ABSTRACT
Background
Health-care professions are among the highly exposed group of population affected by COVID-19 pandemic and identified as the target population to get vaccination against the spread of the infection. However, vaccine reluctance is still high, which may negatively affect the efforts to prevent the spread of the infection. Hence, this study was aimed to assess acceptance of COVID-19 vaccine and associated factors among health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia.
Methods
Institutional-based cross-sectional study was performed among 422 health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia, from March 1 to 30, 2021. Study participants were selected through simple random sampling techniques. Data were collected through a self-administered questionnaire. Multivariable logistic regression analysis was performed to identified factors associated with acceptance of COVID-19 vaccine with a p-value < 0.05 at 95% CI considered as statistically significant.
Result
Overall, 45.3% of health professionals accepted COVID-19 vaccine. Age (AOR: 2.55; 95% CI: 1.32–4.92), being male (AOR: 1.729; 95% CI: 1.32–2.34), had higher risk of COVID-19 (AOR: 1.74, 95% CI: 1.00–3.02), and positive attitude (AOR: 3.26, 95% CI: 2.14–4.96) were found to be statistically significant with the acceptance of COVID-19 vaccine.
Conclusion
The acceptance of COVID-19 vaccine among health professionals was significantly low. Participant’s age, sex, high risk of COVID-19, and attitude toward COVID-19 vaccine were significantly associated with vaccine acceptance. Therefore, the government with respective stakeholders should emphasize addressing the concern of the health professionals and increase attitudes regarding COVID-19 vaccine to scale up vaccine acceptance.
KEYWORDS:
Introduction
Vaccination is one of the most successful and cost-effective health interventions to prevent infectious diseases including the current pandemic. Vaccine development and deployment are one of the most promising health intervention strategies to mitigate the spread of COVID-19.Citation1,Citation2 Thus, huge efforts were devoted by the scientific community and governments’ support was directed toward development of efficacious and safe vaccines for COVID-19.Citation3
Within 1 year of World Health Organization declaring the COVID-19 infection as a pandemic, the COVID-19 Vaccine Global Access (COVAX) was manufactured around 2 billion doses of vaccine and delivered to different countries in 2021. Around 1.3 billion doses of the vaccine were funded by the COVAX facility to the 92 low-income countries overall the world.Citation4
Although COVID-19 vaccine was made after so many efforts, it encountered major challenges to get public acceptance including health professionals (HPs).Citation5–8 Vaccine hesitancy means delay in acceptance or refusal of vaccines despite its availability. According to WHO and SAGE reports, vaccine hesitancy was identified as one of the 10 global health threats.Citation9–11
HPs are categorized among the highly exposed group of population affected by COVID-19 due to several risk factors including continuous exposure to patients, shortages of personal protective equipment (PPE), lack of commitment in using the available PPEs, and lack of sufficient infection control training.Citation12,Citation13 However, vaccine reluctance is highly manifested by the majority of HPs, which needs urgent intervention.Citation14–16 Low acceptance of vaccine against COVID-19 mostly happened due to vaccine safety concern, misconception circulating concerning the vaccine through mass media, knowledge of vaccines, vaccine conspiracies, and negative attitude toward the vaccine.Citation17–19
Globally the overall acceptance of COVID-19 vaccine was very low with 14.8% of participants unable to accept the COVID-19 vaccination.Citation17 A study done in America reported that only 60% of the population accepted the COVID-19 vaccination.Citation20 Another study conducted in the USA among health-care workers showed that only 36% of participants were willing to get vaccinated as soon as it is available.Citation21 In Ethiopia, studies also showed that only 31.4% of the general population and 53.1% of HPs were willing to accept the COVID-19 vaccines.Citation22,Citation23
Protecting HPs from COVID-19 infection would be beneficial for themselves, their household contacts, and their patients, and it is crucial in the preservation and protection of health-care systems.Citation24
Ethiopia has received 2.184 million doses of the Astra Zeneca COVID-19 vaccine via the COVAX initiative on March 7, 2021, and the Ministry of Health launched the vaccine on March 13, 2021, at Yeka Kotebe COVID-19 Hospital, where frontline HPs were vaccinated to announce the beginning of the vaccination campaign.Citation25,Citation26 Around 5.4 million doses of COVID-19 vaccine were expected to be distributed to Ethiopia by May 2021, and the Ministry of Health of Ethiopia plans to vaccinate only 20% of the population due to vaccine constraints by the end of 2021 where HPs were among the priority segment of the population, and to achieve this goal the second campaign of COVID-19 vaccine has already started.Citation27
HPs are the frontline and expected to be models for the rest in advocating and accepting the vaccine to mitigate the spread of COVID-19. To do so, different study findings suggested that misunderstanding related to COVID-19 vaccine willingness must be resolved to scale up the acceptance of COVID-19 vaccination.Citation18,Citation28,Citation29 However, in our context COVID-19 vaccine still experienced many challenges and its acceptance is very low. Therefore, this study was aimed to assess the acceptance of COVID-19 vaccine and identified factors that hinder its acceptance among HPs working in Hospitals of South Gondar Zone, Northwest Ethiopia.
