key: cord-0830604-ucoevth1 authors: Paris, Christophe; Bénézit, François; Geslin, Mareva; Polard, Elisabeth; Baldeyrou, Marion; Turmel, Valérie; Tadié, Émilie; Garlantezec, Ronan; Tattevin, Pierre title: COVID-19 vaccine hesitancy among healthcare workers date: 2021-05-05 journal: Infect Dis Now DOI: 10.1016/j.idnow.2021.04.001 sha: ca28fe6b03f0251831644c26efe9363a2b81b629 doc_id: 830604 cord_uid: ucoevth1 Objective. To characterize healthcare workers’ (HCWs) intention to receive the COVID-19 vaccine by the beginning of the vaccine campaign in France. Methods. Data were collected on a self-administered questionnaire through the website of a tertiary care center (February 9-18, 2021). Results. Among 1,965 respondents, 1,436 (73.1%), 453 (23.1%), and 76 (3.9%) declared themselves in favor, hesitant, or against the COVID-19 vaccine: <60% of auxiliary nurses and technicians intended to be vaccinated, as compared to 60-79% of nurses and support staff, and >80% of medical staff. On multivariate analysis, age, occupation, flu vaccine history, and controversy over the AstraZeneca vaccine tolerability were independently associated with COVID-19 vaccine intention. Conclusions. Patterns of vaccine hesitancy related to the COVID-19 and influenza vaccines are similar among HCWs. Media communication on vaccine side effects have a dramatic effect on vaccine hesitancy. Efforts are requested to inform HCWs about the risk/benefit balance of COVID-19 vaccines. Since the emergence of SARS-CoV-2, healthcare workers (HCWs) have been on the front line in caring for COVID-19 patients, and consequently are at high risk of infection. According to the European center for disease prevention and control (eCDC), the proportion of HCWs among COVID-19 cases varied from 2.2% to 29% in countries with available data [1] . In France, 67,811 HCWs have been infected by SARS-CoV-2 between March 2020 and February 2021, of whom 19 died from COVID- 19 [2] . At the same time, opposition to control measures such as lockdown or wearing mask is growing. In this context, the availability of several vaccines is a major step forward to protect HCWs. However, progress in HCW immunization may be compromised by vaccine hesitancy, characterized by the lack of confidence in or the fear of vaccines [3] . In France, striking heterogeneities have been reported in the proportion of HCWs who receive seasonal influenza vaccines, with a socio-occupational gradient from physicians (67%) to auxiliary nurses (27%) [4] . However, vaccine hesitancy may vary dramatically over time, from one location to another, and according to vaccines. To date, only a few studies focused on COVID-19 vaccination intention in HCWs. A study in Hong-Kong found that young age, confidence in the vaccine, and a sense of collective responsibility were associated with intention to receive the COVID-19 vaccine [5] . In France, a survey among 2,047 HCWs reported that 76.9% of them (95% CI, 75.1-78.9%) intended to get the COVID-19 vaccine, with discrepancies according to age, gender, occupation, and influenza vaccination during the previous campaign (2019-2020) [6] . Of note, these two studies were conducted before COVID-19 vaccines became available. We aimed to assess COVID-19 vaccine intention among HCWs at the beginning of the French campaign, when three vaccines were available (i.e. Pfizer, Moderna, and AstraZeneca). The Rennes University Hospital is a 1,500-bed tertiary care center in western France. For one week, between February 9 and February 18, an anonymous self-administered questionnaire was proposed on the website of our institution for non-vaccinated HCWs, on a voluntary basis. We collected demographic characteristics, occupation, chronic medical During our survey, a large controversy emerged on February 14 following reports of flulike symptoms with high-grade fever and pain, with inability to work during the first 24 hours following AstraZeneca COVID-19 vaccine first shot. The controversy received broad media coverage, and the vaccine was temporarily discontinued in several hospitals. We analyzed COVID-19 vaccine intention of HCWs in relation with their age, occupation, chronic medical conditions at risk of serious COVID-19, history of influenza vaccination, and the timing of questionnaire according to the February 14 controversy, thereafter considered as a cut-off. We conducted a univariate analysis, followed by a multivariate analysis based on logistic regression model, including all precedent variables. The outcome 'to be hesitant or against the COVID-19 vaccine' was modelled in a binary approach. Statistical analyses were performed using the SAS® package, v9.4. Results are presented as odds ratio (OR) with their 95% confidence intervals. A P value below 0.05 was considered significant. The number of HCWs in our hospital during the study period was 8,375 not including students. As 647 had previously tested positive for SARS-CoV-2, and 2,063 had already received at least one dose of COVID-19 vaccine, the eligible population was 5,655. Of them, 1,965 (34.7%) completed the questionnaire: 453 HCWs (23.1%) categorized themselves as 'hesitant', and 76 (3.9%) as 'against' the COVID-19 vaccine (Table 1) . Strong differences among COVID-19 vaccine profiles were observed according to occupations, with <60% of administrative staff, cleaners, auxiliary nurses, workers, and technicians intending to be vaccinated, as compared to 60-79% for nurses, pharmacists, laboratory technicians, and support staff, and >80% for health executives, residents, students, and medical staff. Conversely, no relation was observed between COVID-19 vaccine profiles and allergy, COVID-19 history, and at-risk conditions. The controversy over the adverse effects of the AstraZeneca vaccine was followed by a dramatic decrease in intention to get the COVID-19 vaccine, from 74.8% before to 58.3% after February 14. The multivariate analysis demonstrated that age, occupation, flu vaccine (Table 2) . Interestingly, the proportion of HCWs intending to get a COVID-19 vaccine (mean, 73.2%) was superior to the proportion of HCWs regularly vaccinated against influenza (mean, 51.4%). Finally, the controversy over the severity of common adverse effects of the AstraZeneca COVID-19 vaccine was also associated with hesitancy or opposition against COVID-19 vaccine (OR 1.77 [95% CI 1.22-2.56]). This negative impact was observed across all occupations, but was only significant in administrative staff, nurses, and support staff (Table 3 ). This study confirms the strong differences in COVID-19 vaccine intention among HCWs, mainly according to occupations, and the high correlation with influenza vaccine profiles. Of note, the proportion of HCWs declaring that they would receive the COVID-19 vaccine was higher than the proportion of HCWs who regularly receive the influenza vaccine. To the best of our knowledge, it is the first study performed after COVID-19 vaccines became available in France. This study also documents the dramatic decrease in the proportion of HCWs intending to get the COVID-19 vaccine immediately after the first controversy over the AstraZeneca vaccine tolerability arose. This should be kept in mind by colleagues, institutions, and media: premature communication about suspected side effects carries its own risk of adverse event, namely the progression of vaccine hesitancy. Discrepancies concerning vaccine hesitancy according to socio-economic characteristics (income, education level, occupations) have been previously reported [7] [8] [9] , including among HCWs [5, 10] . We found that striking differences across occupations were also valid for COVID-19 vaccine. The linear gradient across HCWs according to their qualification level (blue collars, auxiliary nurses, nurses to medical staff) [4] was not always retrieved in the literature, and some authors suggested the existence of an inverse U curve across qualification levels [11] . Our findings confirm such interpretation, as for instance administrative staff had higher rate of vaccine hesitancy and opposition than blue collars or cleaners. These differences are probably the expression of vaccine hesitancy [12] and of the complexity of the multiple determinants of vaccine hesitant behaviors, both at the individual and collective levels [13] . Several large categories of determinants have been described, such as individual or collective influences, contextual influences, and specific issues on vaccination [14] . Each of these groups contains several factors such as influential leaders, religion or cultural issues, knowledge/awareness ratio, perception of risk-benefit balance, role of healthcare providers, etc. Accordingly, different health behavior models (such as Health Belief Model or the Protection Motivation Theory) [5, 15] were developed to better explain vaccine hesitancy, and as a goal to reduce this behavioral pattern. Applications of these models to fight the COVID-19 pandemic is a major public health challenge. Among the determinants of vaccine hesitancy, communication and media environment are of paramount importance. To date, the long-term negative effect of such communication is poorly characterized. However, Raude et al. highlighted that it requires only a few media events to observe a durable effect on vaccine hesitancy in France, as documented by the controversy over the association between the measles vaccine and autism, or between the hepatitis B vaccine and multiple sclerosis [16] . As a result, considerable efforts are needed from stakeholders and health providers [10, 17] to positively communicate on the risk/benefit balance of vaccines to a broad scope of media, including social networks [18] . Indeed, information is demonstrated to be an effective tool, rather than a determinant to address vaccine hesitancy [19] . Finally, we observed a strong correlation between influenza and COVID-19) in the EU/EEA and the UK, 2020, April 8th. 2. SPF. Recensement national des cas de COVID-19 chez les professionnels en établissements de soins Report of the SAGE Working Group on Vaccine Hesitancy Couverture vaccinale antigrippale chez les professionnels de santé Editor's Choice: Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey in French healthcare workers during the first pandemic wave: a cross-sectional survey Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? 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New challenges and opportunities offered to fight against vaccine hesitancy Health communication and vaccine hesitancy Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination