Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Questionnaire Development
2.3. Statistical Analysis
3. Results
3.1. Attitude and Practice towards Vaccination against Flu and SARS-CoV-2
3.2. Predictors of COVID-19 Vaccine Hesitancy
3.3. Vaccine Hesitancy among the General Population
3.4. Perceptions towards Relevance of Vaccinations in the Fight against COVID-19
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Situation Report. 2020. Available online: https://www.who.int/publications/m/item/weekly-epidemiological-update---12-january-2021 (accessed on 14 January 2021).
- BBC News. Covid-19 Pandemic: Tracking the Global Coronavirus Outbreak. Available online: https://www.bbc.com/news/world-51235105 (accessed on 28 October 2020).
- Chou, R.; Dana, T.; Buckley, D.I.; Selph, S.; Fu, R.; Totten, A.M. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann. Intern. Med. 2020, 173, 120–136. [Google Scholar] [CrossRef]
- Li, Y.; Campbell, H.; Kulkarni, D.; Harpur, A.; Nundy, M.; Wang, X.; Nair, H. The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number (R) of SARS-CoV-2: A modelling study across 131 countries. Lancet Infect. Dis. 2020, 20, 30785–30794. [Google Scholar] [CrossRef]
- Delamater, P.L.; Street, E.J.; Leslie, T.F.; Yang, Y.T.; Jacobsen, K.H. Complexity of the Basic Reproduction Number (R0). Emerg. Infect. Dis. 2019, 25, 1–4. [Google Scholar] [CrossRef] [Green Version]
- Cowling, B.J.; Ali, S.T.; Ng, T.W.Y.; Tsang, T.K.; Li, J.C.M.; Fong, M.W.; Liao, Q.; Kwan, M.Y.; Lee, S.L.; Chiu, S.S.; et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: An observational study. Lancet Public Heal. 2020, 5, e279–e288. [Google Scholar] [CrossRef]
- Organisation for Economic Cooperation and Development. OECD Employment Outlook 2020: Worker Security and the COVID-19 Crisis. 2020. Available online: https://www.oecd-ilibrary.org/employment/oecd-employment-outlook-2020_1686c758-en (accessed on 15 January 2021).
- Flaxman, S.; Mishra, S.; Gandy, A.; Unwin, H.J.T.; Mellan, T.A.; Coupland, H.; Whittaker, C.; Zhu, H.; Berah, T.; Eaton, J.W.; et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020, 584, 257–261. [Google Scholar] [CrossRef] [PubMed]
- Jeyanathan, M.; Afkhami, S.; Smaill, F.; Miller, M.S.; Lichty, B.D.; Xing, Z. Immunological considerations for COVID-19 vaccine strategies. Nat. Rev. Immunol. 2020, 20, 615–632. [Google Scholar] [CrossRef]
- Omer, S.B.; Yildirim, I.; Forman, H.P. Herd Immunity and Implications for SARS-CoV-2 Control. JAMA 2020, 324, 2095–2096. [Google Scholar] [CrossRef]
- World Health Organization. 2020. Available online: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines (accessed on 4 November 2020).
- Ministero Della Salute. Report Vaccini Anti COVID-19. Available online: https://app.powerbi.com/view?r=eyJrIjoiMzg4YmI5NDQtZDM5ZC00ZTIyLTgxN2MtOTBkMWM4MTUyYTg0IiwidCI6ImFmZDBhNzVjLTg2NzEtNGNjZS05MDYxLTJjYTBkOTJlNDIyZiIsImMiOjh9 (accessed on 4 January 2021).
