Identifying H1N1 and COVID-19 vaccine hesitancy or refusal among health care providers: a scoping review
Authors: Gallant Allyson J. , Harding Andrew , Johnson Catie , Steenbeek Audrey , Curran Janet A. 
Published: March 2023

Objectives:
The objective of this review was to describe and map the evidence around COVID-19 and H1N1 vaccine hesitancy or refusal by physicians, nurses, and pharmacists in North America, the United Kingdom and the European Union, and Australia.

Introduction:
Since 2009, we have experienced two pandemics: H1N1 “swine flu” and COVID-19. While severity and transmissibility of these viruses has varied, vaccination has been a critical component of bringing both pandemics under control. However, uptake of these vaccines has been affected by vaccine hesitancy and refusal. The vaccination behaviors of health care providers, including physicians, nurses, and pharmacists, are of particular interest as they have been priority populations to receive both H1N1 and COVID-19 vaccinations, and their vaccination views could affect the vaccination decisions of their patients.

Inclusion criteria:
Studies were eligible for inclusion if they identified reasons for COVID-19 or H1N1 vaccine hesitancy or refusal among physicians, nurses, and/or pharmacists from the included countries. Published and unpublished literature were eligible for inclusion. Previous reviews were excluded; however, the reference lists of relevant reviews were searched to identify additional studies for inclusion.

Methods:
A search of CINAHL, MEDLINE, PsycINFO, and Academic Search Premier databases was conducted April 28, 2021, to identify English-language literature published from 2009 to 2021. Gray literature and citation screening were also conducted to identify additional relevant literature. Titles, abstracts, and eligible full-text articles were reviewed in duplicate by 2 trained reviewers. Data were extracted in duplicate using a structured extraction tool developed for the review. Conflicts were resolved through discussion or with a third team member. Data were synthesized using narrative and tabular summaries.

Results:
In total, 83 articles were included in the review. Studies were conducted primarily across the United States, the United Kingdom, and France. The majority of articles (n=70) used cross-sectional designs to examine knowledge, attitudes, and uptake of H1N1 (n=61) or COVID-19 (n=22) vaccines. Physicians, medical students, nurses, and nursing students were common participants in the studies, however, only 8 studies included pharmacists in their sample. Across health care settings, most studies were conducted in urban, academic teaching hospitals, with 1 study conducted in a rural hospital setting. Concerns about vaccine safety, vaccine side effects, and perceived low risk of contracting H1N1 or COVID-19 were the most common reasons for vaccine hesitancy or refusal across both vaccines.

Conclusions:
With increased interest and attention on vaccines in recent years, intensified by the COVID-19 pandemic, more research that examines vaccine hesitancy or refusal across different health care settings and health care providers is warranted. Future work should aim to utilize more qualitative and mixed methods research designs to capture the personal perspectives of vaccine hesitancy and refusal, and consider collecting data beyond the common urban and academic health care settings identified in this review.