Vaccination is vital for the prevention and elimination of the COVID-19 disease. The success of a vaccine relies on its efficacy and acceptance, primarily among health care workers (HCWs) who are at high risk of infection (14) with the essential role in the general population’s vaccination behaviors through their consultation (15). Thus, we surveyed different HCWs to measure their willingness to accept receiving the COVID-19 vaccine and assess the respondents’ source of information on COVID-19.
Out of the 3536 study participants, over 60 percent intended to uptake the COVID-19 vaccine, and each of the hesitancy towards the COVID-19 vaccine and refusing up taking the COVID-19 vaccine was reported about 19 percent. While in other studies, almost refused persons were less than those who did not decide (15–17). In different studies, acceptance rates in HCWs ranged from almost 20–80% (15–21).
The COVID-19 vaccine acceptance in our participants (62%) was less than Gagneux-Brunon et al., study (76%), which maybe was related to less proportion of nurses in our study. Whereas, in both and other studies, the acceptance of covid-19 vaccine was less in nurses (18, 22). K. Wang et al. and Fares et al. also reported that only 40.0% and 11.24% of nurses, respectively, intended to accept COVID-19 vaccination (15, 23).
Similar to several studies, in our study, older age and male gender showed more willingness to uptake the COVID-19 vaccine (21, 22, 24), and by increasing years of education, acceptance of the COVID-19 vaccine increased (15, 18). The highest chance of vaccine acceptance in our study and Qattan et al. (21) was in HCWs aged 40-50 years. However, in Elhadi et al. and Fares et al. studies, the younger population was ready to receive the vaccine (15, 19). This finding was not far-fetched, as HCWs were well aware that age is one of the influential risk factors for COVID-19 mortality (25–27). Therefore, it was more probable that elder HCWs accept the COVID-19 vaccine. We also found that in bivariate analysis, Doctors of Medicine were the most willing group to receive vaccination against COVID-19 (71.9%). Also, in multivariate logistic regression analysis, they were 1.77 times more likely to accept the vaccination (aOR: 1.77; 95% CI: 1.67–1.88). This finding was consistent with other studies, which found that compared to other HCWs, Medical doctors were more likely to accept the COVID-19 vaccines if the vaccination was available (28–32).
Our results suggested that the domestic and foreign vaccine products must be provided for better healthcare workers' adherence. As 28.7% of HCWs stated that they would prefer to receive the domestic vaccine. Fu et al. demonstrated that 52.5% of Chinese HCWs believed that the domestic COVID-19 vaccine would be better than those produced abroad (9).
The study finding indicated that only about 10% of HCWs said they did not trust any vaccine. However, trust in a vaccine is associated with vaccine up taking (33), and it is one of the critical attributes of vaccine hesitancy (33). Quinn et al. (2019) reported the trust was a strong and independent predictor of taking the flu vaccine(34). On the other hand, many of those who refused or hesitated COVID-19 vaccination could accept vaccination in the future on the condition that they could trust(35). In this regard, trust in authorities was a key factor (28). Thus, the government and decision-makers had a critical role in creating and maintaining confidence, not only in the safety but also in the effectiveness of the vaccines during mass vaccination programs (36). It seems that by offering the appropriate information about vaccines, decision-making would be facilitated, and the rate of vaccine acceptance would be increased as well.
On the other hand, a population survey of adults indicated that if the healthcare provider recommended vaccination, individuals would be more likely to receive a COVID-19 vaccine (37), which emphasized the role of health providers in the general acceptance of vaccines. So, health care providers and government officials should perform much effort to promote public trust and sincerity (36). Shekhar et al. showed that HCWs who were vaccinated were more likely to recommend vaccines to others (17). On the other hand, intent to be vaccinated was associated with trust in the health care system (38).
We also investigated the relationship of history of infection and hospitalization due to Covid 19 with vaccine uptake in HCWs. So that, in the multivariate logistic regression analysis, our results suggested that participants who had a history of COVID-19 infection were 0.85 times less likely to accept the vaccination (aOR: 0.85; 95% CI: 0.83–0.88). These results were similar to the study of Martin et al., in which they indicated that staff with a history of positive PCR were significantly less likely to be vaccinated. Maybe they believe that they have adequate immunological protection against COVID-19 infection. While, according to the evidence, the risk of infection may increase over time due to concerning waning humoral immunity (39). So, given that HCWs are at the forefront of the fight against COVID-19, offering evidence-based information, they could influence others to decide to receive the vaccine. Also, we found that respondents who were hospitalized due to COVID-19 were 2.18 times more likely to accept the vaccination (aOR: 2.18; 95% CI: 1.97–2.39). Probably, the perceived risk of HCWs who had an experience of hospitalization was higher than when COVID-19 infected them with low severity.
Our result demonstrated that the HCWs who had fewer work experiences were 1.23 times more likely to accept the vaccination; this finding was in agreement with the study by Papagiannis et al. They found that fewer work experiences enhanced the intention of HCWs to uptake the COVID-19 vaccine(40).
Studies indicated that trust in information sources was critical to vaccination acceptance (41). The finding of this study showed that the most trustful sources of information about the COVID-19 vaccine in HCWs were the instructions of the Ministry of Health and authentic medical, scientific resources and sites. Regarding the sources of information in the Fares et al. (15) study, those who used the media as the source of information had the most negative COVID-19 vaccination perception. While, those who obtained information from published scientific articles had the most positive perception, although the difference between these groups was insignificant.
We found that the recommendations of Iranian health managers and officials, international managers and health officials, and academics were influential in HCWs decision to receive the vaccine. Meanwhile, Rozek et al. indicated that individuals who had confidence in international organizations such as WHO was more likely to accept vaccine than those who reported no confidence in the WHO. Trust in health scientists and local and national health ministries were also predictive of reduced vaccine hesitancy (42). Research on the vaccination of HCWs against pandemic H1N1 showed that they were influenced by positive external cues to action, such as physicians and supervisors(43).
Strengths and limitations:
There are several strengths in the present study. First, participants were recruited and surveyed in face-to-face interviews. A multi-stage cluster sampling method by random sampling method was used according to healthcare worker statistics for gender and occupation from each medical sciences university, which led to less bias than online surveys. Second, the sample size was large, and data from a multicenter could affect the generalizability. Third, our study had many findings, which would help policymakers in the national Covid -19 vaccination program. Forth, in the present study, we focused on hospital health workers and primary HCWs (urban and rural).
There were some limitations in the present study. It should be considered that all surveys were snapshots taken at a point in time. Furthermore, we sought to evaluate the intention of HCWs toward accepting a vaccine while the vaccination program was not started yet. Hence, as more information becomes attainable on the effectiveness and safety of COVID-19 vaccines and access to various vaccines, participants might change their attitudes regarding vaccination.