- Plotkin, S. History of vaccination. Proc. Natl. Acad. Sci. USA 2014, 111, 12283–12287. [Google Scholar] [CrossRef] [Green Version]
- E Andre, F.; Booy, R.; Bock, H.L.; Clemens, J.; Datta, S.K.; John, T.J.; Lee, B.W.; Lolekha, S.; Peltola, H.; A Ruff, T.; et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull. World Heal. Organ. 2008, 86, 140–146. [Google Scholar] [CrossRef]
- Larson, H.J.; Cooper, L.Z.; Eskola, J.; Katz, S.L.; Ratzan, S. Addressing the vaccine confidence gap. Lancet 2011, 378, 526–535. [Google Scholar] [CrossRef]
- Dubé, E.; Laberge, C.; Guay, M.; Bramadat, P.; Roy, R.; Bettinger, J.A. Vaccine hesitancy. Hum. Vaccines Immunother. 2013, 9, 1763–1773. [Google Scholar] [CrossRef] [PubMed]
- European Centre for Disease Prevention and Control. Vaccine hesitancy among healthcare workers and their patients in Europe–A qualitative study; ECDC: Stockholm, Sweden, 2015. [Google Scholar]
- Ministero della Salute. Parliamo di Esitazione; Traduzione e adattamento di Let’s talk about hesitancy; ECDC: Stockholm, Sweden, 14 January 2016. Available online: http://www.salute.gov.it/imgs/C_17_opuscoliPoster_366_allegato.pdf (accessed on 14 January 2021).
- Barrière, J.; Vanjak, D.; Kriegel, I.; Otto, J.; Peyrade, F.; Estève, M.; Chamorey, E. Acceptance of the 2009 A(H1N1) influenza vaccine among hospital workers in two French cancer centers. Vaccine 2010, 28, 7030–7034. [Google Scholar] [CrossRef] [PubMed]
- Verger, P.; Fressard, L.; Collange, F.; Gautier, A.; Jestin, C.; Launay, O.; Raude, J.; Pulcini, C.; Peretti-Watel, P. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine 2015, 2, 891–897. [Google Scholar] [CrossRef] [Green Version]
- Maltezou, H.C.; Dedoukou, X.; Patrinos, S.; Maragos, A.; Poufta, S.; Gargalianos, P.; Lazanas, M. Determinants of intention to get vaccinated against novel (pandemic) influenza A H1N1 among health-care workers in a nationwide survey. J. Infect. 2010, 61, 252–258. [Google Scholar] [CrossRef]
- Johns Hopkins University Coronavirus Resource Center. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. 2020. Available online: https://coronavirus.jhu.edu/map.html (accessed on 14 January 2021).
- Felice, C.; Di Tanna, G.L.; Zanus, G.; Grossi, U. Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey. J. Community Heal. 2020, 45, 675–683. [Google Scholar] [CrossRef]
- Reproduction number (R) and growth rate (r) of the COVID-19 epidemic in the UK: Methods of estimation, data sources, causes of heterogeneity, and use as a guide in policy formulation; The Royal Society: London, UK, 2020.
- Holzmann, H.; Wiedermann, U. Mandatory vaccination: Suited to enhance vaccination coverage in Europe? Eurosurveillance 2019, 24, 1900376. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Neumann-Böhme, S.; Varghese, N.E.; Sabat, I.; Barros, P.P.; Brouwer, W.; Van Exel, J.; Schreyögg, J.; Stargardt, T. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur. J. Heal. Econ. 2020, 21, 977–982. [Google Scholar] [CrossRef] [PubMed]
- Lazarus, J.V.; Ratzan, S.C.; Palayew, A.; Gostin, L.O.; Larson, H.J.; Rabin, K.; Kimball, S.; El-Mohandes, A. A global survey of potential acceptance of a COVID-19 vaccine. Nat. Med. 2020, 20, 1–4. [Google Scholar] [CrossRef]
- Dubé, E.; Vivion, M.; E MacDonald, N. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: Influence, impact and implications. Expert Rev. Vaccines 2015, 14, 99–117. [Google Scholar] [CrossRef]
