Attitude Towards COVID-19 Vaccination Among Healthcare Workers: A Systematic Review

Figures & data

Figure 1 PRISMA flow diagram of the study.

Note: Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.⁶²

Table 1 Summary of Baseline Characteristics of the Articles That Were Published Earlier and Included Studies in the Review, 2021

Author Publication Year	Period of Study	Study Design	Study Setting	Average Age in Years (Mean or Median)	Sample Size	Gender (Female %)	Occupation
Gagneux B et al, 2020^Citation56	March–July, 2020	Cross-sectional (online)	France	● >30 years – 22.7% ● 30–49 years – 47.3% ● 50–64 years – 26.8% ● Over 65 years – 3.1%	2047	74%	● Physicians – 21.06% ● Pharmacists – 24.5% ● Nurses – 18.1% ● Assistant nurses – 10.65% ● Midwives – 1.8% ● Physiotherapists – 1.2% ● Others (administrative staff, laboratory staff, research staff) – 22.7%
Kabamba N et al, 2020^Citation33	March–April, 2020	Cross-sectional	Congo	● 18–25 years – 4.7% ● 25–40 years – 63.0% ● ˃40 years – 32.3%	613	49.1%	● Doctors – 27.2% ● Nurses and other healthcare workers – 72.8%
Dimitrios P et al, 2021^Citation45	December 2020	Cross sectional (online)	Greece	● 44.7±10.97	340	49%	● Physicians – 63% ● Dentists – 24% ● Pharmacists – 13%
Francesco D et al, 2021^Citation30	Oct–Nov, 2020	Cross-sectional (online)	Italy	● <30 – 44% ● 30–40 – 31% ● 41–50 – 12% ● 51–60 – 6% ● >60 years – 7%	1723	53%	● Specialized medical doctors – 20% ● Medical residents – 15% ● Medical doctors – 32% ● General practitioners – %8) ● GP trainees – 4% ● Non-MD health professional nurses – 22%
Bartosz S et al, 2021^Citation32	2021	Cross-sectional (online)	Poland	Median (26.94±31.39yrs)	2300	42.17%	● Physicians – 37.78% ● Health care assistants – 37.22% ● Non-medical students and non-healthcare workers –63.10%
–Ameerah M et al, 2021^Citation36	Dec, 2020	Cross-sectional (online)	Saudi Arabia	18–29=23.5% 30–39=43.2% 40–49=23.2% 50–59=6.76% ≥60 years=3.24	736	39.9%	● Frontline healthcare workers – 53.8% ● Others – 46.2%
Abas K et al, 2021^Citation15	January, 2021	Cross sectional study	Pakistan	–	200	–	–
Jana Sh et al, 2021^Citation40	Nogv–Dec, 2020	Cross-sectional study	USA	Mean, 42.5 (13.56) years	5287	72.8%	● Registered nurses – 22.7% ● Scientists and physicians – 19.5% ● Administration and management – 19.2% ● Ancillary services – 17.8% ● Technical support – 8.4% ● Allied health professionals – 6.2% ● Master’s-level clinicians – 5.65% ● Public safety and spiritual care – 0.5% ● Pharmacists – 2.4%
Rahul Sh et al, 2021^Citation15	Oct–Nov,2020	Cross-sectional (online)	USA	18–30 years = (23%) 31–40 years = (30%) 41–50 years = (20%) 51–60 years = (16%) 61–70 years = (9.4%) > 70 years = (0.5%)	3,479	75%	● Direct patient care providers (DPCPs) – 45% ● Direct medical providers (DMPs) – 35% ● Others without direct patient contact – 12%
Caterina L et al, 2021^Citation44	2021	Cross-sectional	Italy	≤30 = 10% 31–40 = 31% 41–50 = 34% ≥51 = 29%	1354	52%	● Physicians – 40% ● Graduate sanitary = 3% ● Nurses and midwives – 42% ● Healthcare assistance staff – 8% ● Healthcare diagnostic staff – 7%
