key: cord-0815995-w8p01epf
authors: Fossen, Mary C.; Bethany, Margaret D.; Modak, Sanjay R.; Parris, Sally M.; Modak, Rohit M.
title: Who’s vaccinated? A closer look at healthcare workers’ coronavirus disease 2019 (COVID-19) COVID-19 vaccine hesitancy and demographics
date: 2021-05-03
journal: Infection control and hospital epidemiology
DOI: 10.1017/ice.2021.192
sha: 916844b983c3fa1b0f9ff84b8cf16d46e6411535
doc_id: 815995
cord_uid: w8p01epf

OBJECTIVE To compare COVID-19 vaccine hesitancy among hospital employees by demographics. METHODS Our institution has offered an mRNA COVID-19 vaccine to all employees since January 2021. We collected data on vaccination rates among hospital employees and looked for differences in demographic groups to determine in which groups vaccine hesitancy is the highest. Those who received at least one dose of vaccine were considered "vaccinated" for this study. RESULTS There was a 71% vaccination rate among all hospital employees as of March 10, 2021. Age over 50 (odds ratio 1.85, 95% CI 1.53 to 2.24, p<0.01), working in a clinical department (odds ratio 1.19, 95% CI 1.01 to 1.42, p = 0.02), and white race compared to black/African American race (odds ratio 4.55, 95% CI 3.74 to 5.52, p<0.01) were all significant factors for receiving vaccination. Gender (odds ratio 1.12, 95% CI 0.94 to 1.35, p=0.10) was not significant. CONCLUSIONS In a population with equal access to the COVID-19 vaccine, there were significant differences in vaccination rates among different demographic groups. Employees under 50 years of age, non-clinical employees, and black/African American employees were less likely to be vaccinated. This suggests that attitudes towards vaccination, and not simply access to the vaccine, are factors in vaccination rates.

To the Editor-Coronavirus disease 2019 (COVID-19) is worldwide pandemic caused by a novel coronavirus, severe acute respiratory coronavirus virus 2 (SARS-CoV-2). This virus was first isolated in January 2020 and rapidly sequenced, with work on the vaccine starting in March 2020. Development of a vaccine using new mRNA technology constitutes an unprecedented scientific achievement. 1 A COVID-19 vaccine first became available to healthcare workers and other priority and high-risk groups in mid-December 2020. Lower than expected vaccination rates have been attributed to problems with access 2 ; however, vaccine hesitancy has also been identified as a contributing factor to lower vaccination rates. 3 Virginia Hospital Center (VHC) is a 437-bed hospital in Arlington, Virginia, located in the Washington, DC, metropolitan area, with 3,401 employees. Our hospital offered the 2-dose Moderna or the 2-dose Pfizer COVID-19 mRNA vaccines to all employees as of early January 2021. We reviewed vaccination rates among employees in our hospital where vaccine access was not an issue.

We evaluated all those who received at least 1 dose of a vaccine through March 10, 2021, and considered this group vaccinated. We examined vaccination rates by age, gender, department, and race, to determine in which groups vaccine hesitancy was highest.

In total, 2,425 employees received a COVID-19 vaccine as of March 10, 2021, resulting in a 71% overall vaccination rate. We observed significant differences in vaccination rates among different demographic groups ( Table 1 ). The odds ratio (OR) for receiving vaccination were significant for those age ≥50 (OR, 1.85), working in a clinical department (OR, 1.19), and white race compared to black race (OR, 4.55). Male sex had an OR of 1.12, but this did not reach statistical significance.

Vaccination rates were higher in employees >50 years old and in employees working in clinical areas. This can be explained due to the known higher risk of poor outcomes with COVID-19 in older patients, and due to the higher exposure of employees to COVID-19 patients in clinical settings. The difference in vaccination rates between white employees and black or African American employees is striking. We selected these 2 groups, as they include most employees at our hospital. Media polling reports that low vaccination rates among African Americans are due to limited access to vaccine. 4 However, the historical distrust of the medical community by African Americans is also well documented. 5 Such distrust may be felt by African American healthcare workers as well.

The vaccine has been available to all hospital employees since early January 2021, but access still may be an issue for some. Vaccination is offered during the workday and takes ∼20-30 minutes, which includes an observation of 15 minutes after vaccination. Although vaccination was officially supported and encouraged by hospital administration, some employees may not have been able to take that time off during their shift. Additionally, much of the messaging around our vaccine clinics occurred by e-mail and text-message reminders, and some may not check e-mail routinely or have smartphones.

In total, 71% of hospital employees have received a COVID-19 vaccine. The proportion of the population that must be vaccinated to provide herd immunity to COVID-19 is not yet known 6 ; however, experts have speculated that vaccination of up to 80% of the population may be necessary. 7 Strategies to increase vaccination rates must be pursued.

Making the COVID-19 vaccine mandatory would be challenging at present, even in a hospital setting, given that the vaccine has only been approved for emergency use. Comparatively, we do not have a mandatory influenza vaccination policy, yet our influenza vaccination rates are >97%. This has been accomplished by a mandatory declination policy that employees have to either show proof of vaccination, receive the vaccine, or sign a document of declination. 8 Such a strategy could be implemented again to potentially encourage and increase the COVID-19 vaccination rates. 

Developing safe and effective covid vaccines-operation warp speed's strategy and approach

KFF COVID-19 vaccine monitor: experiences with vaccine access and information needs

COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates

Little difference in vaccine hesitancy among white and black Americans, poll finds. Nation Public Radio website

Addressing mistrust about COVID-19 vaccines among patients of color

COVID-19): herd immunity, lockdowns and COVID-19. World Health Organization website

Anthony Fauci offers a timeline for ending COVID-19 pandemic. Harvard Gazette website

Increasing influenza vaccination rates among hospital employees without a mandatory policy

Acknowledgments.Financial support. No financial support was provided relevant to this article.

All authors report no conflicts of interest relevant to this article.