Acceptance of COVID-19 Vaccination Among Health System Personnel

Daniel J. Parente, MD, PhD; Akinlolu Ojo, MD, PhD, MBA; Tami Gurley, PhD; Joseph W. LeMaster, MD, MPH; Mark Meyer, MD; David M. Wild, MD, MBA; Reem A. Mustafa, MBBS, PhD, MPH


J Am Board Fam Med. 2021;34(3):498-508. 

In This Article

Abstract and Introduction


Introduction: One-third of the general public will not accept Coronavirus disease 2019 (COVID-19) vaccination but factors influencing vaccine acceptance among health care personnel (HCP) are not known. We investigated barriers and facilitators to vaccine acceptance within 3 months of regulatory approval (primary outcome) among adult employees and students at a tertiary-care, academic medical center.

Methods: We used a cross-sectional survey design with multivariable logistic regression. Covariates included age, gender, educational attainment, self-reported health status, concern about COVID-19, direct patient interaction, and prior influenza immunization.

Results: Of 18,250 eligible persons, 3,347 participated. Two in 5 (40.5%) HCP intend to delay (n = 1020; 30.6%) or forgo (n = 331; 9.9%) vaccination. Male sex (adjusted OR [aOR], 2.43; 95% confidence interval [CI], 2.00–2.95; P < .001), prior influenza vaccination (aOR, 2.35; 95% CI, 1.75–3.18; P < .001), increased concern about COVID-19 (aOR, 2.40; 95% CI, 2.07–2.79; P < .001), and postgraduate education (aOR, 1.41; 95% CI, 1.21–1.65; P < .001) – but not age, direct patient interaction, or self-reported overall health – were associated with vaccine acceptance in multivariable analysis. Barriers to vaccination included concerns about long-term side effects (n = 1197, 57.1%), safety (n = 1152, 55.0%), efficacy (n = 777, 37.1%), risk-to-benefit ratio (n = 650, 31.0%), and cost (n = 255, 12.2%).

Subgroup analysis of Black respondents indicates greater hesitancy to accept vaccination (only 24.8% within 3 months; aOR 0.13; 95% CI, 0.08–0.21; P < .001).

Conclusions: Many HCP intend to delay or refuse COVID-19 vaccination. Policymakers should impartially address concerns about safety, efficacy, side effects, risk-to-benefit ratio, and cost. Further research with minority subgroups is urgently needed.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of Coronavirus disease 2019 (COVID-19), is a respiratory virus that has killed millions worldwide.[1] Many COVID-19 vaccines are under development and rely on widely divergent scientific approaches.[2,3] Through "Operation Warp Speed," the United States government has targeted delivering 300 million doses of a safe and effective vaccine by January 2021.[3,4] The Food and Drug Administration (FDA) has now issued emergency use authorization (EUA) for 2 mRNA-based vaccines developed by Pfizer/BioNTech (BNT162b2) and Moderna (MRNA-1273).[5–8] These vaccines are the fastest ever developed.[2] Health care personnel (HCP) are at increased risk of COVID-19 infection.[9] Health systems – in analogy to seasonal influenza campaigns – have begun efforts to promote workforce COVID-19 vaccine uptake. Recent analyses show that vaccine acceptance may be limited among the general public as between 10% to 35% of the individuals indicate that they will not accept a COVID-19 vaccine.[10–12] COVID-19 vaccine acceptance among the general population has been associated with age, sex, race, marital status, educational attainment, political ideology, trust in media/health agencies/scientists, fear of COVID-19, perceived severity of the COVID-19 pandemic, level of vaccine efficacy, duration of vaccine protection, frequency of reported adverse effects, attitudes toward vaccination in general and prior influenza vaccination.[11–17] An analysis using a behavioral economics approach also showed that rapid vaccine development suppressed vaccine uptake at the same level of effectiveness.[13] FDA emergency use authorization, as compared with full FDA approval, was also associated with decreased vaccine acceptance.[16]

Moreover, health care worker acceptance of influenza vaccination during an influenza pandemic – the most analogous vaccine-preventable disease for which there is significant data – indicates that vaccination uptake is greater in males, physicians, nurses, full-time employees, and persons who perceive greater disease risk.[18] Mandated vaccination by health care institutions was also markedly associated with influenza vaccination uptake (from 45% to 90%).[19]

Data were lacking, however, on attitudes toward COVID-19 vaccination among HCPs. Some new data has become available while this article was under review. A survey of the French public found that HCP were more likely to accept vaccination (multivariable odds ratio [OR], 1.53).[20] A French survey specifically targeting 2047 HCPs showed 76.9% would accept vaccination and that age, gender, fear of COVID-19, perceived individual risk and prior influenza vaccination promoted vaccine uptake.[21] Acceptance of COVID-19 vaccination, however, among HCP varies significantly by geographic location.[22] For example, in a survey of 613 HCPs in the Democratic Republic of Congo, only 27.7% would accept COVID-19 vaccination, and vaccination was promoted by male sex and physician (vs non-physician) job role.[23] An online survey of 1205 nurses in Hong Kong indicated that 63% intended to accept COVID-19 vaccination; interestingly, this exceeded the rate of influenza vaccine uptake (49%).[24] In a separate study by the same research group, vaccine acceptance among Hong Kong nurses was positively associated with private sector employment, chronic medical problems, encounters with known or suspected COVID-19 patients, and prior influenza vaccination.[25] Here, we evaluated HCP willingness to become vaccinated against COVID-19 and identified barriers/facilitators to vaccine uptake among all personnel at a large academic medical center in the Midwest United States.