Predictors of COVID-19 Vaccine Uptake in Healthcare Workers: A Cross-Sectional Study in Greece : Journal of Occupational and Environmental Medicine

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Predictors of COVID-19 Vaccine Uptake in Healthcare Workers

A Cross-Sectional Study in Greece

Galanis, Petros MPH, PhD; Moisoglou, Ioannis PhD; Vraka, Irene MD, PhD; Siskou, Olga PhD; Konstantakopoulou, Olympia PhD; Katsiroumpa, Aglaia RN; Kaitelidou, Daphne PhD

Author Information
Journal of Occupational and Environmental Medicine: April 2022 - Volume 64 - Issue 4 - p e191-e196
doi: 10.1097/JOM.0000000000002463
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Around the world, several vaccines have been proven effective in preventing Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and are being widely used.1–4 The widespread use of COVID-19 vaccines is critical to control the COVID-19 pandemic, but several reasons could delay or decline COVID-19 vaccine uptake. According to a systematic review, the most important reasons for decline of vaccination for COVID-19 are concerns about the safety and effectiveness of the COVID-19 vaccines, medical conditions, religious and ethical reasons, pregnancy, fertility, limited knowledge, and previous COVID-19 diagnosis.5 Hesitancy toward a covid-19 vaccine limits general population protection from SARS-CoV-2. This is aggravated in the case of healthcare workers (HCWs), as they have a higher exposure and transmission risk of the SARS-CoV-2 and may potentially endanger themselves, their co-workers and their patients.

To the best of our knowledge, literature regarding COVID-19 vaccine uptake among HCWs is still poor; six studies have been conducted in this field and only one in Europe.6–11 Respective results showed that the uptake of a COVID-19 vaccine among HCWs is rather different, ranging from 33.3% in the Kingdom of Saudi Arabia6 and 64.5% in the United Kingdom,8 to 86.2% in China11 and 94.5% in the United States.10 Moreover, according to a meta-analysis that included 24 studies and 39,617 participants worldwide, HCWs’ intention to accept COVID-19 vaccination is moderate (63.5%).12 Several socio-demographic factors increase HCWs’ uptake of a COVID-19 vaccine, for example, male gender, older age, higher educational level, white race, etc.5

Up-to-date, only one study on the actual acceptance of a COVID-19 vaccine in HCWs in Europe is reported.8 Moreover, research until now focuses only on socio-demographic determinants of COVID-19 vaccine uptake in HCWs. Thus, we aimed to estimate the uptake of a COVID-19 vaccine in a sample of HCWs in Greece and to expand our knowledge regarding the predictors of COVID-19 vaccine uptake.

METHODS

Study Design and Participants

An on-line cross-sectional study was conducted in Greece during August 2021. From January 2021 until the time of the study, a free of charge COVID-19 vaccine was offered from the Greek government to all HCWs throughout the country. The vaccine was taken on a voluntary basis and was offered irrespective of past history of COVID-19. We used Google forms to create an anonymous version of the study questionnaire. A convenience sample was used since the questionnaire was distributed through social media and e-mails. In particular, investigators posted the questionnaire on their Facebook wall and on specific groups on Facebook concerning HCWs. Moreover, the questionnaire was sent to the investigators’ electronic contacts by e-mail. As a result, it was not possible to measure the response rate. The on-line questionnaire was accompanied by a detailed explanation of the study aim and design, and the choice for HCWs to provide their informed consent in order to participate anonymously in the study. HCWs completed the questionnaire on a voluntary basis without receiving any financial reward. All HCWs over 18 years old were allowed to participate in the study. The Department of Nursing, National and Kapodistrian University of Athens approved the study design (reference number; 370, 02–09–2021).

Sample Size and Power

Given the wide range of COVID-19 vaccine uptake amongst the HCWs in prior studies, a 50% conservative estimate of prevalence was considered appropriate in order to estimate the sample size of our study. Thus, considering the prevalence of COVID-19 vaccine uptake as 50%, precision level as 5%, and confidence level as 95%, a minimum sample size of 385 HCWs was set. Twenty-three predictor variables were used and a minimum number of 230 vaccinated HCWs were included in our study so as to perform a valid multivariate regression analysis.13 Finally, a sample size substantial increase was in order to minimize random error.

