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The coronavirus disease 2019 (COVID-19) vaccines are expected to be widely used, but awareness and acceptance of the new COVID-19 vaccines by healthcare workers (HCWs) was not well known prior to approval by China’s vaccine regulatory authority. The research conducted a cross-sectional survey in Beijing to assess HCWs’ perceptions of the COVID-19 epidemic and attitudes towards vaccination before COVID-19 vaccines were approved. Multivariate analyses were used to evaluate factors associated with willingness to get vaccinated. A total of 8,040 HCWs were recruited; 67.1% reported they would get vaccinated, while the rest were unsure or indicated they would not get vaccinated. Factors associated with willingness to get vaccinated included the epidemic situation and its prognosis, perception of disease severity, and perceived risk of getting infected. Multivariate analyses found two factors strongly associated with willingness, “wanting the vaccine to be free of charge” (OR: 5.78, 95% CI: 5.05–6.60, P<0.001) and “belief that the vaccine was fully evaluated prior to licensure” (OR: 4.45, 95% CI: 3.81–5.20, P<0.001). One factor, “
presence of an underlying disease” was found to be negatively associated with willingness (OR: 0.74, 95% CI: 0.61–0.90, P<0.001). The results supported a free vaccination policy and use of effective measures to remove barriers and convey accurate information about COVID-19 vaccines to enhance acceptance of the vaccines among HCWs in China. The COVID-19 pandemic, caused by the COVID-19 virus also known as SARS-CoV-2, has resulted in global public health and economic crises (1). The general consensus is that successful vaccines should be developed to reduce morbidity and mortality caused by the disease (2). Many countries have been promoting vaccine research and achieving landmark results over the past months (3). Several vaccines completed Phase III clinical trials and have been put into extensive use.
Based on previous experience, it is highly likely that HCWs will be recommended as a priority population for vaccination. Experience has shown that even if vaccines are successfully developed, the acceptance may not be ideal (4). In China, where non-pharmacological interventions (5) have been strictly implemented and the epidemic effectively controlled, awareness and acceptance by HCWs of the new vaccines are not well known. This study conducted a cross-sectional survey in Beijing to provide a reference for formulating rational vaccination strategies.
The setting was 6 (Chaoyang, Fengtai, Changping, Daxing, Miyun, and Huairou) of the 16 districts in Beijing. Overall, ten hospitals, including two Level III general hospitals, two Level II general hospitals, and six Level I hospitals or communities health centers were selected in each district by a systematic sampling method. These hospitals were responsible for diagnosis and treatment of COVID-19 cases, community population screening, and nucleic acid sampling during the epidemic. All doctors, nurses, and technicians in high-risk departments/units were included. In non-high-risk departments, at least five doctors and five nurses were included, unless there were fewer than five doctors or nurses, in which case all were included.
The investigation began in early May 2020 and ended in mid-July 2020 (prior to emergency use authorization of any COVID-19 vaccine in China). An anonymous questionnaire was administered through a WeChat App. Questions included demographic characteristics, perceptions of risk towards the COVID-19 epidemic and severity of the disease, attitudes towards COVID-19 vaccination, and past vaccination history. Five-point Likert scales were used, and responses were classified into three categories — positive, negative, and uncertain. The research implemented quality control measures to ensure achieving target numbers of respondents.
Univariate analysis included frequency and ratio calculations and Pearson’s chi-squared test for differences. Multivariate stepwise logistic regression was used to evaluate factors associated with intention to accept vaccination. All variables significant at the P<0.1 level in univariate logistic regression were included in multivariable stepwise logistic regression analyses. Odds ratios and 95% confidence intervals were calculated. Alpha was set at 0.05. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS/PASW, version 19.0, SPSS Inc, Chicago, IL, USA.).