- Trogen, B.; Oshinsky, D.; Caplan, A. Adverse Consequences of Rushing a SARS-CoV-2 Vaccine: Implications for Public Trust. JAMA 2020, 323, 2460–2461. [Google Scholar] [CrossRef]
- Rubin, E.J.; Longo, D.L. SARS-CoV-2 Vaccination—An Ounce (Actually, Much Less) of Prevention. N. Engl. J. Med. 2020, 383, 2677–2678. [Google Scholar] [CrossRef] [PubMed]
- Murri, R.; Segala, F.V.; Del Vecchio, P.; Cingolani, A.; Taddei, E.; Micheli, G.; Fantoni, M. COVID II Columbus Group. Social media as a tool for scientific updating at the time of COVID pandemic: Results from a national survey in Italy. PLoS ONE 2020, 15, e0238414. [Google Scholar] [CrossRef] [PubMed]
- Wood, S.; Schulman, K. Beyond Politics—Promoting Covid-19 Vaccination in the United States. N. Engl. J. Med. 2021, 384, e23. [Google Scholar] [CrossRef]
- Polack, F.P.; Thomas, S.J.; Kitchin, N.; Absalon, J.; Gurtman, A.; Lockhart, S.; Perez, J.L.; Marc, G.P.; Moreira, E.D.; Zerbini, C.; et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N. Engl. J. Med. 2020, 383, 2603–2615. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Total Participants (n = 1723) | Intent to Be Vaccinated | p-Value | ||
---|---|---|---|---|---|
No or not Sure (n = 568) | Yes (n = 1155) | ||||
Sex (n, %) | Female | 920 (53) | 303 (33) | 617 (67) | 0.999 |
Male | 803 (47) | 265 (33) | 538 (67) | ||
Age group (n, %) | <30 | 762 (44) | 184 (24) | 578 (76) | <0.0001 |
30–40 | 527 (31) | 205 (39) | 322 (61) | ||
41–50 | 200 (12) | 107 (54) | 93 (47) | ||
51–60 | 106 (6) | 47 (44) | 59 (56) | ||
>60 years | 128 (7) | 25 (20) | 103 (80) | ||
Geografic Area (n, %) | Central Italy | 385 (22) | 119 (31) | 266 (69) | 0.2443 |
Northern Italy | 622 (36) | 197 (32) | 425 (68) | ||
Southern Italy and Islands | 716 (42) | 252 (35) | 464 (65) | ||
Occupational profile (n, %) | Specialised Medical Doctor | 337 (20) | 103 (31) | 234 (69) | <0.0001 |
Medical resident | 259 (15) | 55 (21) | 204 (79) | ||
Medical Doctor | 544 (32) | 131 (24) | 413 (76) | ||
General Practitioner | 135 (8) | 49 (37) | 85 (63) | ||
GP trainee | 70 (4) | 16 (23) | 54 (77) | ||
Non-MD health professional | 378 (22) | 214 (57) | 164 (43) | ||
Area of work (n, %) | Surgical | 86 (11) | 26 (30) | 60 (70) | 0.3731 |
Clinical | 356 (44) | 95 (27) | 261 (73) | ||
Non-clinical | 154 (19) | 37 (24) | 117 (76) | ||
Primary health care | 205 (26) | 65 (32) | 140 (68) | ||
Length of service (n, %) | <10 y | 1249 (72) | 364 (29) | 885 (71) | <0.0001 |
>10 y | 474 (28) | 204 (43) | 270 (57) | ||
Self-perceived risk (n, %) | Previous or current SARS-CoV-2 infection | 87 (5) | 33 (38) | 54 (62) | 0.3491 |
Previous or current SARS-CoV-2 Infection in family members or close contacts | 626 (36) | 213 (34) | 413 (66) | 0.4888 | |
Rating self-perceived health status (mean, SD) | 8.5 (1.3) | 8.4 (1.4) | 8.68 (1.3) | - | |
Self-perceived higher risk of contagion or bad outcome for COVID-19 due to health status | 275 (16) | 106 (19) | 169 (15) | 0.0357 | |
People at risk between close contacts or cohabitants (n, %) | Over > 65 | 987 (57) | 299 (30) | 688 (70) | 0.0071 |
Children < 12 | 440 (26) | 166 (38) | 274 (62) | ||
People with disability or current serious disease | 244 (14) | 72 (30) | 172 (70) | ||
Immunocompromised or in treatment with immunosuppressors | 220 (13) | 57 (26) | 162 (74) | ||
Trust in Current Containment Measures (Mean, SD) | 6 (1.9) | 5.8 (1.9) | 6.07 (1.9) | - | |
