Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers

Abstract

ObjectivesTo examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination.DesignCross-sectional anonymous survey among front-line, support service and administrative healthcare workers.SettingTwo large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine.Participants1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff.Primary outcome measuresThe primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers.ResultsAmong 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients.ConclusionsOur data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

COVID-19 Vaccination Hesitancy among Healthcare Workers—A Review

“…Indeed, 86.3% reported that scientific evidence on vaccine safety and efficacy would be the most convincing [133]. Healthcare workers were also more likely to trust the information on COVID-19 vaccines from other HCWs, especially their primary physicians, as opposed to information from hospital management, the federal government, or political authorities [213]. If this is generally true among HCWs, then this may help explain that initially published trials regarding vaccine safety and efficacy were not more convincing.…”

SARS-CoV-2 infections and attitudes towards COVID-19 vaccines among healthcare workers in the New York Metropolitan area, USA

“…Most HCWs in New York are now vaccinated but intensified efforts are needed to target and extend coverage to the unvaccinated. 4 While small, the unvaccinated segment is by no means trivial. HCWs are trusted sources of health information and their attitudes and perceptions can influence patient behaviours and social norms.…”

“… 8–16 Some of these studies have been further limited by their lack of generalisability and their narrow focus on clinicians even though non-clinical staff can also expose others if infected. 4 8 9 16 17 Up to date data are needed to characterise the HCW subpopulations at highest risk for SARS-CoV-2 infection for whom vaccines (including boosters) would particularly be beneficial. Furthermore, a better understanding of factors associated with vaccine hesitancy among unvaccinated HCWs could help inform tailored public health planning, programmes and policy aimed at increasing vaccine uptake.…”

“…Most HCWs in New York are now vaccinated but intensified efforts are needed to target and extend coverage to the unvaccinated 4. While small, the unvaccinated segment is by no means trivial.…”

“…Much of the research on HCW vaccine confidence were conducted before or shortly after COVID-19 vaccines became available through Emergency Use Authorisation and may no longer reflect the current landscape 8–16. Some of these studies have been further limited by their lack of generalisability and their narrow focus on clinicians even though non-clinical staff can also expose others if infected 4 8 9 16 17. Up to date data are needed to characterise the HCW subpopulations at highest risk for SARS-CoV-2 infection for whom vaccines (including boosters) would particularly be beneficial.…”