In what would appear to go beyond vaccine hesitancy to outright refusal, 62.5% of staff at thousands of skilled nursing facilities (SNFs) have turned down COVID-19 vaccine. Along with other healthcare workers in hospitals and other settings, long-term care staff were considered a top vaccine priority because they care for frail residents, the Centers for Disease Control and Prevention (CDC) reports.

“Among 11,460 SNFs, with at least one vaccination clinic conducted during the first month of the CDC Pharmacy Partnership for Long-Term Care Program, a median of 77.8% of residents and 37.5% of staff members received 1 vaccine dose through the program,” the CDC stated.1 “SNFs that provide skilled nursing care and rehabilitation services for persons with complex medical needs have been documented settings of COVID-19 outbreaks. In addition, residents of [long-term care facilities] might be at increased risk for severe outcomes because of their advanced age or the presence of underlying chronic medical conditions.”

Historically, long-term care workers have shunned influenza vaccinations, citing skepticism about the vaccine’s efficacy and claiming such canards as they do not get the flu.

The COVID-19 vaccine raises its own set of suspicions. “Frequently cited reasons for vaccine hesitancy included the perceived rapidity of vaccine development; inadequate information received about vaccine safety, side effects, and administration; and skepticism regarding the clinical trials and vaccine approval processes,” the CDC stated.

A recent survey of long-term care staff found that only 45% of respondents were willing to receive a COVID-19 vaccine immediately, but an additional 24% would consider it in the future.2

Again even though they were classified as healthcare workers and given top priority to be vaccinated another recent survey by Surgo Ventures in Washington, DC, confirmed the problem.

“The long-term care workers were one of the most hesitant groups, and that actually goes across categories of doctors, nurses, other support staff,” says Hannah Kemp, MPA, director of programs at Surgo. “When you compare them to hospital workers, long-term care workers felt less confident that their colleagues were going to be getting the vaccine.”

Indeed, healthcare workers at long-term care facilities rated themselves as less likely to receive the vaccine (with an average intention score of 7.5 out of 10) than workers in hospitals (8.1 out of 10). Although 41% of long-term care facility workers believed only “some” or “a few” of their colleagues would take the vaccine, only 25% of hospital workers did.

“These numbers are worrying, given that these [long-term care] healthcare workers are serving the population at highest risk of severe complications from COVID-19 and are disproportionately low-wage workers,” the Surgo report notes.3 “Additionally, when asked whether they would recommend the COVID-19 vaccine to patients expressing reluctance, 14% of doctors in long-term care facilities said they would recommend against taking the vaccine, compared to 4% in hospitals and 3% in non-hospital facilities.”

Overall, a striking 20% of nurses in the United States are refusing offers to be immunized with COVID-19 vaccine, according to the results of the Surgo survey.

“We found that only 5% of doctors refused, but 20% of nurses did,” Kemp says. “We also saw much higher refusal rates among African Americans.”

The company conducted the survey from Dec. 17-30, 2020, netting 2,504 respondents comprising three groups: healthcare professionals (i.e., physicians, nurses, and dentists); allied health professionals (i.e., health technicians, emergency medical services personnel, and home health workers); and health management and support personnel (i.e., administrative staff and operations staff).

The overall refusal rate for all healthcare groups was 15%, Kemp says. The most common reasons given for turning down COVID-19 vaccine were a lack of evidence of the vaccines’ effectiveness and safety (31%), personal safety concerns (24%), and worrying the vaccine approval process was rushed (16%).

Of the 2,504 respondents, 53% had been offered at least one of the approved COVID-19 vaccines at the time they took the survey. Among that group, the aforementioned 15% refused the vaccine. However, 20% already had taken their first dose of the vaccine and were planning to receive the second shot. In addition, 18% had not yet taken their first dose of the vaccine but planned to do so. Overall, the survey results show 49% of respondents reported they are planning to take the vaccine.

When breaking down vaccination declination by occupational groups, the highest refusal rate (22%) was among allied health professionals, followed by healthcare professionals (13%) and health management and support (10%). “A number of allied health professionals work directly with patients,” Kemp says. “They often have patient interactions, but they may not have as much medical training.”


  1. Gharpure R, Guo A, Bishnoi CK, et al. Early COVID-19 first-dose vaccination coverage among residents and staff members of skilled nursing facilities participating in the Pharmacy Partnership for Long-Term Care Program — United States, December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021;70:178-182.
  2. Unroe KT, Evans R, Weaver L, et al. Willingness of long-term care staff to receive a COVID-19 vaccine: A single state survey. J Am Geriatr Soc 2020; Dec 28. doi: 10.1111/jgs.17022. [Online ahead of print].
  3. Surgo Ventures. U.S. healthcare workers: COVID-19 vaccine uptake and attitudes. January 2021.