Background: COVID-19 booster uptake remained poor among healthcare workers (HCW) despite evidence of improved immunity against Delta and Omicron variants. While most studies used a questionnaire to assess hesitancy, this study aimed to identify factors affecting booster hesitancy by examining actual vaccine uptake across time. Method: COVID-19 vaccination database records among HCW working at seven Singaporean public primary care clinics between January to December 2021 were extracted, with sex, profession, place of practice, vaccination type, and dates. Time to booster was calculated from the date of vaccination minus date of eligibility. Chi-square test was used to compare the relationship between first dose and booster hesitancy, Kaplan–Meier method and log-rank test were adopted to evaluate differences in cumulative booster uptake. Multivariate Cox regression was used to investigate predictors for timely booster vaccination. Vaccination rate was charted across time and corroborated with media releases pertaining to legislative changes. Results: A total of 877 of 891 (98.9%) primary care HCW were fully vaccinated, 73.8% of eligible HCW had taken the booster. HCW were less booster hesitant [median 16 (5–31.3) days] compared to the first dose [median 39 (13–119.3) days]. First dose-hesitant HCW were more likely to be booster hesitant (OR = 3.66, 95%CI 2.61–5.14). Adjusting for sex, workplace, and time to first dose, ancillary (HR = 1.53, 95%CI 1.03–2.28), medical (HR = 1.8, 95%CI 1.18–2.74), and nursing (HR = 1.8, 95%CI 1.18–2.37) received boosters earlier compared with administrative staff. No temporal relationship was observed between booster uptake, legislative changes, and COVID-19 infection numbers. Conclusion: Vaccine hesitancy among HCW had improved from first dose to booster, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging, and strategic legislation might help to reduce delayed booster vaccination.

Background: COVID-19 booster uptake remained poor among healthcare workers (HCW) despite evidence of improved immunity against Delta and Omicron variants. While most studies used a questionnaire to assess hesitancy, this study aimed to identify factors affecting true booster hesitancy by examining actual vaccine uptake across time. Method: COVID-19 vaccination database records among HCW working at 7 Singaporean public primary care clinics between January to December 2021 were extracted, with gender, profession, place of practice, vaccination type and dates. Time to booster was calculated from the date of vaccination minus date of eligibility. Chi-square test was used to compare relationship between 1st dose and booster hesitancy, Kaplan-Meier method and Log-rank test were adopted to evaluate differences in cumulative booster uptake. Multivariate cox regression was used to investigate predictors for timely booster vaccination. Vaccination rate was charted across time and corroborated with media releases pertaining to legislative changes. Results: 877 of 891 (98.9%) primary care HCW were fully vaccinated, 73.8% of eligible HCW had taken the booster. HCW were less booster hesitant [median 16 (5-31.3) days] compared to the 1st dose [median 39 (13-119.3) days]. 1st dose hesitant HCW were more likely to be booster hesitant (OR=3.66, 95%CI 2.61-5.14). Adjusting for sex, workplace and time to 1st dose, ancillary (HR=1.53, 95%CI 1.03-2.28), medical (HR=1.8, 95%CI 1.18-2.74) and nursing (HR=1.8, 95%CI 1.18-2.37) received boosters earlier compared with administrative staff. No temporal relationship was observed between booster uptake, legislative changes and COVID-19 infection numbers. Conclusion: Vaccine hesitancy among HCW had improved from booster to 1st dose, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging and strategic legislation might help to reduce delayed booster vaccination.

Objectives: COVID-19 booster uptake has remained poor among healthcare workers (HCWs) despite evidence of improved immunity against the SARS-COV-2 δ (delta) and ο (omicron) variants. Although most studies have used a questionnaire to assess hesitancy, we aimed to identify factors affecting booster hesitancy by examining actual vaccine uptake across time. Methods: COVID-19 vaccination database records were extracted for HCWs working at 7 Singaporean public primary-care clinics between January and December 2021. Data included sex, profession, place of practice, vaccination type, and dates. Time to booster was calculated from the date of vaccination minus the date of eligibility. The χ2 test was used to compare the relationship between first dose and booster hesitancy. The Kaplan-Meier method and the log-rank test were used to evaluate differences in cumulative booster uptake. Multivariate Cox regression was used to investigate predictors of timely booster vaccination. The vaccination rate was charted across time and was corroborated with media releases pertaining to legislative changes. Results: Of 891 primary-care HCWs, 877 (98.9%) were fully vaccinated and 73.8% of eligible HCWs had taken the booster. HCWs were less booster hesitant (median, 16 days; range, 5–31.3) compared to the first dose (median, 39 days; range, 13–119.3). First-dose–hesitant HCWs were more likely to be booster hesitant (OR, 3.66; 95% CI, 2.61–5.14). Adjusting for sex, workplace, and time to first dose, ancillary HCWs (HR, 1.53; 95% CI, 1.03–2.28), medical HCWs (HR, 1.8; 95% CI, 1.18–2.74), and nursing HCWs (HR, 1.8; 95% CI, 1.18–2.37) received boosters earlier than administrative staff. No temporal relationship was observed for booster uptake, legislative changes, or COVID-19 case numbers. Conclusions: Vaccine hesitancy among HCWs had improved from first dose to booster, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging, and strategic legislation might help reduce delayed booster vaccination. This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on December 28, 2021 (Reg No. 2021/01120).