In our study, the main reasons for vaccine hesitancy were insufficient hindsight on the vaccine, lack of information, and fear of side effects. Indeed, 48.8% of respondents did not feel hesitant to be vaccinated, whereas 34.8% felt little hesitancy, and 16.4% felt strong hesitancy, with a significantly statistically difference between auxiliary nurses and medical practitioners, 35.9% of auxiliary nurses feeling strong vaccination hesitancy compared to 3.8% of medical practitioners (p < 0.001). The main reasons reported for accepting vaccination were personal conviction (61.66%), mandatory vaccination (38.58%) and sanitary pass implementation (23.79%). Statistically significant differences were observed: men, medical practitioners and older employees more often expressing their personal conviction as a reason for vaccination. Laboratory staff and younger employees reported the introduction of the sanitary pass. Hospital housekeeper and employees in the 20–29 year age group expressed having been vaccinated following mandatory vaccination.
Concerning the booster dose, almost 80% (77.99%) of surveyed hospital employees accepted the booster dose. Acceptance of this booster dose varied depending on gender, job category and age. Both initial vaccination and vaccine booster were better accepted by men, medical practitioners and older employees.
In a study conducted in the United States from February to March 2021 in health workrs [2], the acceptance rate for a hypothetical annual booster dose to maintain immunity was 83.6% on average. This acceptance rate varied from 13.8% in the vaccine hesitant group to 89.9% in the vaccine non-hesitant group. This study also showed a progressive upward trend in vaccine acceptance over time since the start of the vaccine campaign. As in our study, vaccine hesitancy was lower among older health workers and those with a higher education level. Acceptance of the vaccine booster was higher than in our study. This may be explained by the fact that this study was carried out in the United States and not in France, where the acceptance of the initial vaccination was lower.
In France, the COVIREIVAC study [3] collected data from 10 to 23 May 2021 from a representative sample of the French population. 77% of respondents intended to get vaccinated against COVID 74.3%, and those vaccinated or intending to be vaccinated reported that they would 'definitely' get a booster dose. This booster acceptance rate is comparable to our study: 77.99% (95% CI = [75.04–80.74]), although slightly lower. Vaccine acceptance seems to increase over time, and this study was conducted in May, which may explain why we found a slightly higher acceptance rate than the COVIREIVAC study. In addition, in our study, populations that were more vaccine hesitant, such as auxiliary nurses and hospital housekeepers, were underrepresented, which may have led to an overestimation of vaccine acceptance. As in our study, age, gender and occupational category had an impact on acceptance rate. Acceptance of the vaccine booster was lower in their 25–34 year age group (60%), reaching over 90% in the over 65 year category. Women more often refused vaccination. There was also variation in vaccination acceptance by socioprofessional category (highest among managers 80.4% versus 59.8% among manual workers) [3].
A worldwide survey on potential COVID vaccine acceptance, conducted in June 2020, reported a global acceptance rate of 71.5% for the future vaccine, with very variable acceptance rates by country, ranging from 54.85% in Russia to 88.62% in China. In France, this rate was 58.89%, the third lowest rate in the study. Older respondents and higher levels of education were associated with greater vaccine acceptance. Unlike our study, no gender differences were found [4]. Another global study ranked French residents as having the highest rate of vaccine hesitancy [5].
In France, acceptance rates found in the literature among the general population or among health workers ranged from 49–77% [3–10]. In our study, just under half of respondents reported that they did not feel hesitant during the initial vaccination, so our results are within the range of the results found in the literature. This great variability can be explained by a variation over time, depending on the phrasing of the survey question (questioning on perceived hesitancy and not acceptance of vaccination) and on recent events.
Acceptance rates can be extremely variable, depending on events and information: in a French study in February 2021 among health professionals at the Rennes university hospital (CHU), 73.1% of respondents said they were in favour of vaccination, 23.1% were hesitant and only 3.9% were opposed to vaccination. This study was conducted during the controversy over the adverse effects of the AstraZeneca vaccine. As a result of this controversy, the authors found a dramatic decrease in the intention to get vaccinated from 74.8–58.3% [10].
As in our study, on several occasions in the general population, as among health care workers, in France and in the world, there is a better acceptance of vaccination by men [3;6;7;11–21], higher age groups [2–8;12–14;16–17;19–20], higher education levels and higher incomes [4–5;12–13;17], and medical practitioners [8;10–11;18–20].
