Identifying factors associated with Covid-19 vaccine hesitancy among healthcare workers across different countries: A systematic review and narrative synthesis

Abstract

Background: In most countries globally, healthcare workers have been classified as a priority group for immunisation against Coronavirus given their frontline position and increased risk of infection. However, studies investigating healthcare workers' attitudes toward the vaccine showed that many healthcare workers were hesitant to take it, with variation in hesitancy rates across countries. Hesitancy to receive the vaccine poses a significant threat to global efforts to reduce the impact of the disease. The World Health Organization defines vaccine hesitancy as a complicated and context-specific delay in accepting or refusing vaccines, notwithstanding the availability of immunisation services. Thus, it is necessary to understand the factors that contribute to vaccine hesitancy among healthcare workers to provide information to support the development and implementation of vaccine policies and practices in the future. Therefore, this systematic review synthesises evidence on healthcare workers' attitudes towards Coronavirus vaccination and discusses the determinants contributing to vaccine hesitancy. Methods: A systematic search was conducted on several scientific and interdisciplinary online databases, such as PubMed, Scopus, CINAHL, Cochrane, Embase, Google Scholar, Global Health and ProQuest, using search terms associated with vaccine hesitancy and healthcare workers. Studies included were only related to healthcare workers’ attitude toward Covid-19 vaccine between January 2020, "the beginning of the pandemic" to 8th of July 2021, which was the last day of the search. Due to the heterogeneity of the studies included, a meta-analysis was not possible to be performed. Therefore, a narrative synthesis approach was used to present and analyse the data. Results: Thirty-two papers from 15 different countries were included. In this review, the findings showed that vaccine hesitancy in healthcare workers varied widely across countries, ranged from (5.5%) to (79%). The lowest vaccine hesitancy rates toward taking the vaccine were mainly found in studies from the "European Regions" and "Regions of the Americas". Demographic variables showed that females, nurses, black race, and workers under the age of 40 years were more hesitant toward the vaccine. Moreover, communication and media influence, self-perceived risk, lack of knowledge, concerns about vaccines' effectiveness, safety, sources of supply, and distrust in the government and pharmaceutical companies were identified as influences on vaccination decision. Conclusion: Further qualitative research is needed to obtain a comprehensive understanding of the effects of vaccination decisions, especially among females, nurses, and ethnic minorities. In addition, future quantitative studies need to consider breaking down the findings from reasons cited for hesitation by gender, age, and other variables to more. This will allow drawing conclusions on the influence of individuals or a collection of factors on vaccine hesitancy. The wide range of vaccine hesitancy reasons identified in this review indicated that no single approach will be effective against vaccine hesitancy. Therefore, the intervention designed to address these concerns needs to be comprehensive, context-specific and tailored depending on the occupational group targeted, country, age, race, and other factors.