Padureanu V et al, 2021^Citation29	April–May, 2020	Cross-sectional (online)	Romania	Mean age of 35.34±10.75 years (range: 21–66 years).	529	68.4%	● Physicians=65.0% ● Nurses=5.9.0% ● Pharmacists=16.2% ● Medical students =12.9%
Gasmelseed A et al, 2021^Citation39	2021	Cross-sectional (online)	Saudi Arabia	≤35 years 134 (56.8%) >35 years 102 (43.3%)	236	71.6%	● Nurses 146 (61.9%) ● Doctors (16.1%) ● Others (22.0%)
Shikha K et al, 2021^Citation31	Sep–Nov, 2020	Cross-sectional (online)	Taiwan	Mean age = 34.43 years	500	58.8%	● Healthcare workers=100%
John J et al, 2021^Citation48	2021	Cross-sectional (online)	Ghana	● 18–24 –5.5% ● 25–30 – 82% ● >30 – 12.5%	305	50.8%	● Junior doctors =100%
Jorge L et al, 2021^Citation12	2021	Cross-sectional (online)	Colombia	● 46.3±18.5= 60%effectiveness ● 47±19.5 = 80% effectiveness	1066	66%	Physicians – 46.3%
Luka P et al, 2021^Citation34	2021	Cross-sectional (online)	Slovenia	● 42% = ≤35 ● 40% = 35–54 ● 18% = ≥ 55	2068	63%	● Doctor =37.2% ● Medical students=15.04% ● others=32.6% ● HC students=15.24%
Asaf Z et al, 2021^Citation42	March–April, 2020	Cross-sectional (online)	UAE	Mean age was 36.3	506	57%	● Residents = 21% ● Specialists =26%
Maayan Sh et al, 2021^Citation43	Dec 2020–Jan, 2021	Cross-sectional	Israel	Mean (±SD) ● Dentist,42.13 (±10.66) ● Dental hygienists = 44.60 (±16.32)	140	34.3% =dentists dental hygienists = all are female	● Dentists = 13.4% ● Dental hygienists = 14.6
Stefania D et al, 2021^Citation38	December 2020	Cross-sectional	Canada	Average = 44	2,761	72%	Nurses and orderlies – 23.1% Physicians – 18.8% Environmental service workers – 4.4% Healthcare managers – 2.5% Other healthcare workers – 24.9%
Martin W et al, 2021^Citation49	Jan–Febr, 2021	Cross-sectional design (online)	Ghana	20–29 = 32.9% 30–39 = 56.0% 40 and above = 11.1%	234	63.2%	● Nurse and midwife = 64.5% ● Allied health workers = 23.5% ● Medical doctors = 12.0%
Samar F et al, 2021^Citation47	Dec 2020–Jan, 2021	Cross-sectional design (online)	Egypt	17–35 = 70.39% 36–66 = 29.61%	385	81.3%	● Physician = 49.87% ● Nursing Staff = 23.12 ● Pharmacist = 22.60% ● Dentist = 3.38% ● Physiotherapist = 1.04%
Sabita P et al, 2021^Citation46	Jan 27 - Febr, 2021.	Cross-sectional descriptive	Nepal	20–30 = 45.9% 30–40= 29.3% 40–50 = 12.4% 50–60= 7.1% Missing = 5.3%	266	71.4%	● Medical and dental officers, postgraduates – 6.4% ● Nursing staff – 30.5% ● General workers – 24.8% ● Paramedics – 14.7% ● Missing – 0.4%
Eyad Q et al, 2021^Citation37	January, 2021.	Cross-sectional study based on an online survey	Arabic-speaking countries(Egypt, Morocco, Tunisia, and Algeria))	30.6 ±10 years	5708	44.4%	–
Anne S et al, 2021^Citation35	January, 2021	Cross-sectional study	Belgium	<35 years = 28.4% 35–44 years = 24.3% 45–54 years= 24.2% ≥55 years = 23.1%	1141	72.7%	Medical doctors – 16.5% Nurses or nursing assistanst – 28.5%– Paramedical staff = 18.4%

Table 2 Summary of Included Studies on the Attitude Toward COVID-19 for Vaccination and Its Determinants Among Healthcare Workers, 2021