A total of 8,040 HCWs participated in the survey; 3,844 (47.8%) were nurses; 2,836 (35.3%) were doctors; and 1,360 (16.9%) were technicians. Most (90.4%) respondents were less than 50 years old and most were female (80.4%); 70.3% had participated in prevention and control of the COVID-19 epidemic; 34.4% came from departments directly involved in diagnosis and treatment of COVID-19 patients; 35.1% reported having received other vaccines in the past three years; and 10.9% reported presence of an underlying disease.
Most respondents considered that consequences of COVID-19 infection were “serious”, and 80.1% perceived they might become infected by the virus; 57.5% indicated that they were at greater risk of COVID-19 virus infection than others. Nearly half were unsure whether the outbreak would come back and thought the global epidemic would last a long time; 67.6% agreed that the epidemic could be prevented by vaccination, and a slightly lower proportion believed in the safety and effectiveness of the vaccine; 73.0% reported their life had been seriously disturbed by the epidemic in the past months; 43.6% estimated life and work would continue to be disturbed in the next six months (Table 1).
Question Total, n=8,040 (%) Doctors, n=2,836 (%) Nurses, n=3,844 (%) Technicians, n=1,360 (%) P value* Q1 Is suffering from SARS-CoV-2 infection serious? Not serious 33(0.4) 14(0.5) 10(0.3) 9(0.7) <0.001 Little serious 307(3.8) 176(6.2) 95(2.5) 36(2.6) Serious 7,700(95.8) 2,646(93.3) 3,739(97.3) 1,315(96.7) Q2 Are you likely to be infected by SARS-CoV-2? Unlikely 2,135(26.6) 612(21.6) 1,000(26.0) 523(38.5) <0.001 Likely 4,382(54.5) 1,646(58.0) 2,094(54.5) 642(47.2) Very likely 1,523(18.9) 578(20.4) 750(19.5) 195(14.3) Q3 Are you at greater risk of SARS-CoV-2 infection than other people? Agree 4,627(57.5) 1,815(64.0) 2,277(59.2) 535(39.3) <0.001 Disagree 1,353(16.8) 480(16.9) 542(14.1) 331(24.3) Unsure 2,060(25.6) 541(19.1) 1,025(26.7) 494(36.3) Q4 If you were infected by SARS-CoV-2, do you think you will suffer from more serious symptoms than others? Agree 1,247(15.5) 420(14.8) 643(16.7) 184(13.5) 0.004 Disagree 2,034(25.3) 759(26.8) 912(23.7) 363(26.7) Unsure 59.2(59.2) 1,657(58.4) 2,289(59.5) 813(59.8) Q5 Do you think China's COVID-19 epidemic will come back? Agree 1,850(23.0) 788(27.8) 850(22.1) 212(15.6) <0.001 Disagree 2,144(26.7) 726(25.6) 951(24.7) 467(34.3) Unsure 4,046(50.3) 1,322(46.6) 2,043(53.1) 681(50.1) Q6 Do you think the global COVID-19 epidemic will last for a long time? Agree 3,996(49.7) 1,679(59.2) 1,738(45.2) 579(42.6) <0.001 Disagree 1,141(14.2) 378(13.3) 539(14.0) 224(16.5) Unsure 2,903(36.1) 779(27.5) 1,567(40.8) 557(41.0) Q7 Do you think COVID-19 can be prevented by vaccination? Agree 5,439(67.6) 1,976(69.7) 2,556(66.5) 907(66.7) <0.001 Disagree 450(5.6) 181(6.4) 208(5.4) 61(4.5) Unsure 2,151(26.8) 679(23.9) 1,080(28.1) 392(28.8) Q8 Do you think COVID-19 vaccines are safe? Agree 4,929(61.3) 1,727(60.9) 2,363(61.5) 839(61.7) 0.902 Disagree 101(1.3) 34(1.2) 47(1.2) 20(1.5) Unsure 3,010(37.4) 1,075(37.9) 1,434(37.3) 501(36.8) Q9 Do you think COVID-19 vaccines are effective? Agree 5,024(62.5) 1,761(62.1) 2,401(62.5) 862(63.4) 0.213 Disagree 48(0.6) 24(0.8) 20(0.5) 4(0.3) Unsure 2,968(36.9) 1,051(37.1) 1,423(37.0) 494(36.3) Q10 How disrupted has your work and life been in the past three months due to the epidemic? Not serious 253(3.1) 62(2.2) 137(3.6) 54(4.0) <0.001 Little serious 1,921(23.9) 588(20.7) 1,003(26.1) 330(24.3) Serious 5,866(73.0) 2,186(77.1) 2,704(70.3) 976(71.8) Q11 In the next period of time (six months), how much do you expect your work and life to be disrupted by the epidemic? Not serious 792(9.9) 269(9.5) 377(9.8) 146(10.7) 0.638 Little serious 3,746(46.6) 1,308(46.1) 1,802(46.9) 636(46.8) Serious 3,502(43.6) 1,259(44.4) 1,665(43.3) 578(42.5) * χ2 test. Table 1. Healthcare worker perceptions of the COVID-19 epidemic by occupation category, Beijing Municipality, China.