Questionnaire

The following socio-demographic data of HCWs were collected: gender, age, marital status, under-age children, educational level, profession, years of experience, self-perceived financial status, self-perceived health status, chronic disease, previous COVID-19 diagnosis, family/friends with previous COVID-19 diagnosis, living with elderly people or vulnerable groups during the COVID-19 pandemic, and providing care to COVID-19 patients. HCWs’ profession was collapsed into the following categories: physicians, nurses, administrative staff, paramedics, nurses’ assistants, and others. Financial status and self-perceived health status were measured in a five-point Likert scale from 0 to 4 (0 = “very poor,” 1 = “poor,” 2 = “moderate,” 3 = “good,” and 4 = “very good”).

Regarding vaccination, seasonal influenza vaccination in 2020 and COVID-19 vaccination were measured with yes/no” answers. Moreover, possible reasons for the decline of vaccination for COVID-19 were recorded, for example, concerns about the safety and effectiveness of COVID-19 vaccines, fear for side effects, religious reasons, pregnancy, previous COVID-19 diagnosis, etc.

Also, self-perceived severity of the COVID-19 pandemic, self-perceived knowledge regarding the COVID-19 pandemic and COVID-19 vaccines, concerns about the side effects of COVID-19 vaccination, trust in COVID-19 vaccines, and trust in the government, scientists, and family doctors regarding the information about the COVID-19 vaccines were measured on a scale from 0 to 10 with higher values indicating higher levels of self-perceived severity of the COVID-19 pandemic, knowledge, concerns, and trust. The relationship between these predictors and COVID-19 vaccination uptake among HCWs has not been studied so far in other studies. Each predictor was assessed via a single item and no separate scale was created.

Statistical Analysis

We used frequencies (percentages) to present categorical variables and mean (standard deviation) to present continuous variables. The Kolmogorov-Smirnov test and normal Q-Q plots were applied to test the normality of the distribution of the continuous variables. Questionnaires with more than 5% of missing data (n = 3) were excluded from the analysis. COVID-19 vaccination was the dependent variable and the outcome was defined as 1 if a HCW took a COVID-19 vaccine. First, we performed univariate logistic regression analysis with each predictor and outcome in order to determine bivariate associations; then all of the independent variables were included in a multivariate logistic regression model so as to eliminate confounding. Adjusted odds ratios, 95% confidence intervals, and P-values were also calculated. In multivariate logistic regression model, P-values < 0.05 were considered significant. All tests of statistical significance were two-tailed. Statistical analysis was performed with the Statistical Package for Social Sciences software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.).

RESULTS

Study population included 855 HCWs. Detailed socio-demographic characteristics of the participating HCWs are shown in Table 1. Mean age of HCWs was 40.9 years and the mean value of years of clinical experience was 14.4. Among HCWs, 80.7% were females, 48.9% had a MSc/PhD degree, 45.3% were nurses, and 20.1% had suffered from a chronic disease. Regarding the COVID-19 pandemic, 10.8% of HCWs were diagnosed with COVID-19, 58.8% had family/friends with a previous COVID-19 diagnosis, and 49.8% provided care to COVID-19 patients. Most of the HCWs considered their financial status as moderate/good (83.6%) and their health status as good/very good (81.9%).

TABLE 1 - Socio-Demographic Characteristics of Healthcare Workers (n = 885)
Characteristics N %
Gender
 Females 714 80.7
 Males 171 19.3
Age (years) 40.9 9.9
Marital status
 Singles 254 28.7
 Married 565 63.8
 Widowed 61 6.9
 Divorced 5 0.6
Children < 18 years old
 No 398 45.0
 Yes 487 55.0
MSc/PhD degree
 No 452 51.1
 Yes 433 48.9
Profession (n = 874)
 Physicians 220 25.2
 Nurses 396 45.3
 Nurses assistants 47 5.4
 Midwives 16 1.8
 Paramedics 73 8.4
 Administrative staff 72 8.2
 Pharmacists 28 3.2
 Biochemists 7 0.8
 Dentists 5 0.6
 Ambulatory staff 10 1.1
Clinical experience (years) 14.4 9.5
Self-perceived financial status
 Very poor 10 1.1
 Poor 80 9.0
 Moderate 483 54.6
 Good 257 29.0
 Very good 55 6.2
Self-perceived health status
 Very poor 3 0.3
 Poor 17 1.9
 Moderate 140 15.8
 Good 446 50.4
 Very good 279 31.5
Chronic disease
 No 707 79.9
 Yes 178 20.1
Previous COVID-19 diagnosis
 No 789 89.2
 Yes 96 10.8
Family/friends with previous COVID-19 diagnosis
 No 365 41.2
 Yes 520 58.8
Living with elderly people or vulnerable groups during the COVID-19 pandemic
 No 626 70.7
 Yes 259 29.3
Providing care to COVID-19 patients (n = 879)
 No 441 50.2
 Yes 438 49.8
Mean, standard deviation.

Table 2 presents HCWs’ attitudes towards COVID-19 vaccination and the pandemic. The majority of HCWs were vaccinated against the COVID-19 (n = 810, 91.5%), while the respective percentage for seasonal influenza in 2020 was 64.6% (n = 572). The most important reasons for decline of vaccination for COVID-19 (n = 74) were concerns about the safety and effectiveness of the COVID-19 vaccines (n = 37, 50%), concerns about the side effects of the COVID-19 vaccines (n = 13, 17.6%), previous COVID-19 diagnosis (n = 9, 12.2%), and females’ effort to get pregnant (n = 7, 9.5%). HCWs reported high levels of knowledge regarding the COVID-19 pandemic and COVID-19 vaccines and moderate concerns about the respective side effects. Regarding the sources of information about the COVID-19 vaccines, HCWs showed more trust in family doctors and scientists than the government.

TABLE 2 - Healthcare Workers’ Attitudes Toward COVID-19 Vaccination and Pandemic (n = 885)
Characteristics N %
COVID-19 vaccination
 No 75 8.5
 Yes 810 91.5
Seasonal influenza vaccination in 2020
 No 313 35.4
 Yes 572 64.6
Reasons for decline of COVID-19 vaccination (n = 74)
 I have doubts about the safety and effectiveness of COVID-19 vaccines 37 50.0
 I am afraid of side effects of COVID-19 vaccines 13 17.6
 I believe that I will not be infected by COVID-19 0 0
 I believe that even if I get infected with COVID-19, nothing bad will happen to me 2 2.7
 I have already been diagnosed with COVID-19 and the vaccine will not be beneficial for me 9 12.2
 I am afraid because I suffer from a chronic disease 3 4.1
 Family physician does not allow me to take a COVID-19 vaccine due to my medical condition 0 0
 My religion does not allow me to take a COVID-19 vaccine 0 0
 I am trying to get pregnant 7 9.5
 I am afraid because I am pregnant 3 4.1
Self-perceived severity of COVID-19 8.3 2.1
Self-perceived knowledge regarding COVID-19 9.1 1.3
Information regarding COVID-19 vaccines 8.7 1.7
Concerns about the side effects of COVID-19 vaccination 5.6 3.1
Trust in COVID-19 vaccines 7.5 2.6
Trust in the government regarding the information about the COVID-19 vaccines 5.5 3.2
Trust in scientists regarding the information about the COVID-19 vaccines 7.6 2.8
Trust in family doctors regarding the information about the COVID-19 vaccines 8.2 2.1
Mean, standard deviation.

