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New research examines vaccination rates among healthcare workers in the U.S. Paul Bersebach/MediaNews Group/Orange County Register via Getty Images
  • Vaccination rates among healthcare workers across 2,000 United States hospitals increased from 36% to 60% between January and April 2021.
  • Rates slowed considerably thereafter, with only 70% of staff fully vaccinated as of September 2021.
  • Healthcare personnel working in children’s hospitals and metropolitan areas have the highest vaccination rates.

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Following the initial peak of COVID-19 vaccine uptake among healthcare personnel (HCP) in the U.S. hospital system in early 2021, rates quickly decreased in the second half of the year. Currently, as much as 30% of HCP remain unvaccinated.

Data analysis from the Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System from January–September 2021, collected from over 3.3 million HCP across 2,086 hospitals, found that as many as 30% of workers were unvaccinated.

A recent study in the American Journal of Infection Control examines self-reported data on vaccination status according to hospital type and location. Hannah Reses, MPH, an epidemiologist in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), led the research team.

Their analysis included children’s hospitals, short- and long-term acute care hospitals (ACH), and critical access hospitals. The study did not include psychiatric, rehabilitation, and religious non-medical facilities.

Data were then stratified by county type and whether the hospitals were in metropolitan or rural areas.

HCP working in children’s hospitals had the highest vaccination rates at 77%, followed by short- and long-term care ACHs at 70.1% and 68.8%, respectively. Critical access hospitals had vaccination rates of 64%.

Hospitals in metropolitan counties had the highest vaccination rate of 71% for HCP, followed by rural counties (65.1%), and non-metropolitan rural counties (63.3%).

Individual vaccination rates among HCP also varied according to the COVID-19 hospital admissions at their workplace and vaccination coverage within their residential counties.

HCP were 14% more likely to be fully vaccinated if they worked in hospitals in the lowest percentile of COVID-19 admissions. They were also 10% more likely to be fully vaccinated in counties with the lowest cumulative cases of COVID-19.

On the other hand, they were 32% less likely to be fully vaccinated in counties with lower community vaccine coverage.

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Following the initial introduction of COVID-19 vaccines in December 2020, there was a 24% absolute increase in uptake among HCP across the hospitals surveyed. From January to April 2021, rates increased from 36% to 60%. However, from April to August, the researchers saw only a 5% increase.

Notably, there was an additional 5% increase in vaccination rates from August to September 2021, which may reflect the recent rise in cases with the Delta variant or vaccine mandates in certain areas. Nevertheless, the total vaccination rate among HCP remains at just 70%.

While the researchers did not delve into the reasons individual HCP remain unvaccinated, they echoed previous research that cites several factors. Reses outlined to Medical News Today the four primary concerns:

  • “COVID-19 vaccine efficacy
  • adverse reactions after vaccination
  • the speed of vaccine development
  • lack of trust in regulatory authorities and the government”

Due to the higher risk of SARS-CoV-2 infection and transmission within hospitals — especially the newer Delta variant — experts continue to explore measures to increase uptake.

Speaking with MNT, Reses cited “vaccine mandates and investments in educational and promotional activities” as effective means of achieving this goal.

The study also notes that vaccinated HCP could help influence other HCP and communities to have the vaccine. They were more likely to recommend it to patients, friends, and family.

The researchers found that reluctant HCP placed greater trust in the recommendations of medical professionals versus regulatory authorities or the government. This collegial approach might enhance compliance while dispelling misinformation.

Dr. William Schaffner, professor of medicine from the Division of Infectious Diseases at Vanderbilt University Medical Center in Nashville, TN, also spoke with MNT.

“We were actually not surprised at all by the 70% vaccination rate among HCP in this study. The initial surge in uptake followed by the drop-off is exactly the same thing that happened when the influenza vaccines were introduced. […] In other words, the early accepters are the ones who come out first. But not everybody is so eager. This includes physicians. HCP are, after all, people.”

Dr. Schaffner then described the resolutions Vanderbilt put in place to overcome the stalled uptake. This included vaccine mandates and intensive educational outreach with a strong focus on diversity inclusion.

He emphasized several points:

“There is no perfect vaccine that is risk-free. Yet, the safety standard for any vaccine is already much higher than it is for pharmaceuticals that receive FDA [Food and Drink Administration] approval. And risk must always be put into context. Yes, COVID-19 vaccines do have small cardiac and clotting risk in the 3-to-5 per 1 million range, but in the face of a pandemic that was causing over 2,000 deaths worldwide on a daily basis, there is almost no comparison.”

Given the timeline of the dataset, this study was unable to account for the Pfizer vaccine approval in August 2021.

According to Dr. Monica Gandhi, professor of medicine and associate chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California San Francisco, simply having an FDA-approved agent solves one of the four concerns regarding vaccine hesitancy.

She told MNT: “the Pfizer vaccine was fully approved by the FDA on August 23, and this analysis only went up to September 15, 2021. It is easier to mandate a vaccine when it is fully approved, so mandates may have gone into effect in some healthcare systems after that approval.”