Perceptions of COVID-19 Vaccines Among Healthcare Assistants

A National Survey

Joshua D. Niznik PharmD, PhD; Jill Harrison MA, PhD; Elizabeth M. White APRN, PhD; Maggie Syme PhD, MPH; Laura C. Hanson MD, MPH; Casey J. Kelley MPH; Lori Porter LNHA, CAN; Sarah D. Berry MD, MPH


J Am Geriatr Soc. 2022;70(1):8-18. 

In This Article

Abstract and Introduction


Background: Limited COVID-19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID-19 infections. Our study objective was to evaluate the perceptions of COVID-19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity.

Methods: An online survey was conducted from December 2020 to January 2021 through national e-mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27-item survey asked questions about experiences and perceptions of COVID-19 vaccines, including how confident they were that COVID-19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID-19 vaccines.

Results: We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID-19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non-white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID-19 vaccines.

Conclusion: Frontline HCAs reported low confidence in COVID-19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID-19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.


The novel coronavirus disease 2019 (COVID-19) pandemic has had devastating effects on frail and chronically ill older adults, and on the frontline healthcare workers who support them. In the United States, more than 460,000 older adults have died from COVID-19 infections.[1] In the long-term care setting, there have been more than 133,000 resident deaths and 1900 staff deaths as of May 2021.[2] The need for social distancing and other restrictions to prevent the transmission of COVID-19 have also contributed to worsening mental health and quality of life in older adults.[3,4] The COVID-19 pandemic has created an unprecedented demand for front-line healthcare workers to provide care under more hazardous conditions with infected patients, putting their own health and safety at risk. This is particularly true of healthcare assistants (HCAs), who provide the majority of direct patient care to functionally impaired older adults residing in both congregate settings and in the community.[5,6] These include certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians.

Although the rollout of COVID-19 vaccines has provided a sense of hope, the health benefits of vaccination programs are entirely dependent on sufficient uptake in the community.[7] Vaccine uptake has been high for older adults, particularly those in nursing homes and other congregate living settings.[8] However, willingness to be vaccinated among the general population is variable and may be lower than 50% in certain areas.[9–14] In the United States, black and Latino/a respondents report more vaccine hesitancy than white correspondents.[15,16] Early investigation suggests that hesitancy is multifactorial, including safety and efficacy concerns, given the rapid approval process.[17]

Vaccine hesitancy among frontline HCAs may have serious consequences for older adults. Despite the critical role of HCAs, rates of vaccination have lagged behind other disciplines.[14] HCAs are predominantly female (90%), and more than 30% and 20% are black and Latino/a, respectively.[18–20] In addition, HCAs are underpaid and overworked, and have been left with scarce resources to deal with surging COVID-19 cases during the pandemic.[21] Given that vaccine distribution and education for healthcare workers has primarily been orchestrated through healthcare organizations and employers, leadership and support in the workplace may be an important factor in influencing the likelihood that HCAs will be vaccinated. Hesitancy may also be driven by historical failures of the healthcare system to inspire trust among minority and disenfranchised groups.[22,23]

To date, there are no studies evaluating COVID-19 vaccine hesitancy among HCAs. Understanding potential drivers of vaccine hesitancy in HCAs is critical for their safety and the safety of older adults who are dependent on their care. Therefore, our objective was to evaluate perceptions of COVID-19 vaccine safety and efficacy in a sample of HCAs, and to examine whether these perceptions differ by race, ethnicity, or work environment.