key: cord-0826598-4kusdtze
authors: Jain, V.; Doernberg, S. B.; Holubar, M.; Huang, B.; Marquez, C.; Brown, L.; Rubio, L.; Sample, H. A.; Bollyky, J.; Padda, G.; Valdivieso, D.; Kempema, A.; Leung, C.; Sklar, M.; Julien, A.; Paoletti, M.; Jaladanki, S.; Wan, E.; Ghahremani, J.; Chao, J.; Weng, Y.; Lu, D.; Glidden, D.; Grumbach, K.; Maldonado, Y.; Rutherford, G.
title: Healthcare personnel knowledge, motivations, concerns and intentions regarding COVID-19 vaccines: a cross-sectional survey
date: 2021-02-23
journal: nan
DOI: 10.1101/2021.02.19.21251993
sha: d6a5ddae0d8ca2f5ac210348feb64aa646e63631
doc_id: 826598
cord_uid: 4kusdtze

Background: Healthcare personnel (HCP) are prioritized for earliest SARS-CoV-2 vaccine administration, yet relatively few data exist on HCP's knowledge, motivations, concerns, and intentions regarding COVID-19 vaccines. Methods: We conducted a cross-sectional survey Nov.16-Dec.8, 2020 among HCP enrolled in a cohort study at three Northern California medical centers serving diverse roles including COVID-19 patient care. Eligible HCP were adult (age<=18) on-site employees of the University of California, San Francisco, San Francisco General Hospital, and Stanford Healthcare. A one-time electronically-administered survey was sent to cohort HCP on November 16, 2020 and responses analyzed. Results: Overall, among 2,448 HCP invited, 2,135 completed the COVID-19 vaccine survey (87.2% response rate). HCPs had mean age 41 years, were 73% female, and had diverse jobs including COVID-19 patient contact. Enthusiasm for vaccination was overall strong, and more HCP (1,453, 69%) said they would definitely/likely receive vaccine if formally FDA-approved versus if approved via emergency use authorization only (785, 35%). While 541 (25%) respondents wanted to be among the earliest to receive vaccine, more desired vaccination after the first round (777, 36%) or >2 months after vaccinations began (389, 18%). Top factors increasing motivation for vaccination included perceiving risk from COVID-19 to self (1,382, 65%) or to family/friends (1355, 63%). Top concerns were vaccine side effects, cited by 596 (28%), and concerns about political involvement in FDA's approval process (249, 12%). Conclusions: HCP were enthusiastic about COVID-19 vaccination for individual protection and protecting others, but harbored concerns about vaccine side effects. Our data may inform emerging vaccine education campaigns.

Two mRNA vaccines against SARS-CoV-2 made by Pfizer/BioNTech [1] and Moderna [2] recently showed 95% and 94.1% efficacy and received U.S. Food and Drug Administration (FDA) emergency use authorization (EUA) in December 2020. The Centers for Disease Control (CDC) Advisory Committee on Immunization Practices endorsed both COVID-19 vaccines [3, 4] and designated healthcare personnel as top priority for immediate vaccination. [5] However, relatively little is known about healthcare personnel's knowledge, attitudes, motivations and intentions surrounding COVID-19 vaccines. To address these questions and inform emerging vaccine education campaigns, we surveyed frontline healthcare personnel at three academic medical centers about COVID-19 vaccines.

Study setting: The CHART Study (COVID-19 Healthcare Worker Antibody and RT-PCR Study) is a longitudinal cohort study of adult (age≥18) healthcare personnel working at the University of California, San Francisco (UCSF), Zuckerberg San Francisco General Hospital, and Stanford Health Care during the pandemic. Cohort members enrolled from July-November 2020 at all three centers. Persons from all job types were eligible to enroll, regardless of whether they directly cared for patients with COVID-19. Exclusion criteria included not working on site during the pandemic or planning to end employment in <6 months. Survey: Participants were sent an electronic link to a web-based eight-question web-based survey via REDCap (Research Electronic Data Capture) about COVID-19 knowledge, motivations, concerns, and intentions on November 18, 2020. Participants completed surveys over three weeks. Data were analyzed on December 8, 2020.

Analysis: Proportions of respondents answering each question were tabulated and analyzed.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) When asked about intention to receive a COVID-19 vaccine with formal FDA approval, 1,453 (69%) indicated they would definitely (35%) or likely (34%) receive it. Only 10% indicated they were unlikely to or definitely would not receive it. When asked about receiving a COVID-19 vaccine that only had FDA emergency use authorization, but lacked formal FDA approval, only 36% said they would definitely (11%) or likely (25%) receive it; this was 48% lower than if vaccine was fully FDA-approved.

When asked about vaccine timing, 541 (25%) indicated desire to be among the first to receive it, while 36% desired receiving it early, but not in the first round. Conversely, 18% indicated desire to wait >2 months before vaccination, and only 5% said they were not planning to receive it at all.

