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Why Some Well being Care Employees Postpone Vaccination

publisher's Note: This piece was first published on January 11th and updated to reflect new research on vaccine phasing out in healthcare workers.

Some hospitals across the country have reported that 40 percent or more of their healthcare workers who could have received a Covid-19 vaccine by January hadn't signed up for it right away. Other health facilities received so many extra doses from employees who refused the vaccine that people outside of that first priority group – including a deputy sheriff and a Disney employee – received gunshots.

A new report by a university consortium released on Friday shows that the uptake and enthusiasm for Covid-19 vaccines in healthcare has also been incredibly uneven. For example, those earning less than $ 50,000 a year were almost three times less likely to be vaccinated by mid-January than those earning more than $ 200,000 – 8 percent versus 23 percent. Those on lower wages were also much more likely to say they would not get the vaccine at all (27 percent versus 11 percent).

These are worrying developments, especially as healthcare workers are at greater risk of contracting the virus and are essential to our efforts to treat Covid-19 patients. Some public health experts hoped this group would be relatively easy to vaccinate – and could help pave the way for wider vaccine adoption. But they also represent an insightful cross-section of America.

A survey by the Kaiser Family Foundation in December found that overall health care workers were about as reluctant to receive the vaccine as the general population (29 percent and 27 percent, respectively). These respondents said they likely would not, or definitely would not, receive the vaccine.

And even those who say they want to get the vaccine may not do so right away. Another December survey of Yale Medicine and Yale New Haven healthcare workers, described in a comment in NEJM Catalyst, found that 85 percent of the 3,500+ respondents said they were "extremely likely" or "somewhat likely" to become a Covid-19 vaccine. So far, roughly 68 percent of their workers have received the vaccine when they were offered it (but this is a significant increase from early January when the rate was 53 percent).

If we understand what is holding back many healthcare workers, we can improve vaccine uptake among the wider population. What is clear is that we will need that The vast majority of people in the US will need to get Covid-19 vaccination to stop the pandemic.

But we also have to be careful. Using the wrong approach or language to promote vaccination could backfire and add to hesitation overall, says Alison Buttenheim, faculty member at Penn Nursing and the Perelman School of Medicine and scientific director of the Center for Health Incentives and Behavioral Economics. "If we go wrong, we could miss the window and blow it," she says.

Here's what we know about health care workers' reluctance to adopt vaccines – and what we can learn from it.

3 Big Reasons Healthcare Professionals Postpone Vaccines

In addition to preventing infection, serious illness, and even death, vaccinating health care workers initially provides an opportunity to gather a wealth of information that we cannot obtain obtained from the general public. This is because health systems not only have data on how many people have been offered and received the vaccine, but also on their demographics.

It's a diverse group: the people who work in health systems include not only nurses and doctors, but also those who move patients, work in catering, take on administrative functions, and keep facilities clean and operational. And people in these many roles encompass age, races and ethnicities, educational level, income level, and many other categories.

"In the US, it is our best attempt to really understand vaccine hesitation and the populations we need to consider to get the best vaccine coverage possible," said Whitney Robinson, an epidemiologist at the University's Gillings School of Public Health of North Carolina.

Early trends provide some important insights into why some health care workers are postponing the vaccine.

1) The hesitation of the Covid-19 vaccine may not be the same as the hesitation of other vaccines

The experts we spoke to noted that most healthcare workers who do not want to receive the Covid-19 vaccine right away may not necessarily turn it down indefinitely. Many nurses, said Buttenheim at the beginning of January, "wait and see:" I wouldn't mind if a few million people got it before me. "Despite robust safety and efficacy data, they want to see more real evidence first.

This is a very different attitude than people who oppose or refuse vaccines for their children, which have been around for decades and have been proven safe. This means, "You can't necessarily just apply what we know about vaccine hesitation about childhood vaccines and other vaccines," says Robinson.

The Yale study found that many of the 15 percent of workers who said they were now less likely to receive a Covid-19 vaccine wanted a year or at least six months of follow-up data on the recipients. Only about 11 percent of these reluctant people said nothing would make them comfortable getting it; and less than 1 percent of them said they were "anti-vaccine" overall. However, as Vice reported, healthcare workers are vulnerable to believing and spreading the misinformation about the Covid-19 vaccine spread via social media.

"Accounts with names like The Holistic Nurse proclaim that they will not be vaccinated and strongly imply that their followers should do the same," write Vice's Shayla Love and Anna Merlan. "It is a uniquely risky situation in which medical professionals are working to undermine trust in a vaccine just when it becomes clear that much of the world's population will need it to protect us all."

2) Covid-19 hesitation among healthcare workers tends to follow education

The new February report found that 29 percent of healthcare workers who hadn't received any education beyond high school said they wouldn't get the Covid-19 vaccine (and 22 percent said they would wait for that most people they knew would have been vaccinated) – compared to 9 percent (or 10 percent) of those with a college degree.

Similarly, of the 15 percent of adults in the Kaiser survey who said they were "definitely not getting" a Covid-19 vaccine, more than half of adults (53 percent) had a high school degree or less. On the other hand, those who said they received the vaccine “ASAP” most likely had at least a college degree.

These patterns are tracked with reports from health systems. For example, groups who receive the vaccine at higher rates are also among the most educated groups. Brita Roy of the Yale School of Medicine, where she is also director of population health and co-author of the Yale NEJM Catalyst study, notes that in early January, about 90 percent of medical residents chose to get the vaccine immediately. compared to around 20 to 25 percent of those involved in environmental services, food service, and transportation (who are likely to have lower general education levels). These latter groups have since started signing up for the vaccine in greater numbers, with 45 percent of those in environmental services choosing the shot and 35 percent of those in the food industry. However, there remains a notable gap between the inclusion of people with more skilled jobs.

