Hesitancy and Refusal of the COVID-19 Vaccine Among Healthcare Professionals: A Cross-Sectional Study in a Portuguese Hospital
DOI:
https://doi.org/10.20344/amp.22540Keywords:
Attitude of Health Personnel, COVID-19 Vaccines, Vaccination Hesitancy, Vaccination RefusalAbstract
Introduction: Vaccine hesitancy is recognized by the World Health Organization as a major global health threat. In the context of the COVID-19 pandemic, this issue has taken on unique dimensions. Healthcare professionals are considered one of the most reliable sources of information regarding vaccination. Their stance on immunization is a determining factor in their likelihood to recommend it to others, with potential repercussions for vaccination uptake rates in the general population. This study aimed to characterize the sociodemographic profile of healthcare professionals at a Portuguese tertiary hospital who declined COVID-19 vaccination and to analyze the reasons for hesitancy/refusal and future vaccination intentions.
Methods: A cross-sectional study was conducted in 2021, targeting healthcare professionals eligible for the completion of the primary COVID-19 vaccination schedule. Those who refused vaccination were asked to complete the “COVID-19 Non-Vaccination Questionnaire”, which included a multiplechoice question and an open response field regarding reasons for hesitancy/refusal and future vaccination intentions. Variables analyzed included gender, age, and professional category.
Results: Among the 6648 healthcare professionals in the sample, 2.3% (n = 153) declined to complete the vaccination schedule. The average age was 46 years (SD = 11), with the proportion in each age group being 1.2% aged ≤ 35 years, 2.5% aged 36 - 45 years, and 3.1% aged > 45 years. The vaccine refusal rate among all professionals of each gender was 2.3% for females and 2.4% for males. A higher proportion of refusals was observed among healthcare assistants (n = 53, 4.0%) and technical assistants (n = 13, 3.0%). Sixteen reasons for vaccine hesitancy/refusal were identified, with the most frequently reported being fear of adverse reactions (n = 31), insufficient research on vaccines (n = 22), and distrust in vaccine efficacy (n = 25). Only 28.1% (n = 43) expressed an intention to be vaccinated in the future.
Conclusion: A high acceptance rate for the primary COVID-19 vaccination schedule was observed. The likelihood of vaccine refusal was similar between genders but higher among individuals over 45 years and operational support staff. The reasons for vaccine refusal that implied concerns about the vaccine’s safety stood out. Further studies are needed to better understand the dynamics underlying vaccine hesitancy/refusal.
Downloads
References
World Health Organization. Fact sheet: immunization coverage. [consultado 2023 nov 30]. Disponível em: http://www.who.int/mediacentre/factsheets/fs378/en/.
The World Health Organization. Ten threats to global health in 2019. [consultado 2023 nov 30]. Disponível em: https://www.who.int/newsroom/spotlight/ten-threats-to-global-health-in-2019.
MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33:4161-4. DOI: https://doi.org/10.1016/j.vaccine.2015.04.036
Smith MJ. Promoting vaccine confidence. Infect Dis Clin North Am. 2015;29:759-69. DOI: https://doi.org/10.1016/j.idc.2015.07.004
Karafillakis E, Larson HJ, ADVANCE Consortium. The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations. Vaccine. 2017;35:4840-50. DOI: https://doi.org/10.1016/j.vaccine.2017.07.061
Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine. 2014;32:2150-9. DOI: https://doi.org/10.1016/j.vaccine.2014.01.081
Chirico F, Teixeira da Silva JA. Evidence-based policies in public health to address COVID-19 vaccine hesitancy. Future Virol. 2023;18:261-73. DOI: https://doi.org/10.2217/fvl-2022-0028
Shrestha S, Khatri J, Shakya S, Danekhu K, Khatiwada AP, Sah R, et al. Adverse events related to COVID-19 vaccines: the need to strengthen pharmacovigilance monitoring systems. Drugs Ther Perspect. 2021;37:376-82. DOI: https://doi.org/10.1007/s40267-021-00852-z
Patel SK, Pathak M, Tiwari R, Yatoo MI, Malik YS, Sah R, et al. A vaccine is not too far for COVID-19. J Infect Dev Ctries;14:450-3. DOI: https://doi.org/10.3855/jidc.12744
Kim JH, Hotez P, Batista C, Ergonul O, Figueroa JP, Gilbert S, et al. Operation warp speed: implications for global vaccine security. Lancet Glob Health. 2021;9:e1017-21. DOI: https://doi.org/10.1016/S2214-109X(21)00140-6
Paudyal V, Al-Hamid A, Bowen M, Hadi MA, Hasan SS, Jalal Z, et al. Interventions to improve spontaneous adverse drug reaction reporting by healthcare professionals and patients: systematic review and metaanalysis. Expert Opin Drug Saf. 2020;19:1173-91. DOI: https://doi.org/10.1080/14740338.2020.1807003
Kutasi K, Koltai J, Szabó-Morvai Á, Röst G, Karsai M, Biró P, et al. Understanding hesitancy with revealed preferences across COVID-19 vaccine types. Sci Rep. 2022;12:13293. DOI: https://doi.org/10.1038/s41598-022-15633-5
Leigh JP, Moss SJ, White TM, Picchio CA, Rabin KH, Ratzan SC, et al. Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries. Vaccine. 2022;40:4081-9. DOI: https://doi.org/10.1016/j.vaccine.2022.04.097
Dzieciolowska S, Hamel D, Gadio S, Dionne M, Gagnon D, Robitaille L, et al. Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian health care workers: A multicenter survey. Am J Infect Control. 2021;49:1152-7. DOI: https://doi.org/10.1016/j.ajic.2021.04.079
McClendon S, Proctor K. American nurses association underscores nurses’ role in successful mass vaccination campaigns: ‘most trusted’ profession key to building public confidence. 2020. [consultado 2024 jan 10]. Disponível em: https://www.nursingworld.org/news/newsreleases/2020/american-nurses-association-underscores-nurses-role---in-successful-mass-vaccination-campaigns---most-trusted--professionkey-to-building-public-confidence/.
Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34:6700- 6. DOI: https://doi.org/10.1016/j.vaccine.2016.10.042
Biswas N, Mustapha T, Khubchandani J, Price JH. The nature and extent of covid-19 vaccination hesitancy in healthcare workers. J Community Health. 2021:46;1244-51. DOI: https://doi.org/10.1007/s10900-021-00984-3
Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9:1763-73. DOI: https://doi.org/10.4161/hv.24657
Piraveenan M, Sawleshwarkar S, Walsh M, Zablotska I, Bhattacharyya S, Farooqui HH, et al. Optimal governance and implementation of vaccination programmes to contain the COVID-19 pandemic. R Soc Open Sci. 2021;8:210429. DOI: https://doi.org/10.1098/rsos.210429
Fieselmann J, Annac K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany. BMC Public Health. 2022;22:846. DOI: https://doi.org/10.1186/s12889-022-13265-y
Gu F, Lin H, Chen Z, Ambler G, Chen X, Chen X, et al. Future covid-19 booster vaccine refusal in healthcare workers after a massive breakthrough infection wave, a nationwide survey-based study. Vaccines. 2023;11:987. DOI: https://doi.org/10.3390/vaccines11050987