Author	Attitude Toward COVID-19 for Vaccination	Determinants (Significantly Associated)
Gagneux B et al, 2020^Citation56	● 76.9% would accept a COVID-19 vaccine. Of these:	● Older age ● Male ● Fear about COVID-19 ● Individual perceived risk and flu vaccination during previous season
Kabamba N et al, 2020^Citation33	● 27.7% = would get vaccinated if the COVID-19 vaccine was available	● Male healthcare workers ● Being a doctor
Dimitrios P et al, 2021^Citation45	● High level of acceptance for COVID-19 vaccine = 78.5%	● Age >45 years ● Absence of fear over vaccine safety ● Information received from the Greek public health authorities
Francesco D et al, 2021^Citation30	● 67% = intended to be vaccinated, ● 26%= were not sure ● 7% = declared refusal	● Being a non-MD health professional ● Using Facebook as main information source about antiSARS-CoV-2 vaccination
Bartosz S et al, 2021^Citation32	● Significant level of willingness to get vaccinated as compared to the control group = 82.95% vs 54.31%	● Positive history of recommended vaccinations ● Fear of COVID-19 of passing on the disease to relatives ● Depression symptoms in the past week ● Fear of vaccination side effects
Ameerah M et al, 2021^Citation36	● 50.52% of respondents were willing to have the COVID-19 vaccine, of these: ● Immediate acceptance = 49.7% ● Delayed acceptance = 50.3%	#Acceptance - Being a male healthcare worker - Perceiving a high risk of infection, - Believing that the COVID-19 vaccine should be compulsory for all citizens and - residents in the country
Abas K et al, 2021^Citation15	Overall attitudes toward vaccination were positive but specific concerns regarding COVID-19 vaccine are prevalent ● Only one-third of respondents were amenable to COVID-19 vaccination immediately ● >1/2 of respondents preferred to defer their decision until reviewing more data ● High percentage of respondents waiting to review more data
Jana Sh et al, 2021^Citation40	Overall, 57.5% of individuals expressed intent to receive COVID-19 vaccine	#Acceptance - Older - Male - White, or Asian
Rahul Sh et al, 2021^Citation15	56% = majority of the HCW were not sure or would wait to review safety data before getting vaccinated 11% = will like to wait for 3 months 10% = will like to wait for 6 months, and 20% = will like to wait at least 1 year. 8% = unwilling to take the vaccine at all	#Acceptance - Increased with increasing age, education, and income level # #Acceptance - Decreased among female, Black, Latinx and rural HCWs
Caterina L et al, 2021^Citation44	Overall, 75% of respondents would get a COVID-19 vaccine	#Acceptance - Younger age (<30 years) - Male - Patients with comorbidities
Padureanu V et al, 2021^Citation29	69% = agreed with the COVID-19 vaccine	● Fear of getting infected ● Working in a designated hospital
Gasmelseed A et al, 2021^Citation39	● Accept the newly developed vaccine- 55.5% ● Advocate for newly developed vaccine - 60.1% ● Both accept and advocate for newly developed vaccine - 51.3%	● Female ● Older age ● Presence of chronic illnesses ● Having an allergy
Shikha K et al, 2021^Citation31	● Low willingness among healthcare workers – 23.4%	● Risk perception ● Preventive COVID-19 infection behaviours ● Willingness to take rapid test
John J et al, 2021^Citation48	● Showed 67% of junior doctors are willing to accept the COVID 19 vaccine	≠Acceptance ● Adverse reaction from vaccine. ● Female doctors ● Junior doctors who live with their nuclear families
Jorge L et al, 2021^Citation12	● Between 77.0% and 90.7% of physicians accept COVID-19 vaccination, according to the scenario evaluated where the vaccine’s effectiveness was 60 or 80%, respectively	● Medical speciality ● Having never paid for a vaccine ● Recommending the administration of the vaccine to their parents or people over 70 years ● Dispensing the vaccine to their children (effectiveness of 60% and 80%.
Luka P et al, 2021^Citation34	59% = intended to vaccinate. Of these: ● 33% = definitively intended to participate in vaccination ● 26% = would probably agree to vaccination	#Acceptance - Older - Male - Physicians - Those who trust official (government) sources
Asaf Z et al, 2021^Citation42	● 85% = overall rate of acceptance for a COVID-19 vaccine, according to our survey
Maayan Sh et al, 2021^Citation43	● Dental hygienists demonstrated significant negative attitudes compared to dentists	#Refusal - Unforeseen side effects Female
Stefania D et al, 2021^Citation38	● 80.9% accepted the vaccine	#Acceptance: Male sex, age over 50, rehabilitation center workers, and occupational COVID-19 exposure #Refusal: vaccine novelty, wanting others to receive it first, and insufficient time for decision-making
Martin W et al, 2021^Citation49	39.3% of them indicated acceptance of COVID-19 vaccines if available 60.7% indicated non-acceptance of COVID-19 vaccines	#Acceptance - Female - Relative being diagnosed with COVID-19 - Trust in the accuracy of the measures taken by the government in the fight against COVID-19 #Refusal - Concerns about the safety of vaccines and - the adverse side effects of the vaccines
Samar F et al, 2021^Citation47	21% accepted vaccination 51% of the participants were undecided 28% refused	#Acceptance: - Risks of COVID-19 - Safety and - effectiveness of the vaccine #Refusal: - Absence of enough clinical trials - Fear of side effects of the vaccine
Sabita P et al, 2021^Citation46	Only just over one-third (38.3%) were willing to be vaccinated	≠Refusal = vaccine safety
Eyad Q et al, 2021^Citation37	Vaccine acceptance rate in this study was 26.7%	≠ Reasons for hesitancy - Concerns about side effects and distrust of the expedited vaccine production and healthcare policies - Age 30–59 - Previous or current suspected or confirmed COVID-19, - Female ge - Not knowing the vaccine type Authorized in the participant’s country - Not regularly receiving the influenza vaccine.
Anne S et al, 2021^Citation35	62.9% = would certainly not get vaccinated 37.1% were hesitant, with different degrees of certainty	≠Acceptance - Older - Being a physician - Being vaccinated against seasonal flu

