4.1. Medical Education Regarding Vaccinology
Healthcare workers are responsible for providing necessary information regarding vaccine safety and dispelling doubts concerning its use. Therefore, an appropriate level of knowledge in the field of vaccinology is of great importance [
1,
15,
16,
17]. Previous medical literature indicates that despite vaccinology being part of mandatory academic subjects in the medical school curriculum, most students do not consider their knowledge sufficient [
1,
17]. This is supported by a study on MS in France [
1]. The lack of knowledge regarding vaccination hence appears to be a large-scale problem affecting higher education across the whole of Europe [
1,
17].
A study of MS by Kernéis et al. found that 66% of the respondents considered their knowledge of immunology and infectious diseases insufficient [
1]. They also demonstrated poor practical skills such as screening for contraindications, knowledge of routes and sites of administration, and management of adverse reactions [
1], and were uncertain about the practical aspects of vaccine costs and reimbursement, adjuvant mechanism of action and potential adverse effects, and communication strategy in response to vaccine hesitancy [
1]. This problem might be attributed to vaccinology being traditionally considered a part of theoretical teaching, focusing mostly on lectures and multimedia presentations. Other studies highlight that a practical way of teaching the subject may prove to be much more beneficial [
18]. The advantage of such a practical approach to teaching is the fact that it requires both more preparation and interaction; moreover, teaching in smaller groups makes it easier for the students to ask questions and for the teacher to check progress.
Our findings indicate that willingness for a swift vaccination against SARS-CoV-2 among MS depends more on the year of studies than on their grading in vaccinology-related subjects. As many studies regarding the vaccination behaviors and attitudes among MS are restricted to a specific year of study, this link has been not properly investigated [
1,
2,
3]. Nevertheless, previous papers exploring this subject are in concordance with our observations [
5]. These findings suggest that students with a more general experience including a closer clinical focus may have a better sense of responsibility for themselves and others.
4.2. Personal Experiences during SARS-CoV-2 Pandemic
Due to the nature of their work and their frequent contact with infected patients and infectious materials, doctors and MS are much more prone to infections [
19,
20]. As such, they are typically tested more frequently, especially using PCR-based tests [
21]. Interestingly, despite being more exposed to the virus and receiving more tests, the number of positive tests obtained by the two groups was at a comparable level (MS: 59 (8.59%) vs. NMS: 95 (7.39%),
p = 0.349).
Despite the fact that, due to their regular contact with the illness, MS might be considered to be more likely to expose their relatives to SARS-CoV-2 infection, this did not appear to be the case: 58.81% of MS relatives suffered from COVID-19 compared to 57.80% of NMS relatives (
p = 0.736). This lack of discrepancy can perhaps be attributed to the better sanitary regime regarding relatives applied by the MS [
22,
23]. This in turn can be supported by the fact that MS were more likely to report fearing infecting their elderly relatives than the NMS group, even those who had recovered from COVID-19. This results in a significant reduction in the number of visits: no visits or at most 1 per month, 398 (58.36%) for MS vs. 656 (51.7%) for NMS. This further translates into lower mortality among the relatives, which was found to be around 7% (
p = 0.889) for both groups.
The fear of infecting or losing a relative to SARS-CoV-2 virus was the greatest fear reported by MS, followed by post-COVID syndrome, general condition deterioration, and professional/academic issues. Both groups of respondents are similarly afraid of the deterioration of their health. The big differences concern the fear of professional/academic problems. This may be related to the fact that students of medical faculties were still participating in classes conducted in hospitals during the study, and the stress caused by learning and exams [
24,
25,
26]. During the COVID-19 pandemic, most of the classes and exams in Poland were conducted online. This change may negatively affect the teaching process, especially the training of MS: the required limitation of practical classes in hospitals disrupts their medical education [
27], and could result in the student failing a semester for administrative reasons [
28].
4.3. The Current Experience and Anxiety Related to Vaccination
The vast majority of the students who took part in the survey reported a willingness to be vaccinated against the SARS- CoV-2 virus. It appears that MS are much more willing to receive the vaccination in comparison to NMS. However, it must be borne in mind that the percentage of those willing to be vaccinated, i.e., higher than 90% in the case of MS, may not be representative of the general population; students who want to receive the vaccination are probably more willing to take part in the questionnaire study. These results are more promising than those obtained in an American survey between 16 and 20 April 2020 testing attitudes among U.S. adults toward a potential SARS-CoV-2 vaccine: only 57.6% were determined to get a vaccine, 10.8% refused vaccination, 31.6% were not sure [
29].