Dong Y, He Z, Liu T, Huang J, Zhang CJ, Akinwunmi B, et al. Acceptance of and preference for covid-19 vaccination in India, the United Kingdom, Germany, Italy, and Spain: an international cross-sectional study. Vaccines. 2022;10:832. DOI: https://doi.org/10.3390/vaccines10060832
Sallam M. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines. 2021;9:160. DOI: https://doi.org/10.3390/vaccines9020160
Khubchandani J, Bustos E, Chowdhury S, Biswas N, Keller T. COVID-19 vaccine refusal among nurses worldwide: review of trends and predictors. Vaccines. 2022;10:230. DOI: https://doi.org/10.3390/vaccines10020230
Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35:775-9. DOI: https://doi.org/10.1007/s10654-020-00671-y
Arshad MS, Masood I, Imran I, Saeed H, Ahmad I, Ishaq I, et al. COVID-19 vaccine booster hesitancy (VBH) among healthcare professionals of Pakistan, a nationwide survey. Vaccines. 2022;10:1736. DOI: https://doi.org/10.3390/vaccines10101736
Koh SW, Liow Y, Loh VW, Liew SJ, Chan YH, Young D. COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore. BMC Prim Care. 2022;23:81. DOI: https://doi.org/10.1186/s12875-022-01693-z
Guidry JP, Laestadius LI, Vraga EK, Miller CA, Perrin PB, Burton CW, et al. Willingness to get the COVID-19 vaccine with and without emergency use authorization. Am J Infect Control. 2021;49:137-42. DOI: https://doi.org/10.1016/j.ajic.2020.11.018
Wang K, Wong EL, Ho KF, Cheung AW, Chan EY, Yeoh EK, et al. Intention of nurses to accept coronavirus disease 2019 vaccination and change of intention to accept seasonal influenza vaccination during the coronavirus disease 2019 pandemic: a cross-sectional survey. Vaccine. 2020;38:7049-56. DOI: https://doi.org/10.1016/j.vaccine.2020.09.021
Kricorian K, Civen R, Equils O. COVID-19 vaccine hesitancy: misinformation and perceptions of vaccine safety. Hum Vaccin Immunother. 2022;18:1950504. DOI: https://doi.org/10.1080/21645515.2021.1950504
Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes toward a potential sars-cov-2 vaccine: a survey of U.S. adults. Ann Intern Med. 2020;173:964-73. DOI: https://doi.org/10.7326/M20-3569
Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: how many people would get vaccinated? Vaccine. 2020;38:6500-7. DOI: https://doi.org/10.1016/j.vaccine.2020.08.043
Gu M, Taylor B, Pollack HA, Schneider JA, Zaller N. A pilot study on COVID-19 vaccine hesitancy among healthcare workers in the US. PLoS One. 2022;17:e0269320. DOI: https://doi.org/10.1371/journal.pone.0269320
Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines. 2017;16:1107-18. DOI: https://doi.org/10.1080/14760584.2017.1381020
Anello P, Cestari L, Baldovin T, Simonato L, Frasca G, Caranci N, et al. Socioeconomic factors influencing childhood vaccination in two northern Italian regions. Vaccine. 2017;35:4673-80. DOI: https://doi.org/10.1016/j.vaccine.2017.07.058
Hak E, Schönbeck Y, De Melker H, Van Essen GA, Sanders EA. Negative attitude of highly educated parents and health care workers towards future vaccinations in the Dutch childhood vaccination program. Vaccine. 2005;23:3103-7. DOI: https://doi.org/10.1016/j.vaccine.2005.01.074
Arat A, Burström B, Östberg V, Hjern A. Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review. BMC Publ Health. 2019;19:290. DOI: https://doi.org/10.1186/s12889-019-6597-4
Gagneux-Brunon A, Detoc M, Bruel S, Tardy B, Rozaire O, Frappe P, et al. Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect. 2021;108:168-73. DOI: https://doi.org/10.1016/j.jhin.2020.11.020
Peterson CJ, Lee B, Nugent K. COVID-19 vaccination hesitancy among healthcare workers—a review. Vaccines. 2022;10:948. DOI: https://doi.org/10.3390/vaccines10060948
Zhou Y, Li R, Shen L. Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies. Vaccine X. 2023;13:100279. DOI: https://doi.org/10.1016/j.jvacx.2023.100279
Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health. 2021;194:245-51. DOI: https://doi.org/10.1016/j.puhe.2021.02.025
