By Ellie Dullea
Healthcare workers play an essential role as trusted vaccine advocates in the community. In a 2017 survey of 400+ Colorado parents, medical doctors were found to be the most influential factor in parents’ plan for their children’s immunizations. Similarly, immunization providers will play a vital role in increasing COVID-19 vaccination rates by easing patient concerns about the vaccine’s safety and efficacy and offering strong recommendations for vaccination.
While attitudes on the COVID-19 vaccine have been incrementally improving and the situation continues to evolve, recent surveys have found that 66% of Los Angeles healthcare workers plan to delay getting a COVID-19 vaccine and that over one-third of nurses in the United States do not intend to get the vaccine once it is available. Past research has shown that physicians are more willing to recommend a vaccine to their patients if they have previously received the vaccine and are confident in the vaccine’s safety and efficacy profile. To combat COVID-19 vaccination hesitancy among physicians and increase public vaccine acceptance, we need to understand what factors influence a healthcare provider’s decision to receive the COVID-19 vaccine and recommend the vaccine to their patients.
As an AmeriCorps VISTA volunteer placed at Immunize Colorado though their CO-mmunity Corps program, I developed a preliminary research project to understand Colorado healthcare providers’ perspectives on a COVID-19 vaccine and how these perspectives may impact patients’ vaccine acceptance. I sought to answer four primary questions:
- What concerns do healthcare providers have about a COVID-19 vaccine?
- Are Colorado providers willing to get a COVID-19 vaccine when it is released?
- How likely are Colorado providers to recommend the vaccine to their patients?
- What information, training, or strategies would they find helpful for speaking to patients about a COVID-19 vaccine?
From October 12 – 23, 2020, five online focus groups were conducted with immunization providers from across Colorado. Focus group participants were recruited with email invitations and flyers sent to local public health agencies and healthcare clinics in 15 Colorado counties. Each online focus group was conducted through Google Meet. Focus groups were roughly transcribed and analyzed for primary themes.
Thirteen immunization providers participated in the focus groups; the providers were from five different Colorado counties: El Paso (6), Jefferson (1), Mesa (1), Weld (3), and Gunnison (1) county. In total, five physicians, six nurses, and two public health administers participated in the focus groups. Five participants work for their local public health agencies while eight providers work for private/nonprofit clinics and hospitals. The majority of the focus group participants were female (11). Eight out of the thirteen participants responded to a short online demographic survey. Of those that responded, all participants self-identified as non-Hispanic white. The focus group participants ranged in age (26-60 years old) and experience in the healthcare field (0-25+ years).
What concerns do providers have about a COVID-19 vaccine?
1. Short Development Timeline
Many of the providers were concerned about the speed at which the novel COVID-19 vaccine is being developed. One provider believed “that they are pushing the [vaccine] through too fast. It just seems like they are trying to get the vaccine out in an unsafe manner and period of testing.” Similarly, another provider stated that “we have never had a vaccine go through so quickly. We’ve had years, decades, in the past to chew and stew on the infection, the treatment, and the prevention of the disease. It’s just different. A vaccine in a matter of months rather than years brings a lot of skeptical thoughts.” Due to the unprecedented speed at which the COVID-19 vaccine has been developed, many providers are concerned that the COVID-19 vaccines will not be tested appropriately. Of course, we know that each vaccine candidate that is authorized for use by the U.S. Food and Drug Administration is only approved if it’s shown to have been thoroughly tested, safe and effective at preventing COVID-19 infection.
2. Safety and Efficacy of the Vaccine
Closely related to worries about the fast development of the COVID-19 vaccines were concerns surrounding the safety and efficacy of the vaccine. One provider stated, “I want to know that if I were to get the COVID-19 vaccine, I would not get long-term side effects. I do not want Guillain Barre Syndrome like the flu vaccines that came out because they went a little too fast on their safety and produced it rather quickly.” Many providers are concerned that because the COVID-19 vaccines are being developed so quickly, the research studies will not be able to catch the long-term effects of the vaccine. As one provider remarked, “the early reports are showing yes the vaccine is effective, but we do not have the time. The companies cannot answer the question on long term efficacy, safety, longevity.”
3. Lack of Data Transparency
Immunization providers are also concerned about their lack of access to data from vaccine trials. One provider commented that she “can’t decide whether to get the vaccine right now because the information is just not there.” Similarly, one provider expressed frustration with the pharmaceutical companies because study data “is not available to physicians. There is nothing that is evidenced based…the information that we get, the companies tend to release the information to Forbes before they release it to a peer-reviewed journal.” Providers complained that the majority of the vaccine information that they get comes from headlines and the media instead of more traditional peer-reviewed medical journals. Without access to the study results, immunization providers in Colorado did not feel like they could decide whether or not to get the vaccine.
