key: cord-1017795-3gq4dap4
authors: Mustapha, Toheeb; Khubchandani, Jagdish; Biswas, Nirbachita
title: COVID-19 Vaccination Hesitancy in Students and Trainees of Healthcare Professions: A Global Assessment and Call for Action
date: 2021-06-30
journal: Brain Behav Immun Health
DOI: 10.1016/j.bbih.2021.100289
sha: 8895421e3a924f824731bfb25871720902982da1
doc_id: 1017795
cord_uid: 3gq4dap4

nan

Amidst the global enthusiasm for the COVID-19 vaccine, vaccination hesitancy received wide attention from the media, scientific community, and policymakers. In particular, glaring media reports of vaccine hesitancy among healthcare professionals emerged despite the prioritization of this group for COVID-19 vaccination. A recent review of more than 75,000 healthcare professionals around the world estimated that more than a fifth of the healthcare workers globally was hesitant about COVID-19 vaccinations (Biswas et. al. 2021) . During the COVID-19 pandemic, a lot of students and trainees in healthcare professions helped serve on the frontlines, worked as volunteers with vaccination campaigns, and took on roles where there could be greater exposure to COVID-19 infection (Bellon and Fares, 2020; Manning et. al. 2021; Kanyike et. al. 2021) . Despite this, not much is known about COVID-19 vaccination preferences and hesitancy in students of healthcare professions around the world.

We conducted a global review to compile empirical evidence on COVID-19 vaccination hesitancy in students and trainees of healthcare professions. The inclusion criteria for the studies in this review were: studies published in the English language, data for studies was collected between April 2020-April 2021, studies quantitatively assessed vaccination hesitancy rates, and included students and trainees in healthcare professions. We searched databases such as CINAHL, Google Scholar, PubMed, EBSCO Host, and pre-print servers with the following keywords: "vaccine", "COVID-19", "hesitancy", "refusal", "vaccination", "coronavirus", "health", "college", "profession", "student", "trainee", "intern", and "resident". The order of keywords was changed in repeated searches across databases to extract the final pool of relevant studies. Discrepancy on suitability and relevance of the studies to be included were sorted by discussion. COVID-19 vaccination hesitancy rates data were extracted from studies if the study participants were "unlikely", "refused", "declined", or "disagreed" with obtaining COVID-19 vaccination. Pooled prevalence for COVID-19 vaccination hesitancy rates among students and trainees of healthcare professions was estimated from the included studies with 95% confidence intervals using randomeffects modeling (Table 1) .

In this global assessment including 19 studies across 39 countries, the overall rate of COVID-19 vaccination hesitancy among 19,991 students/trainees of healthcare professions was 18.9% (95% Ci=14.5-24.2). This rate of COVID-19 vaccination hesitancy (almost one fifth) in students and trainees almost mirrors the rate in practicing healthcare professionals (Biswas et. al. 2021 ). In addition, the major concerns cited by students in healthcare professions are very similar to the concerns cited by practicing healthcare workers and professionals (e.g., concerns about safety, effectiveness, and side effects) (Biswas et. al. 2021; Kose et. al., 2021; Chew et. al. 2021; Grochowska et. al., 2021) .

The high rates of COVID-19 vaccination hesitancy in students of healthcare professions as identified in this review are concerning for multiple reasons. Unvaccinated students and trainees in healthcare professions can pose a risk of COVID-19 infection to themselves, their patients, coworkers, and family members. Healthcare professionals have ethical, legal, and moral obligations to protect their patients and cannot depend on personal protective equipment alone to avoid COVID-19 infections. Furthermore, studies have shown that individuals are more likely to accept COVID-19 vaccination if it is recommended by healthcare providers. If acceptance of COVID-19 vaccines remains lower in healthcare professionals, it remains unclear how they will be able to build confidence in patients and recommend the available vaccines (Kanyike et. al. 2021; Grochowska et. al., 2021; Biswas et. al, 2021) .

While not specific to students and trainees, several strategies have been suggested to increase the uptake of COVID-19 vaccines among healthcare professionals (Biswas et. al, 2021; Chew et. al. 2021; Kose et. al. 2021) . Multipronged strategies with an emphasis on increasing awareness and education, providing easy access to vaccines and prioritizing students and trainees in healthcare professions, using trusted voices and leaders to encourage vaccination, allowing time and incentives to get vaccinated, and setting up healthcare facility-based protocols or mandates to obtain vaccinations have been suggested as potential options. We believe that it is critical for healthcare facilities and healthcare leaders worldwide to reemphasize and prioritize COVID-19 vaccination for students, trainees, and interns in the healthcare professions.

J o u r n a l P r e -p r o o f

Social stigma about vaccines and lower education level Enablers: Trust in sources of information (i.e., government sources and healthcare workers)

Lesser understanding of preventive measures; lower concerns about the pandemic, COVID cases & deaths Enablers: Male gender, history of flu vaccination, higher perceived susceptibility to COVID-19 infection

Low trust in the government, media, and in the German healthcare system Enablers: Male gender, lower perceived health status, and fear of COVID-19 related health threats

USA 1,029* 21.6% Reasons: Concerns about safety, side effects, rapid development, and mistrust in the vaccine development process Enablers: Male gender, old age, high perceived risk of COVID-19 infections, willingness to protect family/patients

8% Reasons: Concerns about safety and side effects, lower perceived risk of COVID-19, fear of needles, lack of time. Enablers: Male gender, past flu vaccination, recommendations from others, greater perceived benefits of vaccines

USA 408 35.5% Reasons: Concerns about effectiveness/side effects, rapid vaccine development, insufficient information about vaccine, mistrust in regulatory agencies, and politicization. Enablers: being minority student, favorable attitude to vaccines

Concerns about vaccines causing autism, fever and malaise, long-term complications

2% Reasons: Concerns about vaccine safety, efficacy, and effectiveness. Lower knowledge about COVID-19 & vaccines. Enablers: Male gender, older age, history of flu vaccination, trust in government/experts, fear of COVID-19 infection Chew

Enablers: increased COVID-19 perceived risk, low perceived vaccine harm Mascarhenas et. al. Dec 2020 USA 245 44.5% Reasons: Concerns about side effects, rapid development of vaccine, mistrust in regulatory agencies, and politicization. Enablers: Trust in public health experts, high perceived risk of infection

Concerns about vaccine safety and side effects, mistrust in government, negative attitudes about vaccines. Enablers: Male gender, older age, historical flu vaccination, knowing someone who was infected

Uganda 600 62.7% Reasons: Concerns about side effects, safety, effectiveness; misinformation on vaccine; trust in personal immunity. Enablers: Male gender, past flu vaccination, higher perceived risk of COVID infection to self/others, believing vaccines Jain et

Enablers: History of hepatitis B vaccine, student of govt medical college, higher perceived risk of COVID-19

Top 3 Enablers: Male gender, older age, past flu vaccination *indicates that the participants were the part of a larger sample ** indicates reasons and enablers for the whole sample. A total of 19 studies with 19,991 participants have been included in this Table. Data collection month instead of publication date for the study have been arranged in chronological order in the table