Unadjusted associations between the predictor variables and vaccination status are shown in Table 3, while multivariate logistic regression analysis is shown in Table 4. According to multivariate analysis's results, seven variables were related to COVID-19 vaccine uptake in healthcare workers. In particular, females and HCWs with previous seasonal influenza vaccination history had a greater probability to take a COVID-19 vaccine. Increased self-perceived knowledge regarding COVID-19 pandemic and increased trust in COVID-19 vaccines were associated with COVID-19 vaccine uptake. On the other hand, HCWs with more concerns about the side effects of COVID-19 vaccination were more reluctant to take a COVID-19 vaccine. Moreover, increased information regarding COVID-19 vaccines and increased trust in family doctors were associated with COVID-19 vaccine hesitancy.

TABLE 3 - Unadjusted Associations Between the Predictor Variables and COVID-19 Vaccination Status (Reference: COVID-19 Vaccine Denial)
Vaccinated Healthcare Workers
Variable No Yes Unadjusted Odds Ratio (95% Confidence Interval) P
Gender 1.47 (0.85–2.54) 0.17
 Females 56 (7.8) 658 (92.2)
 Males 19 (11.1) 152 (88.9)
Age (years) 40.3 (10.3) 41.0 (9.9) 1.01 (0.98–1.03) 0.59
Marital status 1.12 (0.69–1.83) 0.64
 Married 46 (8.1) 519 (91.9)
 Singles/widowed/divorced 29 (9.1) 291 (90.9)
Children < 18 years old 1.71 (1.04–2.81) 0.04
 No 25 (6.3) 373 (93.7)
 Yes 50 (10.3) 437 (89.7)
MSc/PhD degree 1.32 (0.82–2.13) 0.26
 Yes 32 (7.4) 401 (92.6)
 No 43 (9.5) 409 (90.5)
Profession
 Physicians 13 (5.9) 207 (94.1) 4.31 (1.76–10.54) 0.001
 Nurses 31 (7.8) 365 (92.2) 3.18 (1.45–7.00) 0.004
 Administrative staff 8 (11.1) 64 (88.9) 2.16 (0.78–5.96) 0.14
 Paramedics 7 (9.6) 66 (90.4) 2.55 (0.89–7.26) 0.08
 Others 4 (6.1) 62 (93.9) 4.19 (1.23–14.32) 0.02
 Nurses assistants 10 (21.3) 37 (78.7) 1 (reference)
Clinical experience 13.8 (9.4) 14.5 (9.5) 1.01 (0.98–1.04) 0.54
Self-perceived financial status ,
 Good/very good 24 (7.7) 288 (92.3) 2.59 (1.31–5.13) 0.006
 Moderate 35 (7.2) 448 (92.8) 2.77 (1.46–5.25) 0.002
 Very poor/poor 16 (17.8) 74 (82.2) 1 (reference)
Self-perceived health status ,
 Good/very good 59 (8.1) 666 (91.9) 2.82 (0.91–8.72) 0.07
 Moderate 12 (8.6) 128 (91.4) 2.67 (0.77–9.26) 0.12
 Very poor/poor 4 (20.0) 16 (80.0) 1 (reference)
Chronic disease 1.01 (0.56–1.92) 0.98
 Yes 15 (8.4) 163 (91.6)
 No 60 (8.5) 647 (91.5)
COVID-19 disease 2.96 (1.66–5.29) <0.001
 No 57 (7.2) 732 (92.8)
 Yes 18 (18.8) 78 (81.3)
Family/friends with COVID-19 disease 1.77 (1.06–2.97) 0.03
 No 22 (6.0) 343 (94.0)
 Yes 53 (10.2) 467 (89.8)
Living with elderly people or vulnerable groups during the COVID-19 pandemic 1.40 (0.85–2.30) 0.18
 No 48 (7.7) 578 (92.3)
 Yes 27 (10.4) 232 (89.6)
Providing care to COVID-19 patients 1.01 (0.63–1.62) 0.98
 No 37 (8.4) 404 (91.6)
 Yes 37 (8.4) 401 (91.6)
Seasonal influenza vaccination in 2020 7.43 (4.24–13.01) <0.001
 Yes 17 (3.0) 555 (97.0)
 No 58 (18.5) 255 (81.5)
Self-perceived severity of COVID-19 5.8 (2.7) 8.5 (1.9) 1.56 (1.42–1.72) <0.001
Self-perceived knowledge regarding COVID-19 8.8 (1.8) 9.1 (1.2) 1.17 (1.01–1.35) 0.04
Information regarding COVID-19 vaccines 8.4 (1.9) 8.8 (1.6) 1.12 (0.99–1.26) 0.09
Concerns about the side effects of COVID-19 vaccination 8.7 (2.2) 5.3 (3.0) 0.56 (0.48–0.64) <0.001
Trust in COVID-19 vaccines 2.9 (3.2) 7.9 (2.1) 1.77 (1.61–1.94) <0.001
Trust in the government regarding the information about the COVID-19 vaccines 2.0 (2.6) 5.9 (3.1) 1.55 (1.41–1.72) <0.001
Trust in scientists regarding the information about the COVID-19 vaccines 3.8 (3.3) 7.9 (2.4) 1.52 (1.40–1.65) <0.001
Trust in family doctors regarding the information about the COVID-19 vaccines 6.5 9 (3.1) 8.4 (1.9) 1.38 (1.26–1.51) <0.001
An odds ratio < 1 indicates a negative association, while an odds ratio > 1 indicates a positive association.
Values are expressed as n (%).
Values are expressed as mean (standard deviation).
Due to low number of healthcare workers, we merged the following categories: “very poor” and “poor”; “good” and “very good.”

