1. Introduction
In the first half of 2021, the Czech Republic was the fourth most affected country by COVID-19 in the world [
1,
2,
3]. Public health restrictions caused by the COVID-19 pandemic severely affected the entire country, including the healthcare system. The rapid increase in the number of COVID-19 patients resulted in a suspension of non-acute general healthcare in the Czech Republic. Such an approach was similar in most countries of the European Union. Despite general healthcare suppression, one of our previous studies revealed that Czech dentists worked even throughout the pandemic, and Czech dentistry remained more than 90% operative throughout the COVID-19 pandemic [
4]. Such an approach was rare on a European and global scale as dentists are one of the COVID-19 highly vulnerable professional groups [
4,
5]. These factors—the high-level prevalence of COVID-19 in the Czech Republic, the high workload during the pandemic, and the significant risk of infection due to dentists’ work settings—make Czech dentists a unique epidemiological group.
Based on this, the Czech Dental Chamber decided to conduct an extensive survey to determine the impact of COVID-19 on its members. The first phase of the research contained several chapters of different focuses (see Materials and Methods). The chapter focused on COVID-19 prevalence among Czech dentists revealed that despite the high occupational risk, the prevalence among dentists was significantly lower than among the Czech general population [
3]. The study indicated that although the dental profession is associated with a high occupational risk of droplet infection transmission, including SARS-CoV-19, the working conditions of dentists in the Czech Republic have not led to a higher prevalence of COVID-19 infection among them. This could be due to well-chosen anti-epidemic measures adopted by Czech dentists. The results of the next chapter focused on vaccination are presented in this work. The survey is part of a long-term study assessing the impact of COVID-19 on Czech dentists, with the next phase to be initiated in 2022.
The impact of COVID-19 on dentists is a topic that is not sufficiently described. Several works covered the pandemic’s impact on the operation of dental practices, but only a few studies focused on the impact on dental professionals [
6,
7,
8,
9,
10]. Our team was the first to publish a study on the national COVID-19 prevalence of dentists from the beginning of the pandemic to the end of the first half of 2021 [
3]. Although dentists are one of the most vulnerable occupational groups, information about COVID-19 vaccination among them is scarce. There is only a very limited amount of works on this topic, and in the vast majority, it only concerns the willingness, hesitancy, or acceptance of dentists to get vaccinated [
11,
12,
13,
14,
15]. To the best of our knowledge, this is the first study to provide data on real COVID-19 vaccination among dental professionals.
2. Materials and Methods
2.1. Design
The Czech Dental Chamber designed this questionnaire in collaboration with the academic community, experts from the chamber, and general practitioners. The resulting questionnaire was sent together with the request to participate in this self-administered, cross-sectional survey to the officially registered e-mail addresses of the chamber members. The e-mail also included information on the purpose of the study. Participants’ responses were anonymous, untraceable, and did not contain any identifying personal information. No remuneration was provided to the respondents, and completing the questionnaire did not bring them any direct benefits. This study was conducted in accordance with the Declaration of Helsinki. The survey and the content of the questionnaire were approved and supervised by the Executive Board of the Czech Dental Chamber.
Since the entire survey was designed as a tool to widely analyze the impact of COVID-19 on the Czech Dental Chamber members in various aspects, it was divided into several chapters. Each chapter covered a different topic, namely the following: Prevalence, Vaccination, and Epidemiology. Due to data extension and the different focus of individual chapters, their results were analyzed and presented separately. The results of the Prevalence chapter were published in November 2021, the data of the Vaccination chapter are presented in this work, and the Epidemiology chapter will be analyzed in 2022 [
3].
The presented data were obtained from the answers to 9 questions—4 questions were close-ended, and 5 were semi-close-ended (prefilled close-ended answers along with the option to reply in an open form). The questions and answers were exclusively in the Czech language throughout the questionnaire. The wording of the questions and their further specifications are available in
Supplementary Materials Table S1.
2.2. Sample
The Czech Dental Chamber sent an official invitation to participate in the survey to a total of 9922 officially registered e-mail addresses of its members. Each of these addresses was unique and belonged to an individual member. Participation in the questionnaire was possible from 23 June 2021 to 4 September 2021.
The latest official data showed that the chamber had 11,160 members as of 31 December 2020. This means that 88.9% of the members were addressed by this survey. The Czech Dental Chamber membership is compulsory for all dentists working in the country.
2.3. Sample Size Relevancy
The minimum number of research participants (
n) to achieve relevant results was calculated as 372. The calculation was performed using Formula (1) via an online Netquest calculator. A study universe (
N) was quantified as the number of the Czech Dental Chamber members (
n = 11,162), a margin of error (
e) was set at 5%, a confidence level (
Z) at 95%, and a standard heterogeneity (
p) at 50%. The statistical relevance of this study was confirmed as the number of participants (2716) exceeded the minimum required number.
Formula (1). Relevant sample size calculation.
