Health Care Workers Change Their Minds on COVID-19 Vaccines

When the COVID-19 vaccines became available, many health care workers, despite seeing the devastating effects of the virus firsthand, said they did not intend to get vaccinated. But a new Northwestern Medicine study shows how quickly many of them at a large urban health care system changed their minds, resulting in a vaccination rate of 95% by spring 2021.

The study found:

• Only three-fourths of the 4,180 health care workers in the study intended to get vaccinated in winter 2021, but by spring 2021, 95% had been vaccinated.
• Of the health care workers who were unsure about getting vaccinated in winter 2021, 90% had been vaccinated by spring 2021.
• Of the health care workers who indicated no intention to get vaccinated in winter 2021, nearly 60% had changed their minds and gotten vaccinated by spring 2021.

“This study found health care workers’ attitudes about COVID-19 vaccination could change in a very short period of time,” said lead study author Charlesnika Evans, professor of preventive medicine in epidemiology at Northwestern University Feinberg School of Medicine. “It shows there is opportunity to change people’s decisions about not getting vaccinated.”

The study was recently published in the journal Infection Control & Hospital Epidemiology.

The first survey for this analysis was administered to 4,180 Northwestern Medicine health care workers who enrolled in the study in December 2020 through February 2021. The second survey was in June 2021. The survey asked about health care workers’ COVID-19 exposures and experiences and COVID-19 vaccination status. The participants also underwent blood testing to measure their antibodies at enrollment in spring 2020 and six months after enrollment.

Multiple factors likely contributed to health care workers changing their minds, Evans said. They included clear messaging about the safety of the vaccines, convenient access to vaccinations at the hospital, awareness that workplace mandates were coming in the future, as was the Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration.

“We saw a significant change in the number of people who said they would get the vaccine after the EUA was issued. People may have felt, ‘OK, this might be safe for me to take.’ “

Gender, race, and occupation played a role in vaccination acceptance, the study showed. Nurses (versus physicians), non-Hispanic Black (versus Asian) health care workers, and women versus men were less likely to report an intention to get vaccinated.

Individuals who showed negative antibody results were more likely to get vaccinated. People older than 65 years of age were more likely to get vaccinated. Women had a lower intention to get vaccinated than men, especially those who were in their reproductive years. Nurses also had lower intentions to get the vaccine, despite the reports that nurses have the highest rates of COVID-19 within health care workers.

One way to address mistrust is including people who have not traditionally been in research studies, making more of an effort to include them in vaccine or research studies in general, Evans said.

“The fact that they didn’t actively recruit pregnant women into the vaccine studies makes sense early on, but to prove and be sure it’s safe and effective, inclusion of these groups in trials is important,” Evans said. ”However, so far CDC data show that pregnant women have not experienced more adverse events than the general population.”

Furthermore, while a “good portion” of Black participants in the study eventually got vaccinated, “mistrust in the health care system is a concern,” Evans said.

“That’s a larger issue to be addressed within society in general that goes way beyond this study,” Evans said. “We must continue thinking about how to improve our messaging and addressing the issues around mistrust toward the health care system. This is imperative for COVID-19 and other conditions.”

Reference: “Coronavirus disease 2019 (COVID-19) vaccine intentions and uptake in a tertiary-care healthcare system: A longitudinal study” by Charlesnika T. Evans, Benjamin J. DeYoung, Elizabeth L. Gray, Amisha Wallia, Joyce Ho, Mercedes Carnethon, Teresa R. Zembower, Lisa R. Hirschhorn and John T. Wilkins, 27 December 2021, Infection Control and Hospital Epidemiology.
DOI: 10.1017/ice.2021.523

Northwestern authors are principal investigator John Wilkins and co-authors Benjamin DeYoung, Elizabeth Gray, Amisha Wallia, Joyce Ho, Mercedes Carnethon, Teresa Zembower and Lisa Hirschhorn.

The research was funded by Northwestern University Clinical and Translational Sciences Institute (UL1TR001422) and the Northwestern Memorial Foundation.