TABLE 4 - Multivariate Logistic Regression Analysis with COVID-19 Vaccine Uptake in Healthcare Workers as the Dependent Variable (Reference: COVID-19 Vaccine Denial)
Variable Adjusted Odds Ratio (95% Confidence Interval) P
Gender (females vs males) 3.36 (1.11–10.23) 0.03
Age (years) 1.02 (0.94–1.09) 0.67
Marital status (married vs singles/widowed/divorced) 1.06 (0.45–2.54) 0.89
Children < 18 years old (no vs yes) 1.54 (0.62–3.79) 0.35
MSc/PhD degree (yes vs no) 0.91 (0.41–2.01) 0.82
Profession
 Physicians 1.38 (0.27–7.04) 0.69
 Nurses 1.99 (0.56–7.11) 0.29
 Administrative staff 1.65 (0.29–9.44) 0.57
 Paramedics 1.20 (0.17–8.29) 0.85
 Others 2.62 (0.47–14.56) 0.27
 Nurses assistants
Clinical experience 1.01 (0.94–1.09) 0.83
Self-perceived financial status
 Good/very good 0.42 (0.12–1.46) 0.42
 Moderate 0.84 (0.28–2.53) 0.75
 Very poor/poor Self-perceived health status
 Good/very good 2.08 (0.27–15.79) 0.48
 Moderate 1.29 (0.17–9.68) 0.80
 Very poor/poor
Chronic disease (yes vs no) 0.86 (0.31–2.35) 0.76
COVID-19 disease (no vs yes) 2.43 (0.90–6.53) 0.08
Family/friends with COVID-19 disease (no vs yes) 1.86 (0.79–4.36) 0.16
Living with elderly people or vulnerable groups during the COVID-19 pandemic (no vs yes) 1.63 (0.72–3.69) 0.24
Providing care to COVID-19 patients (no vs yes) 0.60 (0.26–1.37) 0.23
Seasonal influenza vaccination in 2020 (yes vs no) 4.25 (1.86–9.75) 0.001
Self-perceived severity of COVID-19 1.17 (0.99–1.39) 0.07
Self-perceived knowledge regarding COVID-19 1.47 (1.06–2.04) 0.02
Information regarding COVID-19 vaccines 0.64 (0.49–0.83) 0.001
Concerns about the side effects of COVID-19 vaccination 0.70 (0.58–0.85) <0.001
Trust in COVID-19 vaccines 1.45 (1.18–1.78) <0.001
Trust in the government regarding the information about the COVID-19 vaccines 1.16 (0.98–1.39) 0.09
Trust in scientists regarding the information about the COVID-19 vaccines 1.08 (0.89–1.31) 0.44
Trust in family doctors regarding the information about the COVID-19 vaccines 0.81 (0.67–0.98) 0.04
An odds ratio < 1 indicates a negative association, while an odds ratio > 1 indicates a positive association.
R2 for the final multivariate model was 62%.
Due to low number of healthcare workers, we merged the following categories: “very poor” and “poor”; “good” and “very good.”.

