Understanding Vaccine Hesitancy Among Healthcare Workers: Implications for Emergency Medical Services

close up doctor holding syringe and using cotton before make injection to patient in medical mask. Covid-19 or coronavirus vaccine
Shutterstock/BaLL LunLa

By Jared Shapiro, DrPH, MPH, HEM, FAcEM, CEM, CHSP, CHEP, NREMT-P, MICP

Abstract

Vaccine hesitancy (VH) is a significant public health issue that impacts the success of vaccination campaigns, especially among healthcare workers (HCWs) who are critical to protecting public health.

This study examines the key factors influencing vaccine hesitancy among HCWs at Montefiore Medical Center in New York, focusing on SARS-CoV-2 and influenza vaccines. Predictive factors such as age, race/ethnicity, job title, and previous vaccination behaviors were analyzed.

Findings reveal that younger HCWs and Black employees were more likely to exhibit vaccine hesitancy, while physicians and those who previously received influenza vaccines were more inclined to accept the COVID-19 vaccine.

These results have important implications for Emergency Medical Services (EMS) professionals, underscoring the need for targeted interventions to address hesitancy and improve vaccine acceptance within frontline healthcare settings.

Introduction

Vaccine hesitancy (VH), defined by the World Health Organization (WHO) as the reluctance or refusal to vaccinate despite the availability of vaccines,1 poses a significant threat to public health efforts, particularly within healthcare settings.

Healthcare workers (HCWs) serve as the frontline defense in managing infectious diseases, and their willingness to receive vaccines is critical to maintaining operational effectiveness during public health crises. Emergency Medical Services (EMS) professionals, who often provide care in high-risk environments, are no exception to this challenge.

Vaccine hesitancy among EMS workers could undermine not only their safety but also the broader public health response during emergencies.

This study examines the factors contributing to vaccine hesitancy among healthcare workers at Montefiore Medical Center, focusing on SARS-CoV-2 and influenza vaccines. The findings will inform strategies for addressing hesitancy within EMS and other healthcare sectors to ensure higher vaccine coverage among frontline workers.

Methods

This study analyzed data from 21,331 healthcare workers at Montefiore Medical Center in New York. The data was drawn from Epic and Cority systems, focusing on vaccine uptake for SARS-CoV-2 and influenza between 2021 and 2023.

The study population included a diverse range of healthcare professionals, from physicians and nurses to non-clinical staff. Key variables such as age, race/ethnicity, job title, and prior influenza vaccination were examined to identify their impact on vaccine hesitancy.

A series of linear and logistic regression models were used to assess the influence of these factors on vaccine uptake. These models enabled a detailed analysis of the associations between demographic factors and vaccine behaviors, offering insights into which groups are more likely to exhibit vaccine hesitancy.

The findings were then analyzed to provide recommendations for EMS professionals, given the importance of vaccination in maintaining public health and operational readiness during emergencies.

Results

The study identified several significant predictors of vaccine hesitancy among healthcare workers. Age emerged as a crucial factor, with younger HCWs, particularly those under 40, exhibiting higher levels of hesitancy compared to older workers.

This finding is consistent with research suggesting that younger individuals often perceive themselves as less vulnerable to infectious diseases, which may contribute to their reluctance to get vaccinated.2

Race and ethnicity also played a significant role in vaccine hesitancy. Black healthcare workers were more likely to exhibit hesitancy compared to their White counterparts, while Asian workers demonstrated higher rates of vaccine acceptance.

These disparities reflect broader trends seen across national healthcare data, highlighting persistent racial disparities in healthcare access and trust.3

Job titles further influenced vaccine behaviors, with physicians showing the highest acceptance rates for both influenza and SARS-CoV-2 vaccines. In contrast, nurses and technicians were less likely to be vaccinated, which may be attributed to varying levels of trust in vaccines or differing levels of engagement with vaccine-related information in their roles.

Previous vaccination behavior was a strong predictor of vaccine uptake, with HCWs who had received the influenza vaccine being 6.2 percentage points more likely to get vaccinated for COVID-19. This suggests that consistent messaging about the benefits of vaccines and building trust in their safety over time can positively influence future vaccine acceptance.