Respondents believed more in professional staff advice (94.1%) compared with statements from media (80.4%); 80.0% of HCWs were convinced the vaccine had been fully evaluated in clinical trials, and 77.4% wanted the vaccine to be free of charge; 67.1% of the respondents reported they would get vaccinated, while 7.9% said they would not, and 25.0% were unsure. The percentage of respondents who would advise family members to get vaccinated (68.2%) was similar to their own willingness to be vaccinated; however, fewer (61.9%) were willing to vaccinate their children. Among willing respondents, vaccination campaigns organized by their hospital (75.3%) were more acceptable than vaccination offered by community clinics (24.7%). Doctors, nurses, and technicians answered questions similarly (Table 2).
Questions Total,
n=8,040 (%)Doctors,
n=2,836 (%)Nurses,
n=3,844 (%)Technicians,
n=1,360 (%)P value* Q1 Do you trust the official statements from the media? Believe 6,462(80.4) 2,385(84.1) 2,983(77.6) 1,094(80.4) <0.001 Disbelieve 319(4.0) 99(3.5) 171(4.4) 49(3.6) Unsure 1,259(15.7) 352(12.4) 690(18.0) 217(16.0) Q2 Do you trust professional staff advice? Believe 7,563(94.1) 2,663(93.9) 3,634(94.5) 1,266(93.1) 0.266 Disbelieve 31(0.4) 13(0.5) 14(0.4) 4(0.3) Unsure 446(5.5) 160(5.6) 196(5.1) 90(6.6) Q3 If the COVID-19 vaccine is approved for licensure, do you want it to be free of charge? Yes 6,221(77.4) 2,125(74.9) 3,043(79.2) 1,053(77.4) <0.001 No 293(3.6) 127(4.5) 115(3.0) 51(3.8) Either is OK 1,526(19.0) 584(20.6) 686(17.8) 256(18.8) Q4 Do you believe that COVID-19 vaccine approved for licensure will have been fully evaluated in clinical trials? Believe 6,431(80.0) 2,220(78.3) 3,118(81.1) 1,093(80.4) <0.001 Disbelieve 144(1.8) 75(2.6) 49(1.3) 20(1.5) Unsure 1,465(18.2) 541(19.1) 677(17.6) 247(18.2) Q5 Will you get vaccinated with a COVID-19 vaccine? Yes 5,395(67.1) 1,849(65.2) 2,636(68.6) 910(66.9) <0.001 No 632(7.9) 269(9.5) 251(6.5) 112(8.2) Unsure 2,013(25.0) 718(25.3) 957(24.9) 338(24.9) Q6 Where would you like to get the COVID-19 vaccine?† Community vaccination clinic 1,331(24.7) 478(25.9) 570(21.6) 283(31.1) <0.001 Vaccination campaign organized by hospital 4,064(75.3) 1,371(74.1) 2,066(78.4) 627(68.9) Q7 Will you advise your family members to get the COVID-19 vaccine? Yes 5,486(68.2) 1,857(65.5) 2,682(69.8) 947(69.6) 0.001 No 514(6.4) 213(7.5) 214(5.6) 87(6.4) Unsure 2,040(25.4) 766(27.0) 948(24.7) 326(24.0) Q8 Will you take your children to get the COVID-19 vaccine?§ Yes 2,643(61.9) 995(59.5) 1,221(62.3) 427(67.0) 0.02 No 359(8.4) 154(9.2) 159(8.1) 46(7.2) Unsure 1,267(29.7) 523(31.3) 580(29.6) 164(25.7) Q9 Who do find most trustworthy for offering COVID-19 vaccine information (multiple choice)? Official media 6,862(85.3) 2,379(83.9) 3,346(87.0) 1,137(83.6) <0.001 Medical specialist 7,134(88.7) 2,427(85.6) 3,511(91.3) 1,196(87.9) <0.001 Relatives and friends 317(3.9) 76(2.7) 155(4.0) 86(6.3) <0.001 Colleagues 415(5.2) 96(3.4) 243(6.3) 76(5.6) <0.001 Medical literature 4,786(59.5) 1,844(65.0) 2,282(59.4) 660(48.5) <0.001 Online media 492(6.1) 105(3.7) 264(6.9) 123(9.0) <0.001 * χ2 test;
