et al. as the top three barriers to HCWs receiving the COVID-19 vaccine in their study. These concerns are probably due to the quick preparation and approval of the vaccine. It may also be due to a lack of comprehensive data about the vaccine and media controversy.
While analyzing the factors related to desire for vaccination it was found that age, religion, residence, and prior COVID-19 infections were significantly associated with willingness for the COVID-19 vaccine. More number of people in the higher age group, i.e., 45–50 years (86%) and >60 years (86.8) were willing to take the vaccine as compared to the lower age group, i.e., <45 years (76.6%). Similar findings were reported in various other studies. This might be because older age groups frequently have several comorbidities and are more susceptible to the negative effects from COVID-19, which makes elderly people highly apprehensive.
In the present study, there was no significant difference in desire for COVID-19 vaccination among men and women. However, male HCWs were found to be more open to vaccinations than female HCWs in most of the studies., Among Hindus 81.9% were willing to get vaccinated, whereas only 25% of both Muslims and Christians were willing to get vaccinated. This may be attributed to the religious beliefs among the study participants. The acceptance of the COVID-19 vaccination was higher in rural areas (90.6%) than in urban areas (76.5%). Moreover, those who had prior COVID-19 infection (95.2%) were willing to be vaccinated as compared to those without prior COVID-19 infections (75.5%). This may be due to their personal experience regarding the severity of the disease. Contrary to this study Shekhar et al. found that HCWs working in rural settings had lower vaccine acceptance rates (26%). They also revealed that those HCWs who believed themselves to be immune to COVID-19 (22%) and felt confident that they will not get infected (27%) had higher rate of vaccine hesitancy.
This study had the limitation that it was conducted just after the COVID-19 vaccination had started for the HCWs. Therefore, it could have overestimated the initial vaccine hesitancy. Furthermore, those who were hesitant may get converted into vaccine acceptors in due course of time. Moreover, this study was undertaken in a single institution. Hence, further studies are required regarding the issue.
| Conclusion|| |
Despite the limited data regarding COVID-19 vaccines, 78.8% HCWs were willing to get themselves vaccinated with the vaccine. However, those HCWs who are hesitant toward COVID-19 vaccines are unlikely to recommend these vaccines to their family members and also to the general public hindering mass vaccinations.
HCWs should be adequately educated about the importance of vaccines, and how they can help in preventing infection and reduce severity in case one is infected. This will increase their confidence in the COVID-19 vaccine.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]