2.4. Data Collection
The e-mail sent as part of the invitation redirected the participants to an online questionnaire in Google Forms (Google, Mountain View, CA, USA). The questionnaire was compatible across the most commonly used display devices and operating systems. The response results were stored in the Google Forms cloud database during ongoing data collection. After data collection was completed, the results were downloaded.
2.5. Statistical Analysis
The data were downloaded from the Google Form cloud database and analyzed. Answers within close-ended questions are presented as a percentage of answers within all answers. The semi-close-ended question was analyzed independently by 3 authors (V.P., J.T., and J.S. (Jan Schmidt)). Results that did not agree between the authors were decided by the fourth author (J.S. (Jakub Suchanek)). The open responses were individually evaluated and grouped according to their meaning into predefined groups or a new group. A new group was created if the number of responses exceeded the threshold specified as n = 5. If this limit was not exceeded, the responses were assigned to the “Others” group. The results are presented as a percentage of answers within all answers. Empty answers were not counted.
A person was considered partly vaccinated if they have received only one dose of a 2-dose vaccine protocol. A person was considered fully vaccinated if they have received a single-dose vaccine or both doses of a two-dose vaccine.
The data were organized and analyzed in Microsoft Office Excel (version 2106 for Windows, Microsoft Corporation, Redmond, WA, USA) and GraphPad Prism (version 8.0.0 for Windows, GraphPad Software, San Diego, CA, USA).
4. Discussion
Dentists are in close contact with patients, and their work environment is associated with high droplet formation. Such conditions predispose dentists to be prone to droplet infections, including COVID-19. Despite this fact, there is insufficient information on the impact of COVID-19 on dentists. Reflecting this situation, the Czech Dental Chamber initiated an extensive survey divided into three chapters: COVID-19 Prevalence, Vaccination, and Epidemiology. Almost a quarter of the entire chamber was involved, resulting in one of the largest national surveys among dentists, both absolutely and relatively. A study on the prevalence of COVID-19 among Czech dentists was published in November 2021, vaccination data are part of this work, and a chapter on epidemiology will be processed early in 2022, making Czech dentists one of the best-described professional groups during the COVID-19 pandemic.
As no information on the vaccination process among Czech dentists was available before the start of the survey, we first decided to find out what approach they have to vaccination, including persons registered for vaccination, followed by a question about the reason for their decision. This procedure was chosen to also include those who had the willingness to be vaccinated but had not been vaccinated yet. The results revealed that almost all participants who showed an interest in vaccination did not delay it, but they were already in the process of vaccination. Their reasons were more than 90% professional, and only 25 respondents stated that they were motivated negatively, e.g., avoiding travel restrictions. A significant proportion of unvaccinated respondents stated medically relevant reasons for avoiding vaccination, such as laboratory-tested antibodies or medical contraindication. In summary, 89.5% of all participants were either registered for vaccination, partly or fully vaccinated, or had objective reasons to avoid vaccination. Some of the medically relevant reasons for avoiding vaccination, such as pregnancy and breastfeeding, are not considered medically relevant reasons to avoid vaccination today. However, in the first half of 2021, there was insufficient information on the safety of vaccines for these groups. The official recommendation for vaccination of pregnant and breastfeeding persons against COVID-19 was not issued in the Czech Republic until June 2021 [
17]. Therefore, the classification of these reasons as “medically relevant” is correct for evaluating the approach to vaccination at the time of the survey, as it was consistent with the current state of knowledge.
Overall, 79.6% of all participants had completed vaccination against COVID-19. This result shows a very positive attitude of Czech dentists to vaccination as its rate is significantly higher than in the general Czech population. However, the comparison of the proportion of vaccinated persons among the members of the Czech Dental Chamber and the entire general population is limited by the different approaches to vaccination on the basis of profession and age. First, health professionals had government-guaranteed priority access to vaccination because of their profession. The general population’s access to vaccination was restricted due to a lack of vaccines in the first half of 2021. Second, dentists are university-educated people; hence, the study group consists of adults of different ages than the general population. To reflect on the potential bias resulting from the professional and age specificities of our study group, we decided to include COVID-19 vaccination statistics of the Czech general population over 25 years old for comparison. As all respondents admitted that their vaccination was completed by the end of June 2021, the first time point for comparison was set at 30 June 2021. On this date, ~40.7% of the general Czech population over the age of 25 years were fully vaccinated [
18,
19]. To eliminate the professional advantage of dentists in having access to vaccination, the second time point for comparison was set at 30 September 2021. At that time, vaccination had been available for a sufficiently long time without professional restrictions to all adults. On 30 September 2021, ~67.5% of the general population over the age of 25 years were fully vaccinated [
18,
19]. From this analysis, it is clear that even after the elimination of bias influences (occupational and age restriction), vaccination among dentists remains significantly higher than in the comparable general Czech population. The authors considered it important that the results of this study are comparable with other studies. Since vaccination data are generally presented mostly as a percentage of the general population, we decided to present the data in the same way and comment on the population specifics of this study here in the Discussion. We believe that the data provide the highest possible informativeness and comparability in this manner.