† only for those who are willing to be vaccinated;
§ only for parents with children under 18 years old.Table 2. Healthcare worker attitudes toward COVID-19 vaccination by occupation category, Beijing Municipality, China.
Results of univariate logistic regression of intention to accept COVID-19 vaccination and related variables are shown in Table 3. In multiple logistic regression models, positive factors significantly associated with intention to get vaccinated included “received other vaccines in the past three years,” “received seasonal influenza vaccine,” agreed with “suffering from COVID-19 virus infection is serious,” “China’s epidemic will come back,” “the global epidemic will last for a long time,” “COVID-19 can be prevented by vaccination”, “the vaccine is safe,” and “the vaccine is effective.” Overall, two factors showed stronger positive associations — “wanting the vaccine to be free of charge” (OR: 5.78, 95% CI: 5.05–6.60, P<0.001) and “believing the vaccines approved for license have been fully evaluated” (OR: 4.45, 95% CI: 3.81–5.20, P<0.001); one factor was negatively associated — “presence of an underlying disease” (OR: 0.74, 95% CI: 0.61–0.90, P<0.001). Gender, age, occupational cohort, ward type, hospital level, academic degree, salary, participation in prevention and control of the epidemic, and perception of infection risk were not associated with intention to be vaccinated.
Variable Value Univariate logistic regression model Multiple logistic regression model Odds ratio (95% CI) P value Adjusted odds ratio
(95% CI)P value Gender Female Reference Male 1.07(0.95–1.20) 0.279 Age group <40 years old Reference Reference ≥40 years old 0.82(0.74–0.91) <0.001 0.90(0.77–1.06) 0.197 Occupational cohort (three largest categories) Doctors 0.88(0.80–0.97) 0.007 1.06(0.86–1.30) 0.617 Nurses 1.14(1.04–1.25 0.007 1.01(0.84–1.22) 0.883 Technicians and others 0.99(0.87–1.12) 0.87 Ward type Other Reference COVID-19 related department 0.99(0.80–1.09) 0.802 Hospital level Level I 0.99(0.90–1.10) 0.911 Level II 1.21(1.04–1.35) <0.001 Level III 0.85(0.78–0.94) 0.001 1.04(0.918–1.179) 0.538 Academic degree Junior college and below Reference 0.001 Reference Undergraduate 1.82(1.33–2.50) <0.001 1.24(0.80–1.94) 0.34 Masters 1.37(1.00–1.87) 0.048 0.97(0.64–1.47) 0.877 Doctor or above 1.19(0.86–1.66) 0.296 0.95(0.62–1.45) 0.801 Salary Less than 5,000 CNY Reference Reference 5,000–9,999 CNY 1.74(1.06–2.85) 0.029 1.06(0.54–2.06) 0.874 10,000–19,999 CNY 1.42(0.87–2.31) 0.163 0.99(0.52–1.91) 0.98 More than 20,000 CNY 1.30(0.78–2.14) 0.314 1.13(0.59–2.20) 0.709 Professional ranks and titles No title Reference Reference Junior 1.62(1.29–2.04) <0.001 