Methods
Study design and study setting
An institution-based cross-sectional study design was conducted in Hospitals of South Gondar Zone, Northwest Ethiopia, from March 1–30, 2021. South Gondar is one of the 11 zonal districts of the Amhara regional state, Northwest Ethiopia. The zone is divided into 15 woredas and Debre Tabor is its capital city. The zone has eight public hospitals (one comprehensive specialized and seven primary hospitals). These are Debre Tabor Comprehensive Specialized Hospital (DTCSH) in Debre Tabor Town, Addis Zemen Primary Hospital (AZPH) in Libo Kemkem Woreda, Nefas Mewucha Primary Hospital (NMPH) in Lay Gaynt Woreda, Ebinat Primary Hospital (WPH) in Ebinat Woreda, Dr. Ambachew Memorial Primary Hospital (Dr. AMPH) in Tach Gaynt Woreda, Andabet Primary Hospital (APH) in Andabet Woreda, Mekane Eyesus Primary Hospital (MEPH) in Estey Woreda, and Wogeda Primary Hospital (WPH) in Simada Woreda.
Source population
The source populations were all HPs who were working in South Gondar Zone public hospitals. Based on the zonal department health official’s report, an overall 1376 HPs are working in all eight hospitals.
Study population
The study populations were all HPs who were working in selected public hospitals of South Gondar Zone during the study period. Among the total 1376 HPs working in eight public hospitals, 1095 HPs were working in the selected hospitals.
Inclusion and exclusion criteria
All HPs who were working in the selected hospitals were included while HPs who were on annual leave, maternal leave, and sick leave were excluded.
Sample size determination
The sample size was determined by using single population proportion formula with the assumption 50% of COVID-19 vaccine acceptance rate due to lack of a related study done previously in Ethiopia, 5% margin of error (d), and considering 10% none response rate; and the final sample size was 422.
Sampling procedure
A simple random sampling technique was employed to select 422 HPs working in the selected public hospitals of the South Gondar zone. Out of eight hospitals, five of them were selected randomly using lottery methods (DTCSH, NMPH, AZPH, Dr. AMPH, and MEPH). Samples were selected and proportionally allocated to each selected hospital based on their total number of HPs (DTCSH = 498, NMPH = 111, AZPH = 208, Dr. AMPH = 105, and MEPH = 173). Therefore, the calculated samples for each hospital were DTCSH = 192, NMPH = 43, AZPH = 80, Dr. AMPH = 40, and MEPH = 67.
Data collection tools and procedure
The data were collected through self-administered techniques using a structured questionnaire, which was prepared in English after reviewing pertinent study literatures and frameworks to assess COVID-19 vaccine acceptance.Citation30–34 The questionnaires had four items (socio-demographic characteristics, health-related characters, attitude-related, and acceptance-related characteristics). The data were collected by four diploma HPs who had previous experience in data collection and were supervised by two BSc HPs.
Study variables
Dependent variable
Acceptance of COVID-19 vaccine (yes/no).
Independent variables
Socio-demographic
Age, sex, ethnicity, educational status, marital status, and working room.
Health status-related characteristics
History of COVID-19 infection, family history of COVID-19 infection (family member who lives in the same household and who has a history of COVID-19 infection irrespective of their relationship), chronic diseases (hypertension, DM, asthma, HIV/AIDS, etc.), and high risk for infection (older age, chronic disease, working area).
Attitude
Positive or negative attitude regarding COVID-19 vaccine.
