Healthcare Workers Differ by Race, Ethnicity in COVID-Vaccine Hesitancy

Even among healthcare workers, certain ethnic and racial groups might need more assurances before receiving COVID-19 vaccines, according to a new survey conducted in San Francisco. Here is what the authors found and what they recommend to help pharmacists and other healthcare professionals increase uptake of immunization against the novel coronavirus.

SAN FRANCISCO – How much do race and ethnicity play a role in the willingness of healthcare workers to receive COVID-19 vaccine?

A study published in JAMA Internal Medicine points out that surveys “have demonstrated racial differences in the public’s willingness to receive a COVID-19 vaccine but have not directly compared vaccine intentions among health workers and the general public.”

In light of that, researchers from the University of California, San Francisco investigated COVID-19 vaccine intentions among racially and ethnically diverse samples of health workers and the general population.

To accomplish that, the study team conducted a cross-sectional survey from Nov. 27, 2020, to Jan. 15, 2021, nested within 2 longitudinal cohort studies of prevalence and incidence of SARS-CoV-2 infection in 6 San Francisco Bay Area counties.

The authors advise that the general population cohort included 3,935 community-residing adults sampled from randomly selected households, and the medical center employee cohort comprising 2,501 employees of 3 large medical centers, who volunteered for biweekly to monthly COVID-19 testing.

Defined as the main outcome measure was likeliness of vaccine uptake, derived from 2 survey queries: (1) “How likely are you to get an approved COVID-19 vaccine when it becomes available?” (using a 1-7 Likert scale anchored at “not at all likely” and “very likely”), and (2) “How early would you ideally like to receive the COVID-19 vaccine?” (asked of respondents scoring ≥3 on the first item).

Also included in the survey were questions reasons to get, and to not get, vaccinated.

Responses were received from 80.3% participants in the general population cohort and 72.1% participants in the medical center employee cohort responded to the vaccine survey.

“Although a higher proportion of medical center employees than members of the general population reported likeliness of vaccine uptake, racial/ethnic differences in likeliness were comparable in both cohorts,” researchers note.

Results indicate that, for the medical center cohort, the adjusted odds ratio (aOR) (95% CI) of likeliness of vaccine uptake relative to White respondents was 0.24 (0.10-0.60) for Black respondents, 0.50 (0.31-0.79) for Latinx respondents, 0.37 (0.27-0.51) for Asian respondents, 0.28 (0.15-0.53) for respondents of other races, and 0.49 (0.29-0.82) for respondents of multiple races.

In the general population cohort, meanwhile, the aOR (95% CI) relative to White respondents was 0.29 (0.20-0.43) for Black respondents, 0.55 (0.43-0.71) for Latinx respondents, 0.57 (0.47-0.70) for Asian respondents, 0.62 (0.38-1.02) for respondents of other races, and 0.65 (0.46-0.92) for respondents of multiple races.

“Ratings of reasons to get vaccinated were similar across racial/ethnic groups, but Black, Latinx, and Asian respondents were significantly more likely than White respondents to endorse reasons to not get vaccinated, especially less confidence in the vaccine preventing COVID-19 (aOR [95% CI] for Black, Latinx, and Asian respondents having low confidence relative to White respondents, 2.39 [1.58-3.61], 2.04 [1.58-2.64], and 1.85 [1.51-2.27], respectively); less trust in companies making the vaccine (aOR [95% CI] for Black, Latinx, and Asian respondents having low trust relative to White respondents, 3.08 [2.00-4.73], 1.85 [1.38-2.48], and 1.34 [1.04-1.72], respectively); and more worry that government rushed the approval process (aOR [95% CI] for Black, Latinx, and Asian respondents relative to White respondents, 2.10 [1.44-3.05], 1.68 [1.34-2.10], and 1.81 [1.53-2.15], respectively),” the authors write.

Essentially, the survey determined that “occupational immersion in a health care setting did not offset disparities in COVID-19 vaccination intentions.” In fact, researchers found that Asian individuals, multiracial individuals, and those of other races “were more similar to Black and Latinx individuals than White individuals in their likeliness of vaccine uptake.”

The authors say they were struck that, even among survey respondents motivated to participate in a longitudinal COVID-19 testing study, racial/ethnic differences in COVID-19 vaccination intentions and concerns about the vaccine persisted.

“Vaccination intentions must be understood as a deliberative and dynamic process; a focus on intentions must not distract from the importance of ensuring equitable access to vaccination,” the authors conclude. “Special effort is required to reach historically marginalized populations, including those in health occupations, to support informed vaccination decision-making and facilitate access. Efforts must acknowledge a history of racism that has degraded the trustworthiness of health and medical science institutions among historically marginalized populations, undermined confidence in COVID-19 vaccines, and perpetuated inequitable access to care.”

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