EXECUTIVE SUMMARY

A surprising number of healthcare employees are resisting the COVID-19 vaccines. Hospitals should take a proactive approach to educate them and encourage vaccination.

  • Vaccine hesitancy varies according to employees’ education in science.
  • Physicians and other leaders should address concerned employees and correct misinformation.
  • Personal stories will be more effective than reciting data and statistics.

Even as millions of Americans continue to receive the COVID-19 vaccine, some healthcare organizations still struggle with a worrying number of employees who will not accept the vaccines.

It seems counterintuitive that healthcare professionals would resist the vaccines, but a Kaiser Family Foundation survey of 1,676 American adults revealed 29% of the respondents who worked in a healthcare setting were hesitant to accept the vaccine, compared to only 27% of other respondents. (The survey findings are available online at: https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/.)

The health nonprofit Surgo Ventures interviewed 2,504 healthcare workers. Fifteen percent of those who were offered the vaccine said they had refused it. (The report is available at: https://surgoventures.org/resource-library/survey-healthcare-workers-and-vaccine-hesitancy.)

Vizient, a healthcare performance improvement company based in Irving, TX, recently surveyed its member hospitals and found 72% of hospital executives said overcoming staff hesitancy or reluctance toward the COVID-19 vaccine was a major concern.

Hospitals currently cannot mandate the vaccines, so they find themselves in the peculiar situation of trying to protect their employees and overcome concerns about adverse effects and the perception of insufficient clinical data about the vaccine, says Tomas Villanueva, DO, MBA, FACPE, SFHM, associate vice president for clinical resources with Vizient and a physician in Miami.

The Food and Drug Administration (FDA) granted emergency use authorizations (EUAs) for three COVID-19 vaccines. Nationwide distribution began with the first doses going to frontline healthcare workers and long-term care residents at skilled nursing and assisted living facilities. The vaccines now are available to most people in many states.

Because the vaccines only received EUAs and not full approval, many legal sources advise healthcare employers not to mandate vaccination for employees until the FDA expands authorization. At that time, healthcare employers would be free to require COVID-19 vaccination as a condition of employment, they say. (For more on this legal issue, see “Vaccine Rollout Brings Legal, Labor Concerns for Employers” in the February issue of Healthcare Risk Management.)

Vaccine hesitancy is not uniform across the healthcare field, Villanueva notes. There is a high rate of acceptance among physicians, and the rate drops with nurses and ancillary services.

Healthcare employees with more education in science are more likely to understand the vaccine process and accept the COVID-19 vaccines, he says. Others may not understand the science, and when faced with overwhelming information, they may turn to similarly situated colleagues and others who reinforce skepticism and misinformation.

“Some of it may be historical in that there can be a racial component, with some data showing that among all healthcare professionals, there is more hesitancy among Black and Latino healthcare workers,” Villanueva explains. “A lot of it has to do with a lack of understanding about how the vaccine came about.”

Hospitals should address the issue head-on with a proactive information campaign. “One of the ways to address fear is giving people straight-up information,” he says. “Use your physicians, nurses, physician assistants, and leverage a diverse group of providers to give the same message about how they have had the vaccine themselves, and why they chose the vaccine.”

Among those who are hesitant, stories tend to be more effective than just reciting facts and statistics, Villanueva says. He tells others about his recent experience with visiting his mother after both were vaccinated.

“Last week, for the first time in over a year, I got to hug my 77-year-old mother. Mom not only is elderly, but has multiple comorbidities. I got to hug her for the first time without either of us wearing a mask,” he recalls. “That is a good reason to be vaccinated.”

Villanueva has visited environmental services in a hospital to explain how he decided to get the vaccine and to answer any questions employees might ask. As a Cuban American, he makes an effort to connect with others of the same background in Miami.

One common concern is people do not understand how the FDA approved the vaccines so quickly. Villanueva explains the FDA did not skip steps or ease the approval process. Rather, they managed to speed up the process of the usual procedures.

“There are multiple steps involved that usually are done sequentially, but they started bringing in ways to do them in a parallel way,” he explains. “The FDA really didn’t take any shortcuts whatsoever. They were very meticulous in how they approved the vaccines under the emergency waiver.”

Another concern is the vaccines themselves were developed quickly. The science behind the vaccines has been developing for years before the pandemic, and researchers were able to accelerate the vaccine science in response to COVID-19.

Healthcare workers also might worry the vaccines will give them COVID-19, after a year of indoctrination about how dangerous the disease is, Villanueva notes. That is not possible with the vaccines.

It also is not possible for the vaccines to alter a person’s DNA. That misconception arose from how the vaccines use a messenger RNA approach.

Another false rumor is the vaccines will cause infertility. “This has gained traction particularly among some of our younger healthcare workers of childbearing age, who have received unfortunately false information about a protein that helps the placenta bind to the uterus. There are some similarities in the genome of that protein and the neutralizing antibody,” Villanueva explains. “But the similarities are very small. It’s like if your phone number and my phone number both have the number one in them, they’re similar. But they don’t function the same way.”

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