1.21(0.85–1.72) 0.302 Intermediate 1.45(1.24–1.69) <0.001 1.30(1.01–1.69) 0.044 Senior 1.03(0.88–1.21) 0.723 0.88(0.71–1.12) 0.279 Underlying disease No Reference <0.001 Reference Yes 0.71(0.62–0.82) <0.001 0.74(0.61–0.90) 0.002 Participated in the prevention and control of epidemic No Reference Reference Yes 0.87(0.78–0.96) 0.005 1.08(0.95–1.23) 0.232 Received other vaccines in the past 3 years No Reference <0.001 Reference Yes 1.69(1.53–1.87) <0.001 1.28(1.05–1.56) 0.015 Received seasonal influenza vaccine No Reference Reference Yes 1.85(1.65–2.08) <0.001 1.43(1.15–1.80) 0.002 Perception Q1 answer Not serious and little serious Reference <0.001 Reference Serious 1.75(1.41–2.18) <0.001 1.34(1.01–1.79) 0.046 Perception Q2 answer Unlikely Reference Reference Likely and Very likely 1.12(1.01–1.25) 0.029 1.14(0.99–1.31) 0.074 Perception Q3 answer Disagree and unsure Reference Reference Agree 1.21(1.10–1.32) <0.001 1.06(0.93–1.21) 0.363 Perception Q4 answer Disagree and unsure Reference Reference Agree 1.16(1.02–1.32) 0.029 1.07(0.90–1.27) 0.463 Perception Q5 answer Disagree and unsure Reference Reference Agree 1.13(1.01–1.26) 0.034 1.33(1.13–1.56) <0.001 Perception Q6 answer Disagree and unsure Reference Reference Agree 1.32(1.20–1.45) <0.001 1.19(1.05–1.36) 0.008 Perception Q7 answer Disagree and unsure Reference Reference Agree 4.40(3.98–4.87) <0.001 1.74(1.52–2.01) <0.001 Perception Q8 answer Disagree and unsure Reference Reference Agree 5.60(5.06–6.19) <0.001 1.91(1.61–2.27) <0.001 Perception Q9 answer Disagree and unsure Reference Reference Agree 5.29(4.78–5.85) <0.001 1.38(1.16–1.65) <0.001 Perception Q10 answer Not serious and little serious Reference Reference Serious 1.11(1.00–1.23) 0.049 1.04(0.91–1.19) 0.583 Perception Q11 answer Not serious and little serious Reference Serious 1.07(0.98–1.18) 0.137 Attitudes Q1 answer Disbelieve and unsure Reference Reference Believe 2.90(2.59–3.24) <0.001 1.23(1.04–1.44) 0.015 Attitude Q2 answer Disbelieve and unsure Reference Reference Believe 6.33(5.13–7.80) <0.001 1.24(0.94–1.65) 0.133 Attitudes Q3 answer No and either is OK Reference Reference Yes 8.12(7.23–9.13) <0.001 5.78(5.05–6.60) <0.001 Attitudes Q4 answer Disbelieve and unsure Reference Reference Believe 9.59(8.46–10.88) <0.001 4.45(3.81–5.20) <0.001 *: Regression analyses were performed on 8,040 individuals who answered the question about their intention to get vaccinated. For the dependent variable “accept COVID-19 vaccination,” answer “Yes” is assigned as 1, answer “No” or “Unsure” is assigned as 0. If the independent variable is an unordered categorical variable, such as “Occupational cohort” and “Hospital level,” it is assigned to be a dummy variable. Table 3. Multiple logistic regression model for healthcare worker intention to accept COVID-19 vaccination, Beijing Municipality, China.*
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