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.33782057

 PubMed Web of Science ®Google Scholar

Gagneux-BrunonA, DetocM, BruelS, et al. Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect. 2021;108:168–173. doi:10.1016/j.jhin.2020.11.02033259883

 PubMed Web of Science ®Google Scholar

Kabamba nzajiM, Kabamba ngombeL, Ngoie mwambaG, et al. Acceptability of vaccination against covid-19 among healthcare workers in the democratic Republic of the Congo. Pragmatic Obs Res. 2020;11:103–109.

 PubMed Web of Science ®Google Scholar

PapagiannisD, RachiotisG, MalliF, et al. Acceptability of covid-19 vaccination among Greek health professionals. Vaccines. 2021;9(3):1–7. doi:10.3390/vaccines9030200

 Web of Science ®Google Scholar

Di GennaroF, MurriR, SegalaFV, et al. Attitudes towards anti-SARS-CoV2 vaccination among healthcare workers: results from a national survey in Italy. Viruses. 2021;13(3):1–11. doi:10.3390/v13030371

 Web of Science ®Google Scholar

SzmydB, KarugaFF, BartoszekA, et al. Attitude and behaviors towards sars-cov-2 vaccination among healthcare workers: a cross-sectional study from Poland. Vaccines. 2021;9(3):1–14.

 Web of Science ®Google Scholar

QattanAMN, AlshareefN, AlsharqiO, Al RahahlehN, ChirwaGC, Al-HanawiMK. Acceptability of a COVID-19 vaccine among healthcare workers in the Kingdom of Saudi Arabia. Front Med. 2021;8(3):1–12. doi:10.3389/fmed.2021.644300

 Web of Science ®Google Scholar

ShekharR, SheikhAB, UpadhyayS, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines. 2021;9(2):1–18. doi:10.3390/vaccines9020119

 Web of Science ®Google Scholar

ShawJ, StewartT, AndersonKB, et al. Assessment of U.S. health care personnel (HCP) attitudes towards COVID-19 vaccination in a large university health care system. Clin Infect Dis. 2021;2019. doi:10.1093/cid/ciab054

 Web of Science ®Google Scholar

LeddaC, CostantinoC, CucciaM, MaltezouHC, RapisardaV. Attitudes of healthcare personnel towards vaccinations before and during the covid-19 pandemic. Int J Environ Res Public Health. 2021;18(5):1–11. doi:10.3390/ijerph18052703

 Web of Science ®Google Scholar

CraiovaP. Perceptions of Covid-19 vaccination among healthcare perceptions of Covid-19 vaccination among healthcare. Prev Med Lab. 2020;124(10):3.