Data quality control
To maintain the quality of the data, the questionnaire was prepared after a rigorous intensive appraisal of pertinent literature. Pretesting of the questionnaire was done on 5% of the sample size (21 HPs) in WPH, which was found in the zone and not part of the actual study. Based on the pretest, modifications, and corrections like wording, logical sequence, and skip patterns were made immediately. Data collectors and supervisors were trained for 1 day about the contents of the questionnaire, confidentiality, and informed consent before the actual data collection. Supervisors and principal investigators had cross-checked, cleaned, and documented the completeness and accuracy of the collected data regularly.
Operational definition
Acceptance of COVID-19 vaccine
In this study, acceptance was defined as the intention to accept to take COVID-19 vaccine. “Do you want to vaccinate against COVID-19 infection when the vaccine become available?” and the responses were “Yes” and “No.”Citation32,Citation35
Attitude toward COVID-19 vaccine
The attitude of the participant was determined based on 10 attitude assessing questions and labeled as good and poor attitude based on mean score.Citation36
HPs who scored greater than or equal to the mean score of attitude questions of COVID-19 vaccine were considered as having a positive attitude, while those who scored less than the mean score was considered as having a negative attitude.
Data analysis
The collected data were coded and entered into Epi-Data version 4.2 and then exported to SPSS version 23 for analysis. Descriptive analysis was carried out, and frequency tables and percentages were used to present the descriptive results. Bivariable logistic regression analysis was done to examine the crude association of dependent and independent variables and variables having p-value≤0.2 were entered into the multivariable logistic regression model for further analysis by controlling confounding factors and finally significant association was declared based on p < .05 and adjusted odds ratio (AOR) with 95% CI.
Results
Socio-demographic characteristics
A total of 422 HPs participated in this study with a response rate of 100%. Of the total participants, nearly half of them (192, 45.5%) belonged to the age group of 30–39 years ranging from 24 to 50 years old. The mean age of the participant was 32.28 (SD± 6.61) years. Nearly three-fourth of the study participants (305, 72.3%) were male and predominantly Amhara (402, 95.3%) and Orthodox Christian followers (403, 95.5%). Of the total respondents, 148 (35.1%) were nurses followed by midwives 83 (19.7%) ().
Table 1. Socio-demographic characteristics study participants working in Hospitals of South Gondar Zone, Northwest Ethiopia, 2021 (N = 422)
Health status-related characteristics of participants
The majority of the respondents 384 (90.8%) and 376 (89.1%) had no self and family history of COVID-19 infection, respectively. About 335 (79.4%) of the HPs had a higher risk of acquiring COVID-19 infection in their future life ().
Table 2. Health status-related characteristics of study participants working in Hospitals of South Gondar Zone, Northwest Ethiopia, 2021 (N = 422)
The attitude of participants toward COVID-19 vaccine
Most of the respondents’ answered “I am not sure” for various elements of attitude measuring questions. According to this study, the major proportion of participants 219 (51.9%) had a negative attitude while 203 (48.1%) had a positive attitude toward COVID-19 vaccines ().
Table 3. Attitude of study participants toward COVID-19 vaccine working in Hospitals of South Gondar Zone, Northwest Ethiopia, 2021 (N = 422)
Acceptance of COVID-19 vaccine and reasons not to accept COVID-19 vaccine
All the participants (422, 100%) reported that they had ever heard about the COVID-19 vaccine. International health organizations (WHO, CDC) (206, 48.8%), television/radio (188, 44.5%), and social media (188, 44.3%) were their main sources of information. Of the total 422 participants, 217 (51.4%) believed that COVID-19 vaccination is an effective way to prevent and control the spread of the COVID-19 pandemic. Overall, this study identified that 45.3% with 95% CI (40.5–50.5) of participants had accepted COVID-19 vaccination as soon as it became available ().
Table 4. Acceptance of COVID-19 vaccine among study participants working in Hospitals of South Gondar Zone, Northwest Ethiopia, 2021 (N = 422)
However, 54.7% of the participants had not accepted COVID-19 vaccine due to various reasons. Among these, concern about unknown side effects (37.4%) was the major reason followed by insufficient trust in the source (producer 31.3%) ().