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The copyright holder for this preprint this version posted February 23, 2021. ; https://doi.org/10.1101/2021.02.19.21251993 doi: medRxiv preprint

In total, 573/2,135 (27%) of healthcare personnel indicated they wanted a COVID-19 vaccine to have near 100% efficacy before receiving it, and 981 (46%) desired 80% vaccine efficacy. Only 448 (21%) said they would receive a vaccine having 60% efficacy. To understand healthcare personnel's prior vaccination patterns, we queried their as a strong or somewhat strong factor influencing them against wanting a COVID-19 vaccine.

On the eve of regulatory approvals of the first two COVID-19 vaccines, [6, 7] we surveyed over 2,000 healthcare personnel at three large Northern California medical centers and found overall very high enthusiasm and intention to be vaccinated for the protective benefits and secondary benefits to family and friends. However, we . CC-BY-NC-ND 4.0 International license It is made available under a 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 February 23, 2021. ; https://doi.org/10.1101/2021.02.19.21251993 doi: medRxiv preprint also found concerns about vaccine side effects and efficacy, and about political influence on regulatory approval processes. To our knowledge, this is one of the largest surveys to date of U.S. healthcare personnel on knowledge and intentions regarding COVID-19 vaccines.

Our findings may help inform public education campaigns directed at healthcare personnel and the general public to promote uptake of COVID-19 vaccines. Additionally, since many individuals will seek information about COVID-19 vaccines from healthcare providers, our data may also help reinforce reasons for vaccination and enable healthcare personnel to respond to concerns and provide reassurance where possible.

[8]

Our findings on motivations for and concerns about vaccination are similar to a September survey in which Los Angeles healthcare personnel cited self-protection and preservation of community health as key reasons for COVID-19 vaccination and expressed confidence in vaccine safety and efficacy.

[9] However, in that study 67% of healthcare workers cited an intention to delay COVID-19 vaccination initially, and 47% expressed reluctance about participating in a COVID-19 vaccine clinical trial, far higher than we found in our more recent survey.

Likewise, in our study, we found more enthusiasm for vaccination than in a recent study conducted at SUNY Syracuse in November 2020 in which only 58% of the healthcare personnel surveyed expressed any intent to be vaccinated.

[10] Notably, our population had a higher degree of racial and ethnic diversity; 53% of our study cohort are white compared with 85% of the SUNY Syracuse population surveyed. Among French healthcare personnel surveyed even earlier in the pandemic in March-July 2020, 77% intended to receive COVID-19 vaccine, motivated primarily by self-risk.

[11] Notably, only 57% of respondents reported receiving influenza vaccine, far lower than the nearly 100% rate we observed.

Healthcare personnel's motivations for COVID-19 vaccination mirror those seen in the general population. In a survey of U.S. adults in April 2020, 58% reported intent to receive a COVID-19 vaccine.

[12] Factors predicting vaccine hesitancy included younger age, African American race, and not having influenza vaccine in the prior . CC-BY-NC-ND 4.0 International license It is made available under a 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 February 23, 2021. year. Notably, the surveys of the U.S. general public [12] and French healthcare personnel [11] were both done early in the pandemic, long before recent reports on vaccine efficacy and safety.

Our study contains certain limitations: it was conducted rapidly from mid-November to early December 2020 in a dynamic environment of emerging data on COVID-19 vaccines. Efficacy and side effect data on the Pfizer-BioNTech [1] and Moderna [2] vaccines were made public during this time. These data may have been available to some but not other respondents. Further, FDA decisions on the two vaccines were not yet available, and emergency authorization for Pfizer-BioNTech and Moderna vaccines occurred, respectively, on December 11 and 18, 2020 [6, 7] -after survey completion. It likely that healthcare personnel's opinions on vaccination will evolve over time; future surveys and ascertainments of vaccination completion are planned to capture these changes.

In summary, among 2,135 Californian healthcare personnel, we found moderate knowledge about COVID-19 vaccines, strong enthusiasm and intention for vaccination, but also certain concerns about possible side effects.

Our data may help inform vaccine education campaigns for both healthcare personnel and the general public.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a 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 February 23, 2021. ; https://doi.org/10.1101/2021.02.19.21251993 doi: medRxiv preprint

This work was supported by a research grant from the Chan Zuckerberg Initiative.

Vivek Jain: Funding from President's Emergency Plan for AIDS Relief and CDC (UO1GH002119), unrelated to this study.

Sarah Doernberg: Consultant, Genentech and Basilea Pharmaceutica, unrelated to this study. Funding from the NIH (UM1AI104681) for work unrelated to this study.

All authors: Research grant funding from Chan Zuckerberg Initiative for this work.

Paterson . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) A: Includes multiple races B: Includes individuals who declined to answer C: Physician assistant, nurse practitioner, California registered nurse anesthetist D: Includes food services/nutritionists (11), medical or nurse assistant or technologist (44), microbiology laboratory worker (7), pathology and morgue workers (9), registration and front desk staff (13), transport (1), phlebotomy (8), physical and occupational therapy (43), radiology technician (33), respiratory/speech therapist (22), ward clerk (4), and other (250)

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted February 23, 2021. ;

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