Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: A Cross sectional study of healthcare workers
Authors: Oliver Kristin , Raut Anant , Pierre Stanley , Silvera Leopolda , Boulos Alexander , Gale Alyssa , Baum Aaron , Chory Ashley , Davis Nichola , D’Souza David , Freeman Amy , Goytia Crispin , Hamilton Andrea , Horowitz Carol , Islam Nadia , Jeavons Jessica , Knudsen Janine , Li Sheng , Lupi Jenna , Martin Roxanne , Maru Sheela , Nabeel Ismail , Pimenova Dina , Romanoff Anya , Schwalbe Nina , Vangeepuram Nita , Vreeman Rachel , Masci Joseph , Maru Duncan 
Published: March 2021

Objectives

To examine factors associated with COVID-19 vaccine receipt among healthcare workers, including healthcare worker job type, race, and gender, as well as the role of vaccine confidence in decisions to vaccinate, and to better understand specific concerns related to COVID-19 vaccination among healthcare workers.

Design

Cross-sectional anonymous survey among front-line, support service, and administrative healthcare workers.

Setting

Two large integrated healthcare systems (one private and one public) in New York City during the initial rollout of the COVID-19 vaccine among healthcare workers.

Participants

1,933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers, and administrative staff.

Main Outcome Measures

The primary outcome was COVID-19 vaccine receipt during the initial rollout of the vaccine among healthcare workers.

Results

Among 1,933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among Black (58%) compared with White (91%) healthcare workers; and lower among Hispanic (69%) compared with non-Hispanic (84%) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine. Across all participants, 27% expressed concern about being experimented on with the COVID-19 vaccine. In a multivariable analysis, concern about being experimented on with the COVID-19 vaccine, concerns about COVID-19 vaccine safety, lack of influenza vaccine receipt, disagreeing that COVID-19 vaccination is important to protect family members, and Black race were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members, and patients.

Conclusions

Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects, or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting Black and Hispanic workers. Further research is urgently needed in developing strategies with healthcare workers to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

SUMMARY BOXES

What is already known?

High uptake of effective COVID-19 vaccines among healthcare workers is critical to pandemic response.

In studies of potential COVID-19 vaccine acceptance prior to COVID-19 vaccine availability, people who identified as Black were less likely to indicate they would accept the vaccine.

Understanding reasons why some healthcare workers chose not to get the COVID-19 vaccine will help us develop interventions to improve COVID-19 vaccine confidence among healthcare workers and in their communities.

What this study adds

We demonstrate high receipt of COVID-19 vaccines in the initial rollout among healthcare workers.

Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate.

We observed substantially lower rates of receipt among Black and Hispanic healthcare workers, independent of differences in vaccine-related beliefs. A quarter of healthcare workers expressed concerns about being experimented on. These results suggest systemic racism may be a critical barrier to equitable vaccination.

Our results highlight that healthcare workers of all types, including those with non-patient-facing roles, play an important role as sources of COVID-19 vaccine information in their communities.