Factors associated with COVID-19 vaccine acceptance
The result of binary logistic regression analysis showed that age, sex, marital statuses, profession, higher risk for COVID-19 infection, test for COVID-19, and attitude toward COVID-19 vaccine were significantly associated with acceptance of COVID-19 vaccine. But in multivariable binary logistic regression analysis, only age, being male, higher risk for COVID-19 infection, and positive attitude toward COVID-19 vaccine had remained statistically significant with acceptance of COVID-19 vaccine.
HPs whose ages ranged from 30 to 39 years were 2.34 times higher the odds of accepting the COVID-19 vaccine (AOR: 2.34; 95% CI: 1.21–4.53) than respondents whose ages ranged from 20 to 29 years. Similarly, participants whose age lay greater than or equal to 40 years were 2.55 times more likely to accept COVID-19 vaccine (AOR: 2.55; 95% CI: 1.32–4.92) as compared with participants whose age was found between 20 and 29 years old. Compared to female HPs, male professionals were nearly two times more likely to accept COVID-19 vaccination (AOR: 1.729; 95% CI: 1.32–2.34).
Moreover, participants who had a higher risk of COVID-19 infection were nearly two times more likely to accept the COVID-19 vaccine (AOR: 1.74, 95% CI: 1.00–3.02) as compared to those who had a low risk for acquiring the COVID-19 infection. Lastly, HPs who had a positive attitude toward the COVID-19 vaccine were 3.26 times more likely to accept the vaccine (AOR: 3.26, 95% CI: 2.14–4.96) as compared to their counterparts ().
Table 5. Factors associated with acceptance of COVID-19 vaccine among study participants working in Hospitals of South Gondar Zone, Northwest Ethiopia, March 1–21, 2021 (N = 422)
Discussion
Since the announcement of efforts to develop a COVID-19 vaccine, several studies have been carried out to measure the perception and acceptance of the vaccine among the general population.Citation37–43 However, the rollout of the vaccine is tiered to various subgroups of the population based on limited availability, and HPs are among the first subgroups of the population to have access to the vaccine. As such, it is crucial to assess predictors of vaccine acceptance among HPs, which will help policymakers target resources to maximize the uptake of COVID-19 vaccine.
To the best of our knowledge, this is one of the first studies in Ethiopia especially in the study area investigating HPs about COVID-19 vaccination. In our study, almost all of the HPs had heard about the COVID-19 vaccine. International health organizations (WHO, CDC) were the commonest source of information at 48.8% followed by television/radio 44.5% and social media 44.3%.
To battle the devastating effect of COVID-19, vaccination offers the most reliable hope for a permanent solution by developing herd immunity. To do so, a vaccine must be accepted and used by a large majority of the population.Citation43 However, the finding of our study showed that only 45.3% of participants accepted COVID-19 vaccination. This was consistent with a study conducted in Malta (44.2%),Citation44 Hong Kong (40.0%),Citation45 and Saudi Arabia (49.71%).Citation35
But this finding was higher than a study conducted in Ghana (39.3%),Citation18 Democratic Republic of Congo (27.7%),Citation36 Jordan (28.4%),Citation46 Kuwait (23.6%),Citation46 and Ethiopia.Citation22 The possible reason might be the time gap, which affects the dissemination of information about the vaccine through various media including the Internet, Facebook, Telegram, Television, and radio. The high commitment of the Ethiopian government to minimize the effect of the pandemic by all possible preventing strategies including vaccination might be another probable reason. Study population difference might also be another reason, for example, a study done in Ethiopia was of the general population but our study focused specifically on HPs who were among the vulnerable group and may had higher knowledge related to the vaccine.
However, our study’s findings were significantly lower than various studies conducted in Pakistan (70.25%),Citation47 Israel (78%),Citation48 France (76.9%),Citation28 Italy (75%),Citation31 Turkey (68.6%),Citation49 Greek (75.8%),Citation32 and Southern Ethiopia.Citation23 The discrepancies might be due to socio-demographic differences and differences in communities’ insight of the seriousness of the pandemic. Besides, variation in access to a wide variety of conspiracy theories and debuts through social media might be another reason. Furthermore, this low acceptance might be explained by the harm of social networks and the spread of misinformation about the quality of the vaccine. Due to this mass media propagation of misinformation about poor vaccine quality and rumors, the HPs may have developed vaccine hesitancy, which can affect their decisions to accept vaccination and to promote the vaccine to their clients and the whole community.