DISCUSSION

A study to estimate COVID-19 vaccine uptake in a sample of HCWs in Greece and investigate the predictors of this uptake was conducted. The majority of HCWs (91.5%) had been vaccinated against the COVID-19. This percentage identifies with the one found in studies in the United States (94.5%) and China (86.2%).10,11 On the contrary, lower COVID-19 vaccine uptake (from 33.3% to 79%) was reported in four studies in the United States, United Kingdom, and Kingdom of Saudi Arabia found.6–9 Data collection time may explain this variability in COVID-19 vaccine uptake, as the closer to September 2021 each study was conducted, the more likely HCWs were to take a COVID-19 vaccine. At the time of our study, COVID-19 vaccination for HCWs was voluntary in Greece, but the government was planning a mandatory vaccination program for HCWs and other occupational groups since September 2021. The intention of the Greek government may partially explain the high percentage of COVID-19 vaccine uptake in HWCs in our study.

Our multivariate regression model revealed varied factors were associated with COVID-19 vaccine uptake in HCWs. In particular, trust in COVID-19 vaccines and fewer concerns about the side effects of COVID-19 vaccination were associated with vaccine acceptance. This finding is confirmed by the literature as the main reasons for the decline of vaccination for COVID-19 include concerns about the COVID-19 vaccine safety and effectiveness.10,11 Thus, policymakers and scientists should provide unvaccinated HCWs with more data on safety and surveillance about the COVID-19 vaccines.

Moreover, we found that increased information regarding COVID-19 vaccines was associated with COVID-19 vaccine hesitancy. High level of information does not necessarily reflect adequate knowledge regarding COVID-19 vaccines as many sources of information during the COVID-19 pandemic (eg, social media, religious leaders, etc.) were and may still be false and misleading. Detection of fake news is associated with the intention to take a COVID-19 vaccine.14 Also, COVID-19 vaccine uptake is higher among individuals that do not use social media as a source of information during the COVID-19 pandemic.6 Research indicates that on-line information related to the COVID-19 pandemic published in many websites is of poor quality and rather inadequate.15–17 Additionally, information regarding COVID-19 vaccines is of particular interest, as these vaccines are innovative and new data is constantly emerging. Governments should develop strategies to regulate the COVID-19 pandemic information circulating on the internet ensuring that websites shall provide evidence-based information related to COVID-19 vaccines.

Our findings demonstrate higher COVID-19 vaccine uptake among HCWs with previous seasonal influenza vaccination history. The role of influenza vaccination in the uptake of the COVID-19 vaccine in HCWs has not yet been investigated in other studies but has already proved to be critical in the intention of HCWs to accept a COVID-19 vaccine.12 Unfortunately, the influenza vaccination rate amongst HCWs is low, even though it is higher than the one detected in general population and high-risk groups.18–21 Refusal of influenza vaccination is evidence of vaccine hesitancy, one of the top 10 threats to global health in 2019 according to the World Health Organization.22 Moreover, COVID-19 vaccine hesitancy in HCWs is crucial as it can undermine public confidence.23,24 Educational programs and workplace strategies are proven effective to improve influenza vaccination coverage amongst HCWs and may also serve as a guide to improve COVID-19 vaccine uptake.25

We also found that females had greater COVID-19 vaccine uptake than males. This finding is interesting as it opposes to the results of previous studies.6,8–10 In general, COVID-19 vaccine hesitancy is more common among females.26–30 Our finding may be so due to the fact that we currently have more knowledge about the safety and effectiveness of COVID-19 vaccines. For instance, the results of recent studies show the effectiveness of vaccines in both pregnant and lactating women.31,32