Holzmann-Littig C, Frank T, Schmaderer C, Braunisch MC, Renders L, Kranke P, et al. COVID-19 vaccines: fear of side effects among german health care workers. Vaccines. 2022;10:689. DOI: https://doi.org/10.3390/vaccines10050689
Torreele E. The rush to create a covid-19 vaccine may do more harm than good. BMJ 2020;370:m3209. DOI: https://doi.org/10.1136/bmj.m3209
Meyer MN, Gjorgjieva T, Rosica D. Trends in health care worker intentions to receive a covid-19 vaccine and reasons for hesitancy. JAMA Netw Open. 2021;4:e215344. DOI: https://doi.org/10.1001/jamanetworkopen.2021.5344
Vergara RJ, Sarmiento PJ, Lagman JD. Building public trust: a response to COVID-19 vaccine hesitancy predicament. J. Public Health. 2021;43:e291-2. DOI: https://doi.org/10.1093/pubmed/fdaa282
Rzymski P, Poniedziałek B, Fal A. Willingness to receive the booster covid-19 vaccine dose in Poland. Vaccines. 2021;9:1286. DOI: https://doi.org/10.3390/vaccines9111286
Day D, Grech L, Nguyen M, Bain N, Kwok A, Harris S, et al. Serious underlying medical conditions and covid-19 vaccine hesitancy: a large cross-sectional analysis from Australia. Vaccines. 2022;10:851. DOI: https://doi.org/10.3390/vaccines10060851
Smith BA, Ricotta EE, Kwan JL, Evans NG. COVID-19 risk perception and vaccine acceptance in individuals with chronic disease. medRxiv [Preprint]. 2022:2021.03.17.21253760. DOI: https://doi.org/10.1101/2021.03.17.21253760
Centers for Disease Control and Prevention. COVID-19 vaccines while pregnant or breastfeeding. [consultado 2023 nov 14]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html.
Bianchi F, Stefanizzi P, Gioia M, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines. 2022;21:1443-54. DOI: https://doi.org/10.1080/14760584.2022.2100766
Del Rio C, Malani P. COVID-19 in 2021—continuing uncertainty. JAMA. 2021;325:1389-90. DOI: https://doi.org/10.1001/jama.2021.3760
Romate J, Rajkumar E, Gopi A, Abraham J, Rages J, Lakshmi R, et al. What contributes to covid-19 vaccine hesitancy? A systematic review of the psychological factors associated with covid-19 vaccine hesitancy. Vaccines. 2022;10:1777. DOI: https://doi.org/10.3390/vaccines10111777
Dara S, Sharma SK, Kumar A, Goel AD, Jain V, Sharma MC, et al. Awareness, attitude, and acceptability of healthcare workers about covid-19 vaccination in western India. Cureus. 2021;13:e18400. DOI: https://doi.org/10.7759/cureus.18400
Dubov A, Distelberg BJ, Abdul-Mutakabbir JC, Beeson WL, Loo LK, Montgomery SB, et al. Predictors of COVID-19 vaccine acceptance and hesitancy among healthcare workers in southern california: not just “anti” vs. “pro” vaccine. Vaccines. 2021;9:1428. DOI: https://doi.org/10.3390/vaccines9121428
Choi K, Chang J, Luo YX, Lewin B, Munoz-Plaza C, Bronstein D, et al. “Still on the fence:” a mixed methods investigation of covid-19 vaccine confidence among health care providers. Workplace Health Saf. 2022;70:21650799211049811. DOI: https://doi.org/10.1177/21650799211049811
Farah W, Breeher L, Shah V, Hainy C, Tommaso CP, Swift MD. Disparities in COVID-19 vaccine uptake among health care workers. Vaccine. 2022;40:2749-54. DOI: https://doi.org/10.1016/j.vaccine.2022.03.045
Bajos N, Spire A, Silberzan L, Sireyjol A, Jusot F, Meyer L, et al. When lack of trust in the government and in scientists reinforces social inequalities in vaccination against covid-19. Front Public Health. 2022;10:908152. DOI: https://doi.org/10.3389/fpubh.2022.908152
Hollingsworth H. Unvaccinated medical workers turn to religious exemptions. [consultado 2022 mar 30]. Disponível em:https://www. usnews.com/news/us/articles/2022-02-14/unvaccinated-medicalworkers-turn-to-religious-exemptions.
Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ. Strategies for addressing vaccine hesitancy—a systematic review. Vaccine. 2015;33:4180-90. DOI: https://doi.org/10.1016/j.vaccine.2015.04.040
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