Geographic disparities were also observed, with HCWs living in New York County more likely to receive vaccines compared to those residing in the Bronx. These differences could be attributed to socioeconomic factors or variations in access to healthcare services.

These findings indicate that vaccine hesitancy among HCWs is influenced by a combination of demographic factors, professional roles, and previous vaccination behaviors.

Addressing these factors through targeted interventions, particularly among younger HCWs, minority groups, and non-physician staff, is critical for improving vaccine coverage within healthcare settings, especially in EMS, where vaccine compliance is essential for maintaining operational readiness.

Discussion

The findings of this study underscore the need for tailored interventions to address vaccine hesitancy among healthcare workers, with specific attention to EMS professionals. Younger healthcare workers and racial minorities, particularly Black employees, exhibited higher levels of hesitancy, suggesting that communication strategies should focus on addressing concerns related to vaccine safety and efficacy within these groups.

Educational campaigns that emphasize the safety and effectiveness of vaccines, especially when delivered by trusted peers or culturally competent messengers, could help to mitigate these concerns.

Moreover, the strong correlation between prior influenza vaccination and COVID-19 vaccine acceptance highlights the importance of consistent public health messaging. Encouraging annual vaccination for common illnesses, such as influenza, may increase trust in newer vaccines like those developed for SARS-CoV-2.

Within EMS, where professionals are on the front lines of public health emergencies, ensuring high vaccination rates is essential for protecting both staff and the communities they serve.

Efforts should also focus on improving access to vaccines in underserved areas, such as the Bronx, where geographic disparities in vaccine uptake were noted. EMS professionals, who are often first responders in these communities, could benefit from community-based outreach initiatives that improve vaccine accessibility and build trust in the healthcare system.

Conclusion

Addressing vaccine hesitancy among healthcare workers, particularly within EMS settings, is crucial for ensuring the success of public health interventions during emergencies.

The findings of this study highlight the need for targeted communication strategies that address the unique concerns of younger healthcare workers, minority groups, and non-physician staff.

By fostering trust in vaccines and increasing accessibility, healthcare institutions can improve vaccine uptake among frontline workers, ultimately enhancing public health and safety during times of crisis.

About the Author

Jared Shapiro is the system associate vice president of Environmental Health and Safety for Montefiore Einstein where he provides strategic direction and oversight for fifteen hospitals, a research-intensive medical school, a school of nursing and three hundred and fifty off-site locations.

Responsible for Environment of Care, Radiation Safety, Laser Safety, Biological and Chemical Safety, Fire and Life Safety, Emergency Management, Laboratory Safety, Construction Safety, Emerging Infectious Disease Unit, Prehospital Care, Fleet Services and Occupational Health and Ergonomics.

Dr. Shapiro is an accomplished healthcare executive with 18 years of experience focused on healthcare operations, operational excellence, regulatory compliance, and performance improvement within the hospital and academic research setting. He is an expert in Life Safety Code, Joint Commission’s Environment of Care, Life Safety, and Emergency Management standards as well as the Center for Medicare and Medicaid Services conditions of participation.

Dr. Shapiro is an associate professor at New York Medical College’s School of Health Science and Practice where he teaches the Master of Public Health program. Dr. Shapiro also moonlights as a paramedic for Hackensack Meridian Health, former deputy commander for the NJ-1 Disaster Medical Assistance Team and former fire chief.

References

1. World Health Organization. (n.d.). Vaccine hesitancy: What it means and how to combat it. Retrieved from https://www.who.int/

2. Beleche, T., Ruhter, J., Kolbe, A., Marus, J., Bush, L., Sommers, B. D., & Koma, W. (2023). Vaccine hesitancy and attitudes among healthcare personnel in the United States. American Journal of Public Health, 113(1), 75-82.

3. Nguyen, K. H., Nguyen, H. T., Corlin, L., Allen, A. M., Yang, M. L., & Solis, R. M. (2022). Racial and ethnic disparities in COVID-19 vaccine hesitancy and uptake. Journal of Racial and Ethnic Health Disparities, 9(3), 979-989.

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