Limitations

Our study suffers from several limitations. Although study population was large, we used a convenience sample which is not representative of the mix of HCWs in Greece. For instance, the females/males ratio in our study was 4:1 indicating a greater participation of females. Moreover, only 50% of the HCWs in our sample were providing care to COVID-19 patients. However, if that number was higher, our results would probably not be affected since the vaccination rate was equal for both HCWs who provided care to COVID-19 patients and those who did not. Additionally, the response rate could not be calculated as we conducted an on-line study. Moreover, vaccine uptake and other information were self-reported and social desirability to bias responses may exist. For instance, some HCWs may have falsely stated that they had received a COVID-19 vaccine. We used an anonymous on-line questionnaire to reduce this bias. Furthermore, we investigated a variety of determinants of COVID-19 vaccine uptake and some of them had not been studied before. However, it is possible that there are other factors affecting COVID-19 vaccination. For instance, we did not take into consideration the setting in which the HCWs worked (eg, primary care, COVID-19 clinic, emergency department, outpatient clinic, etc.) Future research may consider including other factors which may influence COVID-19 vaccine uptake, for example, personality traits, social media variables, fake news, conspiracy theories, etc. Another limitation of our study is the fact that we did not use validated scales/questionnaires to measure severity/fear/safety concerns, etc. but we used single items to measure all constructs. Finally, as is always the case in cross-sectional studies, no causal relationships between independent variables and COVID-19 vaccine uptake can be established.

CONCLUSIONS

Our study provides a timely assessment of COVID-19 vaccination status among HCWs in Greece and identifies specific factors associated with COVID-19 vaccine uptake. Future work is needed to understand the factors influencing the decision of HCWs to vaccinate against the COVID-19. By understanding these factors, policymakers and scientists will be able to develop novel strategies to improve COVID-19 vaccine uptake amongst HCWs. The role of HCWs in the general public health is crucial and their decision to vaccinate can have a positive impact on the general population facilitating the widespread COVID-19 vaccine uptake.

