Why are some health care workers refusing the COVID vaccine?

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Not long after the COVID-19 pandemic began, Dr. Michelle Moniz said she and her colleagues learned of health care workers around the country reporting they would not get a vaccine to protect them from the disease that has killed thousands of their colleagues.

“When COVID started happening, I was very curious about what we were hearing that some folks were not interested in obtaining the vaccine once one was developed,” said Moniz, an assistant professor in obstetrics and gynecology at the University of Michigan. “We have some amazing researchers at [U of M’s] School of Public Health, and so we got a team together to see what this might look like at our own institution.

Dr. Michelle Moniz of the Michigan Medicine Department of Obstetrics and Gynecology

“Vaccines are one of the greatest public health inventions of the last century; why is it that folks are concerned?” Moniz continued. 

To answer that question, a University of Michigan team consisting of Moniz and other researchers sent out a survey in February about vaccine hesitancy to all employees of Michigan Medicine, University of Michigan’s Ann Arbor-based health system. 

Of the 11,387 people who responded, the overwhelming majority were in favor of getting the vaccine: just under 80% of the respondents said they had gotten a vaccine or were scheduled to receive one and 4.8% said they wanted to get it as soon as possible. 

But there were still hundreds of health care workers who were vaccine hesitant — 954 individuals, or 8.4% of respondents, reported they would not be getting the vaccine for now. And 369 people, or 3.2% of survey participants, said they would “not ever” receive it. 

While it was a small percentage of respondents who said they would not get the vaccine, that still could have widespread and dangerous ramifications, Moniz said.

“When a health care worker declines a COVID-19 vaccine, it affects the herd immunity of the health care workforce and potentially the safety of patients and communities that workforce serves,” Moniz said. “And health care workers are a trusted a voice that influences others, so vaccine hesitancy in this group could undermine efforts to widely vaccinate populations and achieve herd immunity.

University of Michigan health workers COVID vaccine study

“We felt like if we understood this better, we could create more effective vaccine messaging and policies that enhance vaccine coverage,” Moniz added.

The reasons behind the health care workers’ vaccine hesitancy were varied, with the most common reasons cited being how quickly the vaccine was developed, insufficient safety and effectiveness data, a disbelief that the vaccine would protect them from COVID-19 infection, and concerns about serious side effects. Nurses were much more likely than physicians, nurse practitioners, nurse midwives, and physician assistants to be vaccine hesitant. Physicians were almost uniformly in favor of the vaccine. Other staff who don’t provide clinical care, such as food service workers and security personnel, had higher rates of vaccine hesitancy.

Respondents who had previously been infected with COVID-19 were more likely to be vaccine hesitant, as were women and Black employees. 

Dr. Abram Wagner, a member of the team that sent out the survey and a U of M research assistant professor of epidemiology who studies vaccine hesitancy, previously noted that systemic racism in health care can cause deeply rooted mistrust of the health care landscape and can deter people of color from pursuing the vaccine. 

In total, about 29% of the study’s respondents reported at least one concern with the COVID-19 vaccine — including about 21% of those who had gotten the vaccine or were planning on getting it. 

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This, Moniz said, is especially important to note because it suggests that people who are currently vaccine hesitant could be persuaded to get a vaccine.

“It suggests there’s a spectrum of beliefs here, and we can help move folks along that spectrum to where people who have concerns may choose to get vaccinated,” she said. “That’s all the more reason to engage with folks and have honest and compassionate conversations that validate people’s concerns but strongly encourage folks to get vaccines.”

The fact that vaccine hesitancy among the health care workers in the survey is not rooted in overall vaccine skepticism, but rather specific concerns about the lack of long-term data on safety, efficacy and potential side effects, also means there’s a real opportunity to address concerns through information about the rigorous clinical trials process, ongoing safety data, and Food and Drug Administration (FDA) approval, the researchers wrote.

But, Moniz emphasized, there can’t only be “more and better” information about the vaccine itself to change people’s minds.

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“We have to lean into empathy,” she said. “The way to do that is to acknowledge the legitimacy of vaccine concerns and fears of the unknown. There’s that step of saying, ‘Yeah, there’s a lot we don’t know. Yes, we haven’t been monitoring this vaccine for decades.’ Saying some concern is perfectly rational is a critical part of trying to dismantle hesitancy.” 

Ultimately, it’s crucial to be able to empathize with people while still “conveying what we know about the vaccine and what we know about the disease is more important than the unknowns,” Moniz said. 

She noted that messaging that emphasizes being a protector for loved ones may reduce vaccine resistance — in other words, it could be more effective to say that getting the vaccine will not only help the vaccinated individual but everyone around them, as well. 

And, Moniz emphasized, it’s crucial that public health officials reach out to specific populations, such as nurses and African Americans, to better understand and address their concerns regarding the vaccine. 

“We can validate concerns, understand the reluctance and try to understand where it comes from,” Moniz said.