Future COVID-19 Booster Vaccine Refusal in Healthcare Workers after a Massive Breakthrough Infection Wave, a Nationwide Survey-Based Study

Abstract

Background: An unprecedented coronavirus disease 2019 (COVID-19) wave occurred in China between December 2022 and January 2023, challenging the efficacy of the primary series of COVID-19 vaccines. The attitudes toward future COVID-19 booster vaccines (CBV) after the massive breakthrough infection among healthcare workers remain unknown. This study aimed to explore the prevalence and determinants of future CBV refusal after the unprecedented COVID-19 wave among healthcare workers. Methods: Between 9 and 19 February 2023, a cross-sectional nationwide online survey was conducted using a self-administered questionnaire vaccine among healthcare workers in China. Sociodemographics, profession, presence of chronic medical conditions, previous COVID-19 infection, attitudes towards future CBV, and reasons for future CBV refusal were collected. We estimated odds ratio [OR] with 95% confidence interval [CI] using a multivariable logistic regression model to explore the factors associated with future CBV refusal. Results: Among the 1618 participants who completed the survey, 1511 respondents with two or more doses of COVID-19 vaccines were analyzed. A total of 648 (41.8%) of respondents were unwilling to receive a future CBV. Multivariable logistic regression analysis revealed the association of CBV refusal with profession (vs. other staff, physician-adjusted OR 1.17, 95%CI 0.79–1.72, nurse-adjusted OR 1.88, 95%CI 1.24−2.85, p = 0.008), history of allergy (adjusted OR 1.72, 95%CI 1.05–2.83, p = 0.032), a lower self-perceived risk of future COVID-19 infection (p < 0.001), and a lower belief in CBV effectiveness (p = 0.014), safety (p < 0.001), and necessities for healthcare workers and the public (p < 0.001, respectively). Conclusions: Our findings highlight that a considerable proportion of healthcare workers were against a future booster dose after an unprecedented COVID-19 wave. Self-perception of future COVID-19 risk, and potential harm or doubtful efficacy of vaccines are the main determinants. Our findings may help public health authorities to establish future COVID-19 vaccination programs.

Impact of the COVID-19 pandemic on behavioral changes in healthcare workers in Italy

“…Instead, HCWs working in Emergency/Critical/Infectious Diseases wards, physicians, and those who need more information about COVID-19 were more willing to accept a vaccine against COVID-19 every year. This confirms the results of other surveys that physicians are more vaccine-acceptant (19,37,38). A higher level of knowledge about vaccine effectiveness and safety than other HCWs could be a possible explanation (39).…”

“…This finding is of great concern, given the well-established observation that HCWs are at higher risk of severe SARS-CoV-2 acquisition than general population and also because in Italy this vaccination is recommended and free of charge also for this group. The observed value was lower than the willingness to receive the second booster dose (52.6%) of HCWs in the same geographic area (18) and a future dose of vaccine in other countries with values of 58.2% (19) and 76.5% (20). However, more than half of the participants (58.1%) believed that COVID-19 vaccine should be mandatory for the HCWs.…”

“…It is well known that the coronavirus disease 2019 (COVID- 19) pandemic has resulted in a global public health emergency, and worldwide there have been 771 million confirmed cases and 7 million deaths (1). Several statewide unprecedented containment public health measures have been implemented in response to the pandemic to reduce its impact and limit the spread of the infection.…”