The decision to receive a vaccine is a complex one. In our study, we asked respondents about the reason(s) that triggered vaccination. Personal conviction was the first reason for vaccination, followed by mandatory vaccination and the introduction of the sanitary pass. Personal conviction can be translated into a positive benefit/risk ratio. The expected benefits may be of different kinds (individual and/or collective protection, eradicating the pandemic, etc.). In our study, we observed the same reasons as in the literature: fear of COVID-19 disease, perceived as dangerous [12;14; 16;21], individual and collective protection [12–14;16], belief in vaccination and science [13], helping to stop the spread of the virus [13;16], for some more specifically in the workplace [14], and the exemption of epidemic measures (travel, leisure, outings, etc.) [14;16]. In their May 2020 study in the United States and Canada, Taylor et al. confirmed that respondents were in favour of receiving the vaccine if they were convinced (reassurance about the safety and efficacy of the vaccine, confidence in health authorities). They then reported mandatory vaccination and the equivalent of the sanitary pass [14].
In our study, mandatory vaccination was the 2nd reason for vaccination for 20–29 years of age. In the COVIREIVAC survey, on French attitudes towards mandatory vaccination, the youngest (18–24 year and 25–34 year age groups) were more frequently opposed to mandatory vaccination in the general population [22], which appears to endorse our results.
As in our study, the most common reasons for hesitancy in the literature were: concern about the safety of the COVID-19 vaccine [2;7;14;21;23–25] and its efficacy [14;24–26], which could include mistrust with respect to the development and marketing approval processes [14–15;26–28] and with respect to governments [14;17;29–30], concerns about rapid vaccine development [3;9;19;28–29]; belief that COVID-19 is not a serious disease [3;6–7], preferring to contract COVID rather than getting vaccinated [19]; potential side effects [7;27;26;28–29] and being opposed to vaccination in general [6;7].
In our study, lack of hindsight and lack of information were respectively the second and fourth reasons for reported hesitancy. In the literature, many vaccine hesitant subjects expressed a willingness not to get vaccinated first, preferring to wait until the vaccine experiences of others were known [9;19;24], and lack of information or time to make a decision [19]. Mistrust in the government was a frequently observed reason for significant hesitancy [17;29–30]. In our study, this reason for hesitancy did not seem as important as in other studies. Mistrust of the government was reported by only 9.59% (81/845) of respondents. Similarly in the literature, mistrust of pharmaceutical firms was widely observed [15; 26–28], whereas in our study this hesitancy was reported by only 8.64% (73/845) of respondents. These data were highly variable and influenced by the form of the survey. In our study, 6 employees reported that mandatory vaccination or the sanitary pass represented a reason for hesitancy. In an Italian study, 4.9% of respondents stated that the Green Pass requirement was also a vaccination concern [25].
The type of vaccine proposed is also very important: a specific rejection of the AstraZeneca and Johnson & Johnson vaccine is found in the literature [10;23]. This reluctance to use these vaccines intensified significantly when public health agencies in Canada, the United States and Europe issued warnings and restrictions on their use and media coverage of these events. In our study, only 3.79% of employees expressed that they could not have the vaccine they wanted. Indeed, we mainly had the Pfizer vaccine, much less controversial than the AstraZeneca or Johnson & Johnson vaccines [23].
Our study has some limitations. Indeed, among the respondents to our study, the 20–29 year age group was underrepresented, and the 50 year group, whilst employees in support functions were overrepresented. One of the hypotheses that may explain this discrepancy is that older employees and support functions have easier access to their professional mailbox, thus having been able to respond in greater numbers to our study. In order to reduce this gap and to make it possible to include employees who do not use their professional mailbox on a daily basis, we also distributed the questionnaire in paper format during any visit to the occupational health and prevention department, during a broader inclusion period (16 November to 10January). Hospital housekeeper, auxiliary nurses and younger employees appeared more hesitant to initial vaccination and vaccine booster. Thus, the composition of our respondent population may have led to an overestimation of vaccination acceptance. The low participation rate (15.8%) is also a limitation. The computer questionnaire was sent once on 6 December 2021. In order to achieve a higher participation rate, we scheduled a follow-up after the holiday season; however, the study was suspended following the release of the DGS-Urgent No. 2022_07 on 10 January 2022, including the booster dose in the mandatory vaccination schedule for healthcare professions. The lack of reminder has probably limited the participation rate, but as we have seen, this method of questioning mainly allows the recruitment of older employees, medical practitioners and support functions who have already largely responded to our study.
Nevertheless, the employees of the hospital group to whom we offered an opportunity to respond were very much in favour of our study. It allowed them to express themselves and allowed us better knowledge of the population we follow on a daily basis, thus allowing improved preparation of future vaccination campaigns.