Are Colorado providers willing to get a COVID-19 vaccine when it is released?
There were varying levels of vaccine hesitancy among Colorado vaccine providers. While three of the immunization providers were willing to get the vaccine as soon as it is available, the majority of providers were more hesitant to get a COVID-19 vaccine. Eight participants were unsure if they would get the vaccine when it is released until they can examine the safety and efficacy data from the vaccine trials. One of these providers stated, “I am not going to recommend anything until I feel comfortable reviewing all the information and have had the vaccine myself.” Finally, two participants wanted to wait at least six months before getting the vaccine. One participant stated, “I would not receive a vaccine if one was available right now. For my personal comfort, I want to wait six months before getting the vaccine.” While there were varying levels of COVID-19 vaccine hesitancy in the group, none of the providers were completely unwilling to get the vaccine.
While many of the immunization providers are willing to consider getting the COVID-19 vaccine in the future, they cautioned against COVID-19 vaccine mandates in the healthcare setting, citing “if we did mandate the vaccine, we would have a significant number of staff members quit.” The immunization providers strongly valued personal autonomy when making decisions whether to get a vaccine.
How likely are Colorado providers to recommend the vaccine to their patients?
All participants strongly valued safety and efficacy data when considering whether to recommend a vaccine to their patients. One provider commented that “as long as it has been proven to be a safe vaccine, I am happy to recommend it.” Many providers were also unwilling to recommend the vaccine to their patients unless they felt comfortable getting the vaccine themselves and recommending the vaccine to their family members. One provider stated, “I am not comfortable recommending a vaccine to my patients unless I feel it is something that I would be supporting for my children.”
What information, training, or strategies would providers find most helpful for speaking to vaccine-hesitant patients about a COVID-19 vaccine?
Immunization providers feel a strong need for consistent and educational messaging around the COVID-19 vaccine. One provider highlighted this need by stating, “I try to give my patients the information that I have and the information that I think would be valuable to them, but we still have a lot of questions ourselves still, too.” To fix this informational gap, “we need this information synopsis in a very clear and scientific way for healthcare workers” and “a more unified place for information.” Within this reservoir of information, “we need a consistent message that is all hinged on concrete evidence” from a trusted source. The providers strongly trusted the CDC, ACIP, CDPHE, local public health agencies, and scientific medical journals and societies. Colorado providers called for short on-demand videos, formal training on vaccine hesitancy, and informational posters and literature. The immunization providers were confident that “once physicians and nurses, and nurse practitioners, have a good understanding of this information and barriers then they will then be able to dispel this information at an appropriate level for their patients.”
To ensure the success of the COVID-19 vaccine and continued public trust in vaccination, we need to reduce COVID-19 vaccine hesitancy among healthcare professionals and ensure that immunization providers have the resources they need to be strong vaccine advocates. Potential solutions include development of an online resource that summarizes the development process of the COVID-19 vaccine and the existing safety and efficacy profile for each vaccine. This resource could include training, posters, and flyers to assist providers in speaking about the COVID-19 vaccines and addressing vaccine hesitancy in the clinical setting. The Colorado Department of Public Health and Environment (CDPHE) and the Centers for Disease Control and Prevention (CDC) have begun to release information, resources and training surrounding the COVID-19 vaccine. However, more could be done to target these resources to providers’ specific concerns and resource needs on the local level.
With a small sample size of 13 immunization providers, these results are only preliminary. Further research should seek to recruit a more racially and ethnically diverse group of immunization providers to improve our understanding of all Colorado immunization providers’ beliefs surrounding the COVID-19 vaccine. Additionally, immunization providers’ opinions and beliefs surrounding the vaccine may have changed after Pfizer/BioNTech and Moderna released their COVID-19 vaccine candidates’ clinical trial results and received emergency use authorization from the FDA, and as providers across the country have begun receiving vaccines. Continued research is needed to adapt to changing information and resource needs as we work to distribute these COVID-19 vaccines for public use. Even though these immunization providers’ opinions may have changed, these results can still be used to improve the uptake of COVID-19 vaccines and develop response plans for future epidemics.
For more information on the COVID-19 vaccine for healthcare professionals, visit the CDC’s website.
Ellie Dullea is Immunize Colorado’s Immunization and Outreach & Education Coordinator, on assignment with the organization through the CO-mmunity Corps AmeriCorps VISTA program.