Information sources on SARS-CoV-2 vaccination (n, %) | Scientific Literature | 1202 (70) | 335 (28) | 867 (72) | <0.0001 |
Expert opinions | 851 (49) | 275 (33) | 569 (67) | ||
Scientific meeting | 669 (39) | 186 (28) | 485 (72) | ||
Media | 273 (16) | 65 (24) | 208 (76) | ||
Facebook group | 276 (16) | 120 (43) | 156 (57) | ||
Journal and website | 382 (22) | 132 (35) | 250 (65) | ||
Attitude towards patients recommendation (n, %) | would recomment | 1219 (71) | 17 (20) | 1046 (91) | <0.0001 |
uncertain | 405 (24) | 32 (57) | 84 (7) | ||
would not recommend | 99 (6) | 74 (13) | 25 (2) |
Self-Reported Reasons of Vaccine Hesitancy | n (%) | |
---|---|---|
Safety | Fear about vaccine content | 455 (80%) |
Fear for side effects | 482 (85%) | |
Fear of pre-existent co-morbidities | 253 (45%) | |
Fear of getting Covid-19 through the vaccine | 234 (41%) | |
Information | Little information about vaccine | 441 (78%) |
Conflicting/misleading information | 390 (69%) | |
Trust | Low trust in control authority | 332 (58%) |
Low trust in pharmaceutical companies | 329 (58%) | |
Conspiracy theories | 75 (13%) | |
Complacency | COVID-19 symptoms are mostly mild | 117 (21%) |
Physiological immunity is better | 148 (26%) | |
Efficacy | Small or doubted efficacy | 433 (76%) |
Univariate Analysis * | Multivariate Analysis ° | ||||
---|---|---|---|---|---|
OR (95% CI) | p-Value | aOR (95%CI) | p-Value | ||
Sex | Male | 0.99 (0.82–1.21) | 0.999 | 1.02 (0.79–1.32) | 0.19 |
Age group | <30 y | 0.47 (0.39–0.58) | <0.0001 | 0.58 (0.41–0.83) | <0.0001 |
Geografic Area | Northen Italy | 0.91 (0.74–1.12) | 0.3443 | 0.95 (0.73–1.24) | 0.46 |
Occupational profile | Health Professionals | 3.65 (2.87–4.63) | <0.0001 | 1.82 (1.31–2.50) | <0.0001 |
Area of work | Clinical | 1.454 (1.11–1.88) | 0.004 | 1.072 (0.76–1.48) | 0.06 |
Length of service | >10 y | 1.83 (1.47–2.28) | <0.0001 | 1.32 (0.82–2.19) | 0.02 |
Previous or current SARS-CoV-2 infection | 1.25 (0.81–1.97) | 0.3491 | 1.22 (0.68–2.13) | 0.53 | |
Previous or current SARS-CoV-2 Infection in family members or close contacts | 1.08 (0.87–1.32) | 0.888 | 0.99 (0.76–1.29) | 0.02 | |
Rating self-perceived health status (mean, SD) | 0.81 (0.83–1.32) | 0.03 | 0.99 (0.89–1.10) | 0.02 | |
Information sources on SARS-CoV 2 | Facebook group | 1.71 (1.3–2.22) | <0.0001 | 1.48 (1.06–2.07) | <0.0001 |
Seasonal flu vaccination | Flu vaccination during last season | 0.28 (0.22–0.35) | <0.0001 | 0.37 (0.29–0.48) | <0.0001 |
Intention towards Flu vaccination for the current season | 0.66 (0.43–0.98) | <0.0001 | 0.79 (0.61–1.02) | 0.02 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Di Gennaro, F.; Murri, R.; Segala, F.V.; Cerruti, L.; Abdulle, A.; Saracino, A.; Bavaro, D.F.; Fantoni, M. Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy. Viruses 2021, 13, 371. https://doi.org/10.3390/v13030371
Di Gennaro F, Murri R, Segala FV, Cerruti L, Abdulle A, Saracino A, Bavaro DF, Fantoni M. Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy. Viruses. 2021; 13(3):371. https://doi.org/10.3390/v13030371
Chicago/Turabian StyleDi Gennaro, Francesco, Rita Murri, Francesco Vladimiro Segala, Lorenzo Cerruti, Amina Abdulle, Annalisa Saracino, Davide Fiore Bavaro, and Massimo Fantoni. 2021. "Attitudes towards Anti-SARS-CoV2 Vaccination among Healthcare Workers: Results from a National Survey in Italy" Viruses 13, no. 3: 371. https://doi.org/10.3390/v13030371