The more positive approach to vaccination against COVID-19 among Czech dentists could be due to their education type, as all Czech Republic dentists have graduated from medical universities. This is in accordance with the findings of Siegler et al., who observed higher willingness toward COVID-19 vaccination among persons with a bachelor’s or graduate degree than among persons with lower education [
20]. Additionally, a work of Abedin et al. indicates that people with a higher level of education have a more positive approach to vaccination [
21]. It is also interesting that although the previous study revealed that the prevalence of COVID-19 was higher among Czech dentists than in the general Czech population, their willingness to vaccinate was higher [
3]. On the other hand, the willingness to be vaccinated can be higher in dentists who are also willing to participate in this kind of study. Additionally, some respondents could not disclose a refusal to vaccinate for professional reasons and avoid social disapproval. For more reliable data, it would be necessary to have the respondents’ medical records available for verification, which is impossible due to the confidentiality of this data.
The vaccination rate among respondents in age categories over 60 years was notably higher (by 10–15%) than in younger groups. Such a result may be due to the greater danger of COVID-19 for the elderly. The highest proportion of fully vaccinated people was among males aged 60–70, and the lowest among females aged 30–40. The ratio of vaccinated individuals was statistically higher among men. However, we do not consider this result epidemiologically significant as rather sociological. Compared to the entire study population, fewer people under the age of 30 and over 70 are represented among the study participants. These differences partially balance each other, as the vaccination rate was lower among people under 30 and higher among people over 70 in the general Czech population. However, this result can still be a source of bias.
From the presented data, it is evident that over 73% of respondents stated that their vaccination was completed by the end of March 2021, the rest by the end of June 2021. None of the respondents indicated that their vaccination was completed after June 2021, although the survey ended on 4 September 2021. These results suggest that there was an apparent attitude towards vaccination among respondents. Those who wanted to be vaccinated did so by a majority as soon as possible. Those who avoided vaccinations have consistently maintained this approach. In future population studies among Czech dentists, it will be interesting to see how this approach changes after introducing further measures, such as compulsory vaccination of health professionals. This will be addressed in the next phase of our research.
The most commonly accepted type of vaccine among respondents was Comirnaty (Pfizer). We believe that this was for two reasons. First, this vaccine has been presented as the most effective. Second, Comirnaty (Pfizer–BioNTech) was the majority vaccine given in vaccination centers, and most respondents stated that they were vaccinated there. This was probably due to vaccination management in the Czech Republic that was based mainly on large vaccination centers. In the first half of 2021, the situation with access to vaccination was organizationally complicated, even for eligible groups such as health professionals. Most members of the Czech Dental Chamber managed their vaccination by themselves via official registration, but some used the assistance of the chamber. The purpose of the vaccination management question was to find out which part of the chamber members used the standard registration process, identify the chamber’s role in the organization, and the facilities in which the dentists were vaccinated. Unfortunately, within those who were vaccinated with the assistance of the chamber, it was not possible to decipher in which facility the chamber provided them with vaccinations. Despite this limitation, we decided to present these data as it provides important information about where the dentists were vaccinated.
The comparison of this study with the studies of other authors is limited by the different methodology, population, or time window of the studies. To date, there is only a very limited number of studies focusing on vaccination among dentists, and most of them focus only on respondents’ willingness to get vaccinated and not on actual vaccination data. At the same time, these studies usually included smaller numbers of participants compared to ours. Nasr et al. conducted an online survey involving 529 Lebanese dentists between 15 and 22 February 2021 [
11]. A total of 86% of participants were willing to receive or have already received a COVID-19 vaccine. Compared to our study, in which 83.9% of participants answered that they were either registered for vaccination or that vaccination had already started or was completed, this is a similar result. The authors also mention that the high level of vaccine acceptance is probably due to the high occupational risk of COVID-19 infection. This also corresponds with the results of our study, as 91.5% of respondents stated that the reasons for vaccination were primarily professional. According to an online survey performed by Zigron et al., the overall rate of acceptance for a COVID-19 vaccine among Israeli dental professionals during March-April 2020 was 85% [
12]. A study by Papagiannis et al. among healthcare professionals involving 80 dentists in December 2020 showed a 78.5% acceptance level of the COVID-19 vaccine [
13]. Another online survey performed among 2678 healthcare workers in France and French-speaking parts of Belgium and Canada in October and December 2020 showed a 71.6% high or moderate acceptance rate of the COVID-19 vaccine [
14]. A COVID-19 vaccine acceptance survey among US healthcare workers performed in October and November 2020 showed that 36% of respondents were willing to take the vaccine as soon as it became available, 56% were not sure or would wait to review more data, and 8% did not plan to get the vaccine [
15]. The data from these studies generally show similar results to our study. However, they identify only a possible approach to vaccination, not a result that reflects a real vaccination rate. Our work is one of the first to provide real data on healthcare workers vaccination and, as far as we know, the first to provide data on vaccination among a completely homogeneous population of dentists. The next phase of the research describing the impact of COVID-19 on Czech dentistry will be initiated in 2022, providing further comparable epidemiological and sociological data.