This study is first of its kind to depict the COVID-19 vaccination intention among community health worker in India. Of the 357 community health workers, just over half responded positively regarding intention to uptake COVID-19 vaccination. Education, exposure to COVID-19 cases, perception of risk, and trust in the healthcare system were factors which affected intention to get vaccinated.
More than half (58%) of the respondents showed their intention of getting vaccinated in the current study, however, this level of acceptance might not be sufficient to break the chain of transmission [17, 18]. In a survey conducted among French healthcare workers, 77% declared they would intend to get vaccinated against COVID-19[19]. Rates of intention ranged from 92% in physicians, 65% among nurses, 70% among midwives and 67% in other HCWs [19]. Healthcare workers in Congo reported, around 28% were willing to get vaccinated [20]. In India, 86% planned to get COVID-19 vaccination whenever available, in a survey conducted among the general population [21]. The differences in study population and the time when the survey was conducted might explain the differences.
Having a graduate or a post-graduate degree was associated with higher intention of up taking the vaccine as compared to a diploma/ high school education in our study. This was similar to other studies who reported higher education was associated with greater uptake of the hypothetical vaccine [15, 22].
Those participants who were exposed to COVD-19 cases were less inclined to uptake the hypothetical vaccine in the current study. This was in contrast to studies conducted among healthcare workers in Canada and China, where exposure or suspected exposure to a COVID-19 patient was associated with higher intention of acceptance [23, 24].
Those who perceived they were not at risk of getting infected by COVID-19 were more likely to opt for a COVID-19 vaccine when it was available, in this study. Risk perceptions are central to many health behavior theories. Several studies have found positive association between risk perceptions and engagement in protective behavior like vaccination [19, 25, 26], while other studies have reported negative relationships [27]. It can be speculated that perceived control might have affected the study results. High levels of perceived control has been reported to be associated with lower health risk perception [28], and higher intentions towards protective behavior [29]. The role of perceived control as a moderator between perceived risk and vaccination intention could be explored in future studies.
In the current study, the odds of accepting the vaccine was almost three times more among those who trusted the healthcare system as compared to those who did not. A positive effect of trust in the health system and the government on vaccination intention and uptake has been reported previously [15, 30, 31].
This is the first study as per our knowledge which has examined the intention to accept COVID-19 vaccine among community health workers in India. However, it has a number of limitations. The study was cross-sectional in nature with convenience snowball sampling; the intention to uptake vaccine might change with time. Responses were recorded using an online survey which might have led to potential biases in reporting. Also, questions were available in English language and not in regional languages which might have prevented non-English speaking CHWs from participating.
Despite almost all participants having knowledge regarding the community circulation of the virus and the development of a COVID-19 vaccine, it is of considerable concern that just over half expressed their intention to uptake the vaccine once it’s available. In a country like India, where community healthcare workers act as a bridge between the healthcare system and the general population, their recommendation plays an influential role in the general population’s vaccination behavior. The grass-root level workers serve as an important source of information for the community, and their perception of COVID-19 vaccination can be a key factor in influencing the public’s decision to get vaccinated. The low positive response regarding acceptance of a COVID-19 vaccine among the study participants is worrying. There is a significant need to address the CHW’s vaccine related concerns and improve their trust in the healthcare system to increase acceptance rate of COVID-19 vaccine.