The MS appear to have significantly lower fears with respect to vaccination. It has been proposed that this may be due to their greater knowledge and realization in this area acquired in the educational process [
17]. Still, regardless of the group, the strongest fears among all the respondents were those concerning the long-term effects of vaccines. Following this, MS reported concerns about the short-term side effects such as fever or malaise. The NMS appeared to be more concerned about what is regarded as conspiracy theories, often propagated by vaccination skeptics: the alleged association between vaccination and autism, restrictions on personal liberties, the chance of microchip implantation, governments’ attempt to control the birth count [
30]. Unfortunately, advocates for these theories can also be found among MS; for example, both groups report concerns about the association between vaccination and autism at a comparable level. It may lead to a decline in vaccination rates [
31,
32]. The spread of such theories is most likely a result of insufficient vaccinology classes throughout the whole education process as well as the wide reach of conspiracy theories on social media [
17,
33,
34].
Injection site reactions and systemic adverse effects, such as headache/lethargy, joint pain, and fever remain the most commonly reported adverse events [
35], which is in concordance with data obtained in our survey study (see
Table 3). Moreover, MS have a full set of mandatory vaccinations and more often decide to receive recommended vaccinations (e.g., for influenza) [
36]. However, the two groups are equally in favor of the complete vaccination package recommended for children according to the vaccination calendar [
17].
4.4. The Factors Influencing Pro-Vaccination Attitudes
Interestingly, the academic year that the student is attending had a strong influence on their willingness to undergo vaccination: year 3 (2–5) vs. year 2 (1–4;
p < 0.001). However, the grades which the students received in subjects highlighting the role of vaccination did not have such a strong influence: microbiology (
p = 0.877); infectious disease course (
p = 0.743); introduction of pediatrics (
p = 0.524). This highlights the hypothesis that clinical experience gained by active educational approaches (such as case-based, hands-on practical clinical placements or serious games) are more effective at forming appropriate attitudes and behaviors among MS than the provision of inadequate theoretical knowledge and overrepresentation of lectures [
1,
2].
In both groups, the willingness for a swift vaccination can be attributed to the following factors: the fear of COVID-19 infection (
p < 0.001), the level of fear of relatives being infected (
p < 0.001), the fear of possible vaccine side effects (
p < 0.001), the general level of fear (
p = 0.002) and stress (
p < 0.001) in the last seven days. There appears to be a wide spectrum of public fears in general, both legitimate and unjustified [
32]. For this reason, we encourage an objective public debate based on researched and postulated strategies that will help to dispel unjustified concerns [
37].
Our findings do not indicate any significant link between anxiety and a willingness to receive a vaccination. This dependency appears to vary between previous studies. Yu et al. noticed that higher anxiety levels during the COVID-19 pandemic did not decrease the vaccination coverage, which prevented a surge in vaccine-preventable disease incidence [
38]. Moreover, some studies suggest that a higher anxiety level increased the determination to vaccinate and strengthened the feeling that vaccination was the correct course of action [
39]. In contrast, some researchers have noticed that high maternal anxiety levels may result in an increased risk of incomplete vaccination status in infants. For example, Ozkaya et al. assessed this odds ratio as 4.35 (95%CI: 1.87–8.79); statistically significant results were observed even after controlling for sociodemographic factors [
40]. These differences may be associated with variations in intensities of fear of infectious diseases and possible side-effects of vaccination. The difficulties may be also strengthened by the existence of a spectrum of childhood diseases which may be triggered and/or exacerbated by infectious agents but also vaccinations, e.g., juvenile idiopathic arthritis [
41,
42].
The results show that the willingness to vaccinate rapidly was not affected by the severity of depressive symptoms during the previous seven days (
p = 0.957) and the monthly outgoings (
p = 0.137). Previous studies examining the relationships between depression symptoms and vaccinations found that even a modest number of depressive symptoms may sensitize the inflammatory response system in older adults and produce amplified and prolonged inflammatory responses after infection, as well as other immunological challenges [
43]. Fortunately, depression symptoms did not change significantly after vaccination against influenza [
43].
