While few other studies examined the attitude and behavior of healthcare workers and medical students towards the COVID-19 vaccines based on their personal experiences and past vaccination history [31] [32] [33] Medical Students and SARS-CoV-2 Vaccination: Attitude and Behaviors). To our knowledge, this is the first paper to provide a deeper view of the attitudes and knowledge of healthcare workers and students on the molecular mechanism of NBVs, predominantly the newly approved mRNA COVID-19 vaccines. Additionally, the study showcased the difference in attitudes between DNA-based and RNA-based vaccines, also a poorly covered area in literature.
The participants’ demographics and their professional characteristics discussed in (Table 1) showed similar patterns in both the educated and uneducated groups. A higher percentage of female participants (59%) chose to fill the questionnaire with educational material attached than male participants (41%), suggesting that female healthcare workers show greater willingness to read educational materials than males. Noting that the study participants of both sexes had almost identical attributes concerning their level of education and other demographic factors. Surprisingly, physicians showed the least interest in being part of the “educated” group’s sample than any other healthcare field which could be referred to them having confidence in their previous knowledge on the topic or due to their heavier workload.
In assessing the knowledge and attitude of healthcare workers, students, and researchers on their preferred type of NBVs, the analysis revealed the population to view RNA-based NBVs as a safer option as compared to DNA based ones as a whole (Table 2), which perhaps reveals an issue of skepticism towards the safety of DNA therapy as a whole.[34] [35]
Giving a brief educational material about NBVs yielded no difference when challenged by questions not solidly based on scientific theory (RNA being more readily degraded than DNA, or DNA producing foreign proteins only), which indicates a healthy scientific base among Jordans’ healthcare workers regarding this topic (Table 2). On the other hand, the educational material proved significant in altering the participants' attitude on NBVs safety in favor of the RNA-based NBVs as opposed to DNA-based NBVs due to the reduced risk of genome incorporation (gene editing)[36], a very common theme in the controversy surrounding NBVs. Yet, about one third were still surprisingly skeptical of the possibility of this emerging type of vaccines being a form of gene therapy[37], despite that the educational material provided them with improved knowledge and agreement of the population as shown in (Table 2), and that RNA does not get incorporated into the genome[36], which shows a heightened concern against NBVs (perhaps more so of DNA based ones). It may be that healthcare workers view NBVs as a form of gene therapy merely due to the possible misconception that NBVs is a “therapeutic” module against a disease utilizing a “gene” albeit a viral gene. Other parameters of (Table 2) yielded no difference in attitudes regarding their safety when a comparison is made between the educated versus the uneducated groups.
When asked about the safety of NBVs in general (Table 3), only a mere third of the population across both groups (33%) considered NBVs as safe as their non-NBVs counterparts while as much as half of the total study population stayed neutral, pointing towards a clear alarm against NBVs in the population. Educational material did not play any significant role in changing the knowledge base or attitude towards NBVs in healthcare workers. The majority of the population were concerned about possible undiscovered long-term effects of NBVs and agreed that phase 1 trials were not successful in adequately revealing any potential adverse effects of these vaccines. This could indicate a significant gap in knowledge regarding the components of NBVs or knowledge of their previous safety profile assessment in these components in vaccines and therapeutics years before SARS-CoV-2 vaccines such as flu, Zika, and CMV. Interestingly enough, the controversy on the safety of NBVs was not as pronounced as it is now with COVID-19, which could be due to the pandemic, aggressive and unprecedented nature of COVID-19 which was not experienced by most people alive today.
Table 3 also showed that more than two-thirds of the population agreed that the full safety effect of NBVs cannot yet be determined, which can be viewed in a very positive light as phase 4 trials only just begun, and healthcare workers are only adopting a healthy approach towards the safety of these vaccines. Moreover, the study’s population agreed that these vaccines would be effective in preventing severe illness with COVID-19,[30] a very important result coming out of the phase 3 trials, which would effectively reshape the health emergency of COVID-19.
Table 4 dives deeper into the participants' knowledge about NBVs and their effectiveness[38]. The educated group showed noticeable agreement that NBVs should be the industry standard, although not significant. The most significant difference between the two study groups was, without surprises, the sharp increase amongst the educated group in declaring that “NBVs is a form of gene therapy” is a true statement when they faced it, confirming all of the previous points made about the skepticism surrounding “gene therapy”. The belief that RNA-based NBVs are more effective than their DNA-based counterpart was also significantly elevated in the educational group. The remaining statements did not illustrate any significant difference between the two groups.
Assessing the impact of the provided educational material on changing the attitudes of the healthcare population in Jordan towards NBVs leaves us with interesting findings. To our surprise, barring eliminating the fear of participants regarding RNA-based NBVs being incorporated into the human genome, the educational material failed to drastically improve the attitudes of the study’s population towards the safety of NBVs in general. This indicates the evident need for a clear, rich, and routinely updated educational material well integrated with the curriculum of various healthcare programs regarding NBVs and other modern techniques used in vaccinology. That shall aim to diminish fear arising from various misconceptions circulating around the topic, especially ‘gene therapy’, ultimately ensuring an elevated quality of knowledge and formulated opinions of healthcare workers towards NBVs.
The healthcare workers’ knowledge and attitudes are of extreme importance for healthcare sectors to improve the success of vaccination programs [39]. The majority of controversy in the population relies in part on the opinion of healthcare workers or physicians (in or out of context). Thus, a well-educated front of vaccine providers (which are ultimately the healthcare workers themselves) would serve to paint an accurate picture to the patients to make a well-informed decision and consequently reduce the heated controversy surrounding the topic. Efforts from different well reputable organizations (CDC, WHO…etc) have attempted to adopt this role with varying degrees of success however, with the unprecedented anti-vaccine sentiment that is mounting in the general masses and stemming from many political, social, and educational factors, healthcare workers are still touched by these sentiments. This may serve as fuel for further controversy with the current vaccine rollout and any possible future NBVs vaccination campaigns. In our view, a unified front that has a less governmental characteristic and more of a popular front would be essential in improving vaccine efforts and outcomes, both inpatients and the healthcare field staff.