3) There are historical reasons for black health workers to be skeptical about early health intervention

Colored people make up about 40 percent of the US healthcare workforce. A deep history of institutionalized medical racism means that people of skin color in the United States have often been the subject of unethical experimentation and often sowed legitimate suspicions of the medical establishment. Unfortunately, many of these groups were among the hardest hit by the pandemic, also due to centuries of systemic racism.

"I want these populations so heavily burdened with Covid-19 to have priority," says Robinson. But she admits that even this ethos could make people suspicious. "This is so unusual in the way healthcare normally works in the US that people may be taking a break," she says.

And while some workers who have not yet received a vaccine may be asked to sign up through simple reminders or other behavioral issues to help overcome suspicions caused by systemic racism, "this is not an objectionable problem," says Buttenheim. "These concerns and the story will not be resolved by a 'Mythbusters' fact sheet or any other study. It is a really frank discussion about what you need to be comfortable with this vaccine."

Another step in addressing this is also for health and medical institutions to communicate clearly and get a grip on past grievances and to state their goals for equitable medical treatment now and in the future.

Now is the time to address the vaccine's hesitation

The rate at which healthcare workers are declining or delaying Unfortunately, Covid-19 vaccines are no surprise to many experts. "I have had a proven record of banging my head against the wall for several months in preparation to develop a vaccine acceptance strategy," said Saad Omer, professor of infectious diseases at the Yale School of Medicine and director of the Yale Institute global health.

Although some were optimistic that health workers would be particularly good at taking the vaccine, Robinson was also skeptical. "Everyone who works in this field saw this coming," she says. "This is one of my frustrations: we know things we haven't reacted to."

And there is a lot of research going on about how people can feel best about receiving a vaccine in general that we can borrow to some extent for the new Covid-19 vaccines.

For starters, we know what not to do when approaching people who do not want to get a vaccine. "'You're wrong' – that usually doesn't work," notes Robinson. "It's a tricky thing." She found that one of the most effective techniques is to understand where people come from and how they hesitate. Realizing the novelty of vaccines will likely be important in addressing people's concerns – both in this first and later priority.

How to Talk to Vaccine Reluctant People: A thread for epidemiologists, and people in general, about what the research suggests and what has worked for me in the past.

– Maria Sundaram, PhD (@mariasundaram) December 7, 2020

Incentivizing people financially or otherwise can actually discourage them from getting vaccinated, especially if they already have concerns about the side effects.

Many health systems are already working hard to improve communication strategies with workers, provide peer-to-peer discussion opportunities, and even talk to their employees outside of work.

“Healthcare workers are also parishioners. So reaching them through social media and our local media, as well as internal communications, was critical, ”said Mike Dacey, president and chief operations officer of Riverside Health System in Virginia (where they are located) now about 66 percent Acceptance among workers) wrote to Vox in an email. "We encourage team members who are eligible to receive the vaccine to do so within their designated phase to best serve the safety and health of our team and our community."

In a December JAMA point of view, Buttenheim and her co-authors also suggested five behavior-based strategies to get more people to get the Covid-19 vaccine:

Let community and state leaders support the vaccine
Frame vaccination as a “public act” that benefits others; maybe even hand out stickers
Make the vaccine free and easy
Give people early access to the vaccine – if they sign up early
Finally, make vaccination an entry requirement, e.g. B. for schools, workplaces and even restaurants, gyms or airplanes

Other experts note that being transparent about possible side effects, both large and small, helps build trust. For example, some people have rejected a January 6 CDC report that found several severe allergic reactions – anaphylaxis – after Covid-19 vaccinations, at a rate of about 11 per 1 million doses, or about 0.001 percent of people who who receive the vaccine. and did not cause any deaths (unlike the virus itself). However, it would have been unlikely that these events would have cropped up in the trials involving tens of thousands of people, which is why the government carefully records all vaccines after they are launched.

Lower side effects are also important for communicating clearly and improving trust and transparency now and in the future. "The planning to screen the population for minor side effects and share this data with our healthcare workers will also be useful for the community and the (larger) population," Brita Roy wrote in an email to Vox.

"The sooner we can have more people vaccinated, the sooner we can return to normal appearances," says Buttenheim. And we have to get a lot of people vaccinated. The director of the National Institute for Allergies and Infectious Diseases, Anthony Fauci (after revising his public immunity estimates), says we need 70 to 90 percent of people who are immune to the virus to quell the pandemic.

Healthcare workers who refuse their first chance at a vaccine may find it difficult to get back on line. There is no guarantee when people can get a vaccine if they wait after the set period – until more doses are available to the public. And still immediately, some states, including Connecticut, resupplied facilities based on the number of doses they could give in the previous week. When intake is chronically low, availability may also decrease.

The fact that many health care workers do not immediately reject the vaccine and instead want to wait and see gives a small glimmer of hope. Acceptance of the vaccine "Will likely grow once the social norm is set," says Omer, with the result that more people get it when they can.

Right now, many are advocating using the science and information we already have to meet people where they are and help them feel comfortable when they get the shot. "We just have to be one step ahead," says Robinson. “So much reaction has been reactionary when it comes to Covid-19. I just hope we can break this cycle. "

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