This study found that COVID-19 vaccine acceptance increased with increasing age. This mirrors the trends seen with a study performed in the USA,Citation33 Pakistan,Citation47 France,Citation28 and the Democratic Republic Congo.Citation36 Higher vaccine acceptance with increasing age might be due to higher perceived susceptibility of the infectious pandemic.Citation42,Citation50
As mentioned elsewhere, vaccine acceptance was more likely among males as compared to females.Citation28,Citation30,Citation35,Citation36,Citation46,Citation51 This might be due to the lesser tendency observed among males to believe in vaccine and virus origin conspiracies.Citation52,Citation53 Since they mostly relied on medical doctors, scientists, and scientific journals as opposed to females, who relied more on social media platforms. Besides, females were less likely to perceive the disease, which may result in lower vaccine acceptance due to complacency as evidenced by Sallam M. et al.Citation52 Once more, males had an increased risk perception of disease compared to females. Perceptions of risk are an inherent part of the decision-making process. Data collected from Chinese death rates found that a gender gap is evident in the causality rate; 64 per 100 males (4.7% mortality rate) compared to 36 per 100 females (2.8% mortality rate).Citation54,Citation55
In line with other findings,Citation35,Citation56,Citation57 vaccine acceptance was higher in HPs who have perceived a higher risk of COVID-19 infection. This might be explained by individuals who are at risk of COVID-19 and were in a need to build immunity by taking the vaccination.
Moreover, HPs who had a positive attitude toward COVID-19 vaccine also had an increased need to be vaccinated. Likewise, a study done in the Democratic Republic of Congo stated that attitude is a positive predictor for acceptance of the vaccine.Citation36 The possible reason might be a positive attitude toward the vaccine may avoid misconception and misinformation regarding the vaccine and outweigh its importance and then encouraging to acceptance the vaccine.
Fear of unknown side effects (68.4%) was the main reason for the non-acceptance of COVID-19 vaccination, which was in line with many studies.Citation32,Citation48,Citation58 Concerns about vaccine effectiveness were also another major reason for non-acceptance of the COVID-19 vaccine, which accounts for 57.1%, and this was supported by a study done by Corey L. et al.Citation59 and Dean NE et al.Citation60 This emphasized that the government needs to give tangible and reliable information regarding the general characteristics of the vaccine including the possible side effects to rule out misconceptions and rumors concerning the vaccine.
Conclusion
We found that the acceptance of COVID-19 vaccine among HPs was significantly low. Participants’ age, sex, higher risk of infection, and attitude toward the vaccine were found to be significantly associated with COVID-19 vaccine acceptance. Despite the HPs are both the frontline and high-risk subgroup and strong advocates for eliminating vaccine hesitancy, their willingness to be vaccinated is an alarming sign for rushing effective intervention to increase the acceptance of the vaccine.
Therefore, the government in collaboration with other stakeholders should emphasize addressing the concern of the HPs regarding the side effect and safety of the vaccine. Besides trying to increase willingness especially in the younger community by providing reliable information to avert the misconception and rumors that negatively affect their attitude toward the vaccine and to protect others by getting oneself vaccinated may be the key to promote vaccine acceptance.
Strengths and limitations of the study
Despite the study trying to address the main tackles to combat the global pandemic COVID-19, it has its own limitation. First, accepting the vaccine at the time being may not be certain as vaccine may substantially change over time. Second, the design may limit inference on the rotating connection of the association detected.
Abbreviations
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Authors’ contribution
ADA, NTA, LAT, and BGK inception designed the study, conduct data analysis, result interpretation, manuscript drafting, wrote the paper, and revised the manuscript. EDY, EWA, GNM, and HGB participate in the data collection, editorial, data entry, and analysis. All authors read and approved the final paper.
Ethics approval and consent to participate
Ethical clearance was obtained from Debre Tabor University College of Health Sciences institutional ethics review committee. A formal letter was given to the selected health institutions from the College of Health Sciences. Moreover, informed written consent was obtained from each respondent and they informed their right to withdraw from the study at any time. Confidentiality and privacy of participants were secured by omitting any identifier.
Acknowledgments
The authors would like to acknowledge Debre Tabor University for ethical clearance and technical support as well as the Debre Tabor Zonal Health Department office for providing the necessary preliminary information. They also extend their heart full gratitude to all research assistants and study participants for their genuine participation in this study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
References
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