REFERENCES

1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021; 384:403–416.
2. Logunov DY, Dolzhikova IV, Shcheblyakov DV, et al. Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia. Lancet 2021; 397:671–681.
3. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020; 383:2603–2615.
4. Wu Z, Hu Y, Xu M, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy adults aged 60 years and older: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis 2021; 21:803–812.
5. Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Kaitelidou D. Predictors of COVID-19 vaccination uptake and reasons for decline of vaccination: a systematic review. Public and Global Health 2021; doi.org: 10.1101/2021.07.28.21261261
6. Barry M, Temsah M-H, Aljamaan F, et al. COVID-19 vaccine uptake among healthcare workers in the fourth country to authorize BNT162b2 during the first month of rollout. Public and Global Health 2021; doi.org/10.1101/2021.01.29.21250749
7. Gharpure R, Guo A, Bishnoi CK, et al. Early COVID-19 first-dose vaccination coverage among residents and staff members of skilled nursing facilities participating in the pharmacy partnership for long-term care program-United States, December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:178–182.
8. Martin CA, Marshall C, Patel P, et al. Association of demographic and occupational factors with SARS-CoV-2 vaccine uptake in a multi-ethnic UK healthcare workforce: a rapid real-world analysis. Public Global Health 2021; doi.org/10.1101/2021.02.11.21251548
9. Pacella-LaBarbaraML, ParkY, PattersonD, et al. COVID-19 vaccine uptake and intent among emergency healthcare workers: a cross-sectional survey. J Occup Environ Med 2021; doi.org/10.1097/JOM.0000000000002298.
10. Schrading WA, Trent SA, Paxton JH, et al. Vaccination rates and acceptance of SARS-CoV-2 vaccination among U.S. emergency department health care personnel. Acad Emerg Med 2021; 28:455–458.
11. Xu B, Gao X, Zhang X, Hu Y, Yang H, Zhou Y-H. Real-world acceptance of COVID-19 vaccines among healthcare workers in perinatal medicine in China. Vaccines 2021; 9:704.
12. Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Intention of health care workers to accept COVID-19 vaccination and related factors: a systematic review and meta-analysis. Public Global Health 2020; doi.org/10.1101/2020.12.08.20246041.
13. Moons KGM, de Groot JAH, Bouwmeester W, et al. Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med 2014; 11:e1001744.
14. Montagni I, Ouazzani-Touhami K, Mebarki A, et al. Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health (Oxf) 2021; fdab028doi.org/10.1093/pubmed/fdab028
15. Cuan-Baltazar JY, Munoz-Perez MJ, Robledo-Vega C, Perez-Zepeda MF, Soto-Vega E. Misinformation of COVID-19 on the Internet: infodemiology study. JMIR Public Health Surveill 2020; 6:e18444.
16. Fan KS, Ghani SA, Machairas N, et al. COVID-19 prevention and treatment information on the internet: a systematic analysis and quality assessment. BMJ Open 2020; 10:e040487.
17. Joshi A, Kajal F, Bhuyan SS, et al. Quality of novel coronavirus related health information over the internet: an evaluation study. Sci World J 2020; 2020:1562028.
18. Blank PR, Schwenkglenks M, Szucs TD. Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons. BMC Public Health 2008; 8:272.
19. La Torre G, Mannocci A, Ursillo P, et al. Prevalence of influenza vaccination among nurses and ancillary workers in Italy: systematic review and meta analysis. Hum Vaccin 2011; 7:728–733.
20. Sheldenkar A, Lim F, Yung CF, Lwin MO. Acceptance and uptake of influenza vaccines in Asia: a systematic review. Vaccine 2019; 37:4896–4905.
21. Wang Q, Yue N, Zheng M, et al. Influenza vaccination coverage of population and the factors influencing influenza vaccination in mainland China: a meta-analysis. Vaccine 2018; 36:7262–7269.
22. World Health Organization. Ten threats to global health in 2019. 2020. Available from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019. Accessed June 22, 2021.
23. MacDonald NE, Dube E. Unpacking vaccine hesitancy among healthcare providers. EBio Medicine 2015; 2:792–793.
24. Opel DJ, Heritage J, Taylor JA, et al. The architecture of provider-parent vaccine discussions athealth supervisionvisits. Pediatrics 2013; 132:1037–1046.
25. Black CL, Yue X, Ball SW, et al. Influenza vaccination coverage among health care personnel—United States, 2017-18 Influenza Season. MMWR Morb Mortal Wkly Rep 2018; 67:1050–1054.
26. Gagneux-Brunon A, Detoc M, Bruel S, 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 2020; doi.org/10.1016/j.jhin.2020.11.020
27. Nzaji MK, Ngombe LK, Mwamba GN, et al. Acceptability of vaccination against COVID-19 among healthcare workers in the Democratic Republic of the Congo. Pragm Observ Res 2020; 11:103–109.
28. Shaw J, Stewart T, Anderson KB, 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; ciab054.
29. Unroe KT, Evans R, Weaver L, Rusyniak D, Blackburn J. Willingness of long-term care staff to receive a COVID-19 vaccine: a single state survey. J Am Geriatr Soc 2021; 69:593–599.
30. Verger P, Scronias D, Dauby N, et al. Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020. Euro Surveill 2021; 26.
31. Ciapponi A, Bardach A, Mazzoni A, et al. Safety of components and platforms of COVID-19 vaccines considered for use in pregnancy: a rapid review. Vaccine 2021; 39:5891–5908.
32. Garg I, Shekhar R, Sheikh AB, Pal S. COVID-19 vaccine in pregnant and lactating women: a review of existing evidence and practice guidelines. Infect Dis Rep 2021; 13:685–699.
Keywords:

attitudes; COVID-19; Greece; healthcare workers; vaccine uptake

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