key: cord-0748129-6x16yxcb authors: Mohamed-Hussein, A. A.; sayed, i. g.; Makhlouf, n.; Makhlouf, H.; Abd El Aal, H.; Kholief, K.; Saad, M. M.; Abdellal, D. A. title: A national survey of potential acceptance of COVID-19 vaccines in healthcare workers in Egypt date: 2021-01-15 journal: nan DOI: 10.1101/2021.01.11.21249324 sha: aa2e9802324dce46863760b3f827865f769044d7 doc_id: 748129 cord_uid: 6x16yxcb Background: Since the start of COVID-19 outbreak investigators are competing to develop and exam vaccines against COVID-19. It would be valuable to protect the population especially health care employees from COVID-19 infection. The success of COVID-19 vaccination programs will rely heavily on public willingness to accept the vaccine. Aims: This study aimed to describe the existing COVID-19 vaccine approval landscape among the health care providers and to identify the most probable cause of agreement or disagreement of COVID-19 vaccine. Methods: A cross-sectional online survey was done. Results: The present study included 496 health care employees, 55% were at age group from 18-45 years old. History of chronic diseases was recorded in 40.4%, and definite history of drug/food allergy in 10.1%. Only 13.5% totally agree to receive the vaccine, 32.4% somewhat agree and 40.9% disagreed to take the vaccine. Causes of disagreement were none safety, fear of genetic mutation and recent techniques and believe that the vaccine is not effective (57%, 20.2%, 17.7% and 16.6% respectively). The most trusted vaccine was the mRNA based vaccine. The age of health care employees and the presence of comorbidities or chronic diseases were the main factors related to COVID-19 acceptance (P<0.001 and 0.02 respectively). Conclusion: Vaccine hesitancy is not uncommon in healthcare employees in Egypt and this may be an alarming barrier of vaccine acceptance in the rest of population. There is an urgent need to start campaigns to increase the awareness of the vaccine importance. totally agree to receive the vaccine, 32.4% somewhat agree and 40.9% disagreed to take the vaccine. Causes of disagreement were none safety, fear of genetic mutation and recent techniques and believe that the vaccine is not effective (57%, 20.2%, 17.7% and 16.6% respectively). The most trusted vaccine was the mRNA based vaccine. The age of health care employees and the presence of comorbidities or chronic diseases were the main factors related to COVID-19 acceptance (P<0.001 and 0.02 respectively). Conclusion: Vaccine hesitancy is not uncommon in healthcare employees in Egypt and this may be an alarming barrier of vaccine acceptance in the rest of population. There is an urgent need to start campaigns to increase the awareness of the vaccine importance. Keywords: COVID-19 vaccines; acceptance; healthcare workers; Egypt; safety; efficacy The COVID-19 outbreak postures a grave risk to human health (1) and investigators are competing to develop and exam vaccines against . When vaccines become available, the success of the immunization database will depend on the community's approval of the vaccines. Recent researches have shown that although a large majority state they would agree a novel vaccine against COVID-19 (3) (4) (5) , about one quarter state they would refuse (4, 6, 7) . A COVID-19 vaccine has been declared as vital to finish the pandemic and several experimental trials to evolve a vaccine for COVID-19 infection are presently being coordinated at an augmented level (1). In England, a Vaccine task-group has been developed to 'accelerate earlier and harmonize efforts to study and then develop a corona-virus vaccine and ensure a vaccine is manufactured available to the public as early as feasible (8) . The success of COVID-19 vaccination programs will rely heavily on public willingness to accept the vaccine. Health-care employees represent an enormous number of COVID-19 contaminated individuals (9) . In this circumstance, health-care employees are both probable transmitters and illness victims (10) . It would be valuable to protect these health care employees from COVID-19 contagion not only for themselves, but further for their family contacts and their cases. The World Health Organization (WHO) had planned health professionals, as a significance group for COVID-19 immunization (1) . The query of obligatory vaccination against COVID-19 for health professionals will be a subject of argument. After clinical development, All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. ; https://doi.org/10.1101/2021.01.11.21249324 doi: medRxiv preprint immunization against COVID-19 will face the obstacle of community approval. WHO in 2019 identified 10 hazards for global health: including vaccine indecision and a pandemic risk (11) . The world is currently fronting both hazards. Hesitancy to a vaccine refers to postponement in approval or rejection of vaccines regardless of accessibility of the services of vaccination (12). Vaccine indecision also alarms health professionals: doctors (13, 14) , and nurses (15) . The aim of this study was to describe the existing COVID-19 vaccine approval landscape among the health care employees and to identify the most probable cause of agreement or disagreement of COVID-19 vaccination. Study design and sampling: A cross-sectional online-based study was (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Translation and piloting: The online survey consisted of closed-ended questions in English and Arabic (for nurses, laboratory workers and radiology technicians). It was pilot tested on ten subjects to check the clarity of the questionnaire; related data were included in the final dataset. The link to Google Forms was then distributed to potential respondents. A forward and backward translation was conducted for all the items of the questionnaire. One translator was in charge of translating the scales from English to Arabic, and a second one performed the back translation. Discrepancies between the original English version and the translated one were resolved by consensus. Questionnaire and data collection: An electronic questionnaire was used to collect the data. In December 2020, participants completed a questionnaire via Google forms. The aim of our sampling was to be representative of all the Egyptian health care employees based on age, sex, and profession. Exclusion criteria: Age below 18 years, non-health care employees and those who refuse to participate in this study. The following data were collected including: 1-Baseline demographic data including the occupation status and the presence of comorbid disorders. 2-Query whether the participant had history of allergy to certain food or drugs. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. measures. bivariate analysis was used to assess the factors that can affect All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. and 0,02 respectively) ( Table 3 ). The current study surveyed the potential acceptance of health care employees to COVID-19 vaccines as they serve on first line of pandemic response efforts and more exposed to infection. The main findings showed that 45.9% agree to receive the vaccine (13.5% totally agree, 32.4% somewhat agree) and 40.9% disagreed to take it. Causes of All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. ; https://doi.org/10.1101/2021.01.11.21249324 doi: medRxiv preprint disagreement were none safety, fear of genetic mutation and recent techniques and believe that the vaccine is not effective. The age of health care employees (older participants tend to approve more) and the presence of comorbidities or chronic diseases were the main factors related to COVID-19 acceptance. During 2020, the international organizations and national regulatory authorities in collaboration with multinational pharmaceutical industry directed their efforts for developing COVID-19 vaccines as the pandemic continues. By the end of 2020 five vaccines have been authorized to be used on emergency use authorization (EUA) basis (17). In the current study, 32.4% of participants expressed their response using statement "somewhat agree" to accept the vaccine while the lower percentage of participants 13.5 % used "totally agree". These indicate general willingness of health care employees to accept the vaccine, however "somewhat agree" statement may indicate hesitancy and background specific concern regarding new vaccine acceptance. This hesitancy was confirmed when the participants were asked about the causes of disagreement of vaccination. The higher percentage 57% of participants said "not safe clinically" which indicate lake of reassurance regarding vaccine safety and future unknown adverse events. In the context of the vaccine acceptance, a survey study was done in Congo included 613 Congolese health care workers (HCWs) reported only 28% of participants would accept the vaccine against COVID-19 (18). Another study from France included 3259 respondents to the online questionnaire and it was observed that nearly 3/4 of the participants (77.6%, 95% CI 76.2-79%) would accept the vaccine. The proportion of healthcare workers willing to get vaccinated was 81.5%, while it was 73.7% in non-healthcare workers (4) . Moreover, studies conducted in All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The intention to accept the vaccination against COVID-19 among the Egyptian HCWs is low compared to studies from western countries but better than African's; this may be interpreted by many factors: The current results demonstrated that social media and TV media are the main source of knowledge for the participants; 77 % and 40.3%, respectively. Unfortunately these sources are not preferable to be the All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. ; https://doi.org/10.1101/2021.01.11.21249324 doi: medRxiv preprint source of knowledge due to misinformation that can they give to the public (conspiracy theory) such as some social media posts claimed the use of mRNA based vaccine for COVID-19 can change population's DNA (21, 22) . This is may be added to increase the hesitancy of vaccine acceptance. To assess the factors that can affect the acceptance of the vaccine in present study, univariate regression analysis was used, and the study demonstrated significant correlation regarding age and history of chronic diseases. This may be explained by fear of those groups about the impact COVID-19 on their comorbidities reported in many studies indicating that Diabetes Mellitus (23) chronic hepatic and renal diseases (24) and multiple comorbidities especially neurologic can increase both morbidity and mortality in COVID-19 patients (25) . According to the present study, although the higher percentage of the participants had the intention to accept the vaccine but overall, it considers low acceptance of the respondents. The vaccine hesitancy in the Egyptian HCWs can be the major barrier that affects the decision of the vaccine acceptance in Egypt. According to a global survey conducted in 19 countries included 13,426 participants to assess the potential acceptance of COVID-19 vaccine; 71.5% would somewhat like to uptake the vaccine. Although they reported the higher percentage of vaccine acceptance but differences in the acceptance ranged from (80%) in Asian nations and less than (55%) in Russia (26) . Accordingly, it is not surprising that acceptance of the vaccine is low in Egypt as vaccine hesitancy exist globally. The concerns about the safety of the vaccine was recorded in 57% of participants in the study. Similar data were reported in different areas and numerous factors associated with vaccine hesitancy all over the world All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. ; All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 15, 2021. ; https://doi.org/10.1101/2021.01.11.21249324 doi: medRxiv preprint World Health Organization. WHO. WHO Director-General's opening remarks at the media briefing on COVID 19 Vaccines the race for coronavirus vaccines No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity Impact of COVID-19 and health system performance on vaccination hesitancy: Evidence from a two-leg representative survey in the UK. Available at SSRN 3627335 Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine Willingness to vaccinate against COVID-19 in Australia. The Lancet. Infectious Diseases A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and politicisation. The Lancet. Infectious diseases The French public's attitudes to a future COVID-19 vaccine: the politicization of a public health issue The UK Government's Vaccine Taskforce: strategy for protecting the UK and the world. The Lancet Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit World Health Organization. WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination World Health Organization; 2020. Ten health issues WHO will tackle this year n Discrepancies between general practitioners' vaccination recommendations for their patients and practices for their children Vaccine hesitancy among general practitioners: evaluation and comparison of their immunisation practice for themselves, their patients and their children Vaccine hesitancy and self-vaccination behaviors among nurses in southeastern France. Vaccine Vaccine rumours debunked: Microchips, 'altered DNA' and more Impact of social media on knowledge dissemination between physicians during COVID-19 virus outbreak: A cross sectional survey Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell metabolism Prognosis of COVID-19 in patients with liver and kidney diseases: an early systematic review and meta-analysis. Tropical Medicine and Infectious Disease Impact of comorbidities on COVID-19 outcome. medRxiv A global survey of potential acceptance of a COVID-19 vaccine