Discussion

In this study, factors associated with SARS-CoV-2 vaccine acceptance were identified in a sample of nearly 3,000 employees in a health system in the Midwest. More than half of surveyed employees reported planned vaccine acceptance. Male sex, older age, low likelihood of prior COVID-19, and occupation as a physician were independently associated with vaccine acceptance. However, a proportion of employees who had initial vaccine hesitancy or refusal reported receiving at least 1 dose of SARS-CoV-2 vaccine.

The 51% vaccine acceptance rate was consistent with published surveys of American HCWs, which have shown 36%–58% acceptance rates for the vaccine. ^{Reference Kuter, Browne and Momplaisir3–Reference Shekhar, Sheikh and Upadhyay5} The presented study supports prior findings that male gender and older age may be associated with vaccine acceptance among HCWs. ^{Reference Kuter, Browne and Momplaisir3–Reference Shekhar, Sheikh and Upadhyay5} Fewer studies have compared occupational groups, but available data suggest that physicians have a higher rate of vaccine acceptance. ^{Reference Gagneux-Brunon, Detoc and Bruel6,Reference Kabamba Nzaji, Kabamba Ngombe and Ngoie Mwamba7}

Published study results have been mixed regarding associations between direct patient care and vaccine acceptance. Some show higher acceptance in HCWs providing direct patient care, ^{Reference Gagneux-Brunon, Detoc and Bruel6} and others show an opposite relationship. ^{Reference Kuter, Browne and Momplaisir3,Reference Shaw, Stewart, Anderson, Hanley, Thomas, Salmon and Morley4} Our results indicate no association between direct patient care and planned vaccine status. Among direct patient care providers, no differences were detected between inpatient and emergency room providers compared with outpatient providers. Also, vaccine acceptance status was balanced among those providing care to patients undergoing aerosol-generating procedures (AGPs).

A study of Philadelphia HCWs by Kuter et al ^{Reference Kuter, Browne and Momplaisir3} showed that a prior COVID-19 test was associated with higher vaccine acceptance. The present study did not reflect this association. In addition, our study revealed greater vaccine acceptance in participants self-reporting a low likelihood of previously having had COVID-19. Speculatively, this relationship could be due to a perceived lack of need for SARS-CoV-2 vaccine if one has already had COVID-19 or because those who are more risk averse may be more likely to accept the vaccine.

The presented study differs from other reports because the HCW population was a large, nonacademic healthcare system with a significant portion of respondents based in the outpatient setting. In addition, the study is the first to survey HCWs from the Midwest United States. Also unique to the study is the examination of how initial vaccine acceptance, hesitancy, or refusal are related to eventual reported uptake of the SARS-CoV-2 vaccine. These data underscore the need to support SARS-COV-2 vaccine efforts targeting both hospital- and clinic-based HCWs as well as those who have previously had COVID-19 by demonstrating that initial vaccine hesitancy or refusal can change in a short period.

The study has several limitations. Study data were based on self-reported survey responses, and not all eligible employees participated. Participants completing the survey and a subsequent survey later in the study could systematically differ from those completing them earlier. Employees who reported not receiving the vaccine on the subsequent survey could have gone on to receive it. Employee characteristics associated with acceptance status were selected based on descriptive statistics, and these need to be further examined for external validity.