 Google Scholar

AhmedG, AlmoosaZ, MohamedD, et al. Healthcare provider attitudes toward the newly developed COVID-19 vaccine: cross-sectional study. Nurs Rep. 2021;11(1):187–194. doi:10.3390/nursrep11010018

 Web of Science ®Google Scholar

KukretiS, LuMY, LinYH, et al. Willingness of taiwan’s healthcare workers and outpatients to vaccinate against covid-19 during a period without community outbreaks. Vaccines. 2021;9(3):1–10. doi:10.3390/vaccines9030246

 Web of Science ®Google Scholar

AnnanJJK, NormanBR, MensahB, EnimilA, KokuroC. Willingness to accept vaccination against SARS-cov-2: a survey of junior doctors. World J Adv Res Rev. 2021;9(3):159–166. doi:10.30574/wjarr.2021.9.3.0092

 Google Scholar

Alvarado‐socarrasJL, Vesga‐varelaAL, Quintero‐lesmesDC, et al. Perception of covid‐19 vaccination amongst physicians in Colombia. Vaccines. 2021;9(3):1–15. doi:10.3390/vaccines9030287

 Web of Science ®Google Scholar

PetravićL, ArhR, GabrovecT, et al. Factors affecting attitudes towards covid-19 vaccination: an online survey in Slovenia. Vaccines. 2021;9(3):1–15. doi:10.3390/vaccines9030247

 Web of Science ®Google Scholar

ZigronA, DrorAA, MorozovNG, et al. COVID-19 vaccine acceptance among dental professionals based on employment status during the pandemic. Front Med. 2021;8(2):1–5. doi:10.3389/fmed.2021.618403

 Web of Science ®Google Scholar

ShachamM, Greenblatt-KimronL, Hamama-RazY, et al. Increased covid-19 vaccination hesitancy and health awareness amid covid-19 vaccinations programs in Israel. Int J Environ Res Public Health. 2021;18(7):3804. doi:10.3390/ijerph1807380433917327

 PubMed Web of Science ®Google Scholar

DzieciolowskaS, HamelD, GadioS, et al. Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: a multicenter survey. Am J Infect Control. 2021;000:1–6.

 Google Scholar

AgyekumMW, Afrifa-AnaneGF, Kyei-ArthurF, AddoB. Acceptability of COVID-19 vaccination among health care workers in Ghana. Adv Public Heal. 2021;2021. doi:10.1101/2021.03.11.21253374

 Google Scholar

FaresS, ElmnyerMM, MohamedSS, ElsayedR. COVID-19 vaccination perception and attitude among healthcare workers in Egypt. J Prim Care Community Health. 2021;12:2150132721101330333913365

 PubMed Web of Science ®Google Scholar

PaudelS, PalaianS, ShankarPR, SubediN. Risk perception and hesitancy toward COVID-19 vaccination among healthcare workers and staff at a medical college in Nepal. Risk Manag Healthc Policy. 2021;14:2253–2261. doi:10.2147/RMHP.S31028934104016

 PubMed Web of Science ®Google Scholar

QunaibiE, BashetiI, SoudyM, SultanI. Hesitancy of Arab healthcare workers towards covid-19 vaccination: a large-scale multinational study. Vaccines. 2021;9(5):1–13. doi:10.3390/vaccines9050446

 Web of Science ®Google Scholar

SpinewineA, PéteinC, EvrardP, et al. Attitudes towards covid‐19 vaccination among hospital staff—understanding what matters to hesitant people. Vaccines. 2021;9(5):1–13. doi:10.3390/vaccines9050469

 Web of Science ®Google Scholar