Given the caring nature of their profession, the general public may assume that there is no vaccine hesitation among healthcare workers. It may surprise (and anger) the community when health workers oppose the introduction of a COVID vaccine mandate.
In France, about 3,000 health workers have been suspended for not being vaccinated. In Greece, health workers have opposed mandatory vaccination plans. Similar scenes have been played in Canada and New York State.
In Australia, health workers have reportedly joined protests in Melbourne and Perth. A small number of non-vaccinated staff members are challenging the vaccination mandate in the NSW Supreme Court. Beyond the hospital sector, there are reports of staff members leaving the aged care sector after the introduction of the mandate.
The hesitation among health workers reflects concerns in the wider community. But the risks of vaccination in health settings mean we must acknowledge these concerns and support informed decision-making.
Read more: ‘Living with COVID’ looks very different for front-line health workers, already exhausted
a series of concerns
More than 90% of healthcare workers in NSW and Victoria have received a COVID vaccine. But there remains a small percentage of people who work in hospitals and other clinical settings who are hesitant or want to choose the vaccine they receive. NSW health statistics show that currently around 7% (or 7,350 staff members) have not been vaccinated.
Internationally, the prevalence of COVID vaccination hesitation among healthcare workers is between 4.3 and 72% (average 23%).
In the US, one in four hospital workers who came into direct contact with patients had not received a single dose of a COVID vaccine by the end of May.
A study conducted in the first few months of this year found that while most health workers intended to accept a COVID vaccine, 22% were unsure or did not intend to vaccinate. These findings match those of a study in Italy that found that 33% of health workers were unsure or did not intend to vaccinate.
The top three reasons health workers are hesitant echo similar concerns expressed by some in the wider community: vaccine safety, efficacy and side effects.
Earlier surveys conducted abroad showed that less than a third of healthcare workers felt they had enough information about COVID vaccines. And, like the wider community, health workers are vulnerable to misinformation and sometimes have an inadequate understanding of how vaccines are developed.
While hospital patients are more likely to be the source of a COVID outbreak in a hospital, unvaccinated health and aged care workers still pose a risk to patient and resident safety. Transmission of COVID to or among non-vaccinated health workers is a risk to the wider community, including their families and friends.
Beyond the risk of transmission, vaccine-hesitant health workers also have an impact on widespread vaccine trust. Health workers are seen as a reliable source of information and are trusted by the community.
There are videos on social media, YouTube and TikTok of individual health workers speaking about COVID vaccines, often repeating misinformation or expressing uncertainty about the safety or effectiveness of vaccines. The potential impact of these viral videos may increase compared to speakers who do not work in the health professions. University of Washington researcher Rachel Moran, who investigates Internet misinformation, says such health workers are
There is considerable debate among doctors and nurses about COVID vaccines, while in fact, there is a general consensus about their efficacy and safety, taking advantage of the credibility of medical professionals to create a false impression.
Read more: ‘Are you double dosed?’ How to ask friends and family if they have been vaccinated, and how to handle it if they say no?
How can we all stay safe?
Going forward, when it comes to healthcare workers and vaccine hesitation, we must acknowledge three things:
1. Don’t judge
While there is an ethical imperative and duty of care for healthcare workers to receive a COVID vaccine, we must ensure that non-vaccinated staff members have the opportunity to discuss vaccines in a non-judgmental manner.
Like the general public, we need to find out who health workers trust and connect them with reliable resources to ease their fears. This can be done through hospital websites, discussions with their primary health care providers, or evidence-based information.
2. Do what works
Unlike in the community setting, there has been a gap in funding for the development and testing of resources and interventions focused on supporting health and aged care worker vaccines.
Understanding the specific strategies that work to support vaccine introduction, without the need to go straight to mandates, is important not only from a patient safety standpoint but also from an occupational health and safety lens.
These findings are relevant to COVID and other commercial vaccine programs.
3. Ensure Supply and Access
Before a mandate can be launched, there is a need for adequate supply and equitable access to vaccines. We need to ensure that people have the opportunity to review vaccine safety and effectiveness data and receive the vaccine as they wish.
Careful planning, consultation and communication with key groups can improve the acceptability of mandates.
In the coming weeks, more healthcare workers are likely to resign or be sacked for failing to comply with the COVID mandate. There will be people in social media who will call the situation “the right move”. But some health workers will be vocal on the issue, privately or publicly, and doubt the vaccine. It is important that we prepare for these situations, especially in regional areas where there may be less voice and greater reliance on long-serving health workers.
Read more: 9 psychological barriers that lead to hesitation and denial of a COVID-19 vaccine