https://orcid.org/0000-0002-1363-5916
ABSTRACT
Encouraging healthcare workers (HCWs) to be vaccinated is a global challenge and plays a fundamental role in combating COVID-19 pandemic. Beyond national policy, which could be different between countries, the decision to be vaccinated involves personal opinions, values, risk perception and attitudes. HCWs may have their own concerns and fears about vaccination beyond being part of the health system. They have a national role in encouraging public vaccination and therefore we recommend strengthening their involvement as policy agents. The health system should equip HCWs with information on the nature and scope of circulating concerns in their communities. At the same time, be attentive to their concerns, equip them with established knowledge and work to strengthen their confidence in the vaccine.
Dear Editor,
We thank the authors for their important discussion about trust in the COVID-19 vaccine and the role of healthcare workers in vaccine communication in reference to our article “Attitudes of healthcare workers and members of the public toward the COVID-19 vaccine: A cross-sectional survey”.Citation1
Encouraging healthcare workers to be vaccinated is a global challenge and plays a fundamental role in combating the COVID-19 pandemic.Citation2 Many determinants can influence vaccine decision-making. Beyond national policy, which could be different between countries, the decision to be vaccinated involves personal opinions, profound values, personal risk perception and attitudes. Therefore, regardless national health policy, it is possible to learn from colleagues around the globe and it is an opportunity to share knowledge and organizational insights. We believe it is time for a mutual global effort to eradicate the disease, as the authors point out, and during 2020 we held a dialogue with officials in China for peer learning on how to fight the pandemic and strengthen messages in the public.Citation3
The unique status of healthcare workers – on one hand – as part of the health system, and an influential role model, and on the other hand- as individuals who may have their own concerns and fears about vaccination, requires reference to both characteristics. Healthcare leaders should be aware that medical workers may experience moral tension between their duty to patient’s health and their right to make an autonomous decision.Citation4 As part of the awareness of the personal factors in making the decision to be vaccinated, the World Health Organization proposed targeted strategies for healthcare workers and recommended actions to empower healthcare workers and cooperation as vaccine advocates.Citation5 Additionally, In order to identify concerns and barriers of healthcare workers to vaccination and strengthen confidence in the COVID-19 vaccine, it is recommended to carry out studies among healthcare workers in each country, to reveal the unique characteristics of the country, the health system, and the vaccination.
We define healthcare workers as agents of change; therefore, their source of knowledge is important: they need available evidence-based information about COVID-19 vaccine.Citation6 Policy makers should be sure of its reliability and the accessibility to healthcare workers in a way that mobilizes them for health insights, and ensure that they have access to information appropriate for their perspectives and education level.Citation7 It should be noted that the information should be continuously updated and maintain its quality during the epidemic.
Trust and transparency are cornerstones of vaccine acceptance.Citation8 It is important to improve trust between all the actors – the health system leadership, healthcare workers and the public, in order to promote vaccination. The clinical and epidemiological uncertainty together with the feeling of serious threat during the COVID-19 epidemic, were a major challenge. They also led to conspiracy theories. We believe that healthcare workers have a national role in encouraging public vaccination (not only in their personal contact with patients). Therefore, we recommend strengthening the involvement of healthcare workers as policy messengers. The authors also pointed out their importance in developing countries and this should be seen as a global challenge. In Israel, well-known physicians, hospital administrators and medical officials participated in the COVID-19 vaccination campaign and conveyed important messages. A targeted communication campaign for healthcare workers, which will include professionals, hospital managers together with healthcare workers who will share their experience on getting vaccinated, can help strengthen and deepen trust to intensify vaccination. Sharing positive emotions and stories may even be more effective than sharing data when attempting to reduce vaccine hesitancy in healthcare workers.Citation9
Healthcare workers have a powerful influence on vaccine acceptance of their patients and the public at large,Citation5 thus recommendations provided by them may play an influential role in encouraging the public to get vaccinated. The health system should equip them with information on the nature and scope of circulating concerns in their communities.Citation10 At the same time, be attentive to their concerns and equip them with established and accessible knowledge and work to strengthen their confidence in the vaccine with targeted strategies for healthcare workers. Focused public health education can promote every physician to be an agent of influence in vaccination, we therefore suggest considering a change in the medical school curriculum.
As for the elderly, who are population at risk and a great challenge in the COVID-19 pandemic, the authors mentioned vaccination rate of 63.16% in Shanghai. According to the Israel Ministry of Health dashboard,Citation11 the percentage of the unvaccinated between the ages of 60–69 is 7.3%, while between the ages of 70–79 only 0.85% are not vaccinated at all, meaning the vast majority of elderly were targeted and complied with the vaccination national strategy: Beyond giving priority for vaccination to the population 60 years and older in the national vaccination program, special efforts were made: Israel’s national emergency medical service (MDA) brought vaccines to all nursing homes and geriatric facilities. The health plans, together with the local authorities, transported homebound patients by car or ambulance to vaccination centers. Later on, health plan personnel brought the vaccines to the homes of homebound elderly patients, and vaccinated them there.Citation12 The special treatment for the elderly population was also through a newly created focused program established by the Ministry of Health’s throughout the pandemic (Magen Avot) meant to protect those older persons in long-term care institutions.
An important point was to have trust toward a sustained national insurance coverage to ensure a continuous vaccination program to the entire population in need. In Israel, it was preliminary decided that the first dose of COVID-19 vaccine will be provided only to those who were saved the second dose, in order to meet the benefit goal of the two doses. Vaccination shortage at that time enforced a national stratification by age: first over 60, then: 55–59 and so on. This well-organized strategy had several strengths: firstly, it produced a sense of accountability, secondly, it raised an important social value- to care for old members of society at risk, and finally reflected the decision to protect to the most vulnerable valuable groups of the population- the elderly alongside medical workers.
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References
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- Berry SD, Johnson KS, Myles L, Herndon L, Montoya A, Fashaw S, Gifford D. Lessons learned from frontline skilled nursing facility staff regarding COVID-19 vaccine hesitancy. J Am Geriatr Soc. 2021;69(5):1140–46. doi:10.1111/jgs.17136.
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- Rosen B, Waitzberg R, Israeli A, Hartal M, Davidovitch N. Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program. Isr J Health Policy Res. 2021;10(1):43. doi:10.1186/s13584-021-00481-x.