The COVID-19 vaccination is one of the most crucial strategies for containing the COVID-19 pandemic. HCWs are more likely to contract COVID-19 than the general population, so their attitude toward the vaccination is crucial since it can determine how well the general population responds to it [21].
The aim of this study was to assess Egyptian HCWs' attitudes toward the COVID-19 vaccine. The 455 HCWs who participated in this study were divided into three groups—VA, VH, and VR—based on their attitude toward COVID-19 vaccine. Most of participants were vaccine accepting (70.5%). Of the participants, one-third had previously contracted COVID-19, and the majority of them had prolonged disease course. The majority of participants believed that they were at high risk for both COVID-19 infection and vaccination side effects. There was a statistically significant difference between the VA, VH, and VR groups regarding perception and knowledge of conventional and COVID-19 vaccines. Fear of infection and the desire to resume normal life were the main drivers behind the COVID-19 vaccination. The two major barriers, however, were waiting for additional expertise and having doubts about the effectiveness of the vaccines.
About one third (33.4%) of participants reported having previously contracted COVID-19, a rate that was comparable to that in a prior study also involving Egyptian HCWs [22]. Other studies done in nations with higher incomes found a much lower percentage of COVID-19 infection [23] [24]. In a different study on the general population, the percentage of people with a history of prior COVID-19 infection was around 20%, and there was no difference in this percentage between those in the medical and non-medical fields [25].
Most participants in this study were vaccine accepting (70.5%). This high rate of vaccine acceptance was comparable to the findings of earlier studies conducted on family physicians [26], primary care physicians [27], pediatricians [28], pharmacists [29], dentists [30], medical students [31] and HCWs [32] [33]. Additionally, a recent meta-analysis of ten studies on dental practitioners and students indicated that vaccine acceptability was higher in middle eastern nations [34].
The majority of individuals in other studies, however, were shown to be hesitant to receive COVID-19 vaccine [35] [36]. In a global study that was conducted in 12 countries, the majority of participants were in favor of vaccinations; nevertheless, Egypt and African nations had the lowest vaccination acceptance rates. Higher income countries showed greater vaccine adoption in the same study [37]. In another survey of nurses and midwives, the VR group was found to have the highest percentage (more than 90%), with participants worried about the vaccine's side effects and how rapidly development occurred [38]. Notably, vaccine acceptance in recent surveys was higher than earlier one. This may be ascribed to more recent and available studies, public vaccination campaigns, and political motivations.
Participants from urban areas were more vaccine accepting and these results were consistent with the finding reported by Biswas et al, in which, HCWs working at urban areas, were more vaccine accepting [39]. However, there was no difference as regard age, gender or working with COVID-19 patients in our cohort. In previous studies, it was observed that males and physicians were more accepting of vaccinations than females and nurses [40] [24] [41]. Because of this, physicians play a significant part in increasing public acceptability of the COVID-19 vaccine.
Previous exposure to COVID-19 infection is associated with higher vaccine acceptance (Malik, Malik, and Ishaq 2021) (Elhadi et al. 2021).However , there was no difference between VA, VH, VR groups in this study with relation to prior or family history of COVID-19 infection.
More acceptance of the vaccine was linked to stronger awareness of the COVID-19 vaccine and higher knowledge scores [36]. In the present study, there was a significant difference between the 3 groups as regard perception towards conventional and COVID-19 vaccination and knowledge score. These results were in line with previous studies, which showed a substantial difference between the VR, VH, and VA groups in terms of attitudes toward vaccination and perceptions of the safety of the COVID-19 vaccine [43] [35].
Physicians were reported to be primary source of information in about half of our participants (49%) followed by social media for young participants (<45 years) and television for others (≥45 years). It was found that higher education HCWs rely mainly on institutional sources and scientific literature, however, lower education HCWs rely on internet, mass media and opinions of family and friends [41]. Social and mass media are important sources of information [44].However, using social media as a source of information is associated with more vaccine hesitancy [45], while using national websites is associated with less hesitancy [35].
In this study, fear of infection, being at high risk of infection, and the desire to resume normal life were the main drivers for COVID-19 vaccination in the VA group. Similar causes were reported by previous studies conducted on family physicians and other HCWs [26] [32]
Concerns about safety and efficacy are also important barriers against vaccination [21] [31].In this study, the major barriers to the COVID-19 vaccination in the VR group were waiting for additional experience with these new vaccines and having doubts about the vaccines' efficacy. It was previously reported that the biggest obstacles to vaccination acceptability were the quick creation of the vaccine and a lack of adequate information [46] [44]. Additionally, a lack of clinical trials and concern about side effects are the main reasons why people are hesitant to obtain the vaccination. Providing this group with adequate factual information will boost their acceptance of the vaccine. [22].
Among participants, 179 (39.3%) had received COVID-19 vaccine. In certain studies, a lower vaccination rate was noted [21]. However, some research indicated a far greater rate [47] [48]. Astrzeneca (53.1%) and Sinopharm (20.7%) were the two most frequently received vaccines in our cohort. This was according to which was available for each participant. In general, m RNA vaccines are the most preferred vaccines [48]. Additionally,Pfizer and Astrazeneka vaccines are the most popular vaccination types in Arabic-speaking and African countries [49] [50] .
In conclusion, our results emphasize the value of including HCWs in pandemic vaccination campaigns. HCWs were very accepting of COVID-19 vaccines and played a crucial role in assisting patients in their vaccine decisions despite having expressed vaccine concerns. The community adopts these perceptions because of exposure to false information, which is magnified by the media. Recognizing and addressing issues at all levels is essential for increasing the reach of COVID-19 vaccination campaigns.
This study has many strengths. First, we performed a multicenter study including HCWs with various levels of education and employment experiences. Second, this study sheds essential light on the potential obstacles to and drivers behind vaccination among HCWs who an important source of human resources in vaccination are. Third, this study offers important information regarding the actual conversion of vaccine acceptance into vaccine uptake as well as adverse reactions following vaccination.
However, the study has several limitations. First, because the study was cross-sectional, it was challenging to evaluate the causes and effect relationships. Second, we employed convenience sampling, which could have biased the results. Third, some sites collected data before vaccination began, while others did so after it had begun, which may have an impact on HCWs' attitudes. Hence, as more information about the safety and efficacy of COVID-19 vaccines becomes available, individuals may have different attitudes towards vaccination.