Who's vaccinated? A closer look at healthcare workers' coronavirus disease 2019 (COVID-19) COVID-19 vaccine hesitancy and demographics.

To the Editor—Coronavirus disease 2019 (COVID-19) is worldwide pandemic caused by a novel coronavirus, severe acute respiratory coronavirus virus 2 (SARS-CoV-2). This virus was first isolated in January 2020 and rapidly sequenced, with work on the vaccine starting in March 2020. Development of a vaccine using new mRNA technology constitutes an unprecedented scientific achievement.[1] A COVID-19 vaccine first became available to healthcare workers and other priority and high-risk groups in mid-December 2020. Lower than expected vaccination rates have been attributed to problems with access[2]; however, vaccine hesitancy has also been identified as a contributing factor to lower vaccination rates.[3]

Virginia Hospital Center (VHC) is a 437-bed hospital in Arlington, Virginia, located in the Washington, DC, metropolitan area, with 3,401 employees. Our hospital offered the 2-dose Moderna or the 2-dose Pfizer COVID-19 mRNA vaccines to all employees as of early January 2021. We reviewed vaccination rates among employees in our hospital where vaccine access was not an issue.

Methods

We evaluated all those who received at least 1 dose of a vaccine through March 10, 2021, and considered this group vaccinated. We examined vaccination rates by age, gender, department, and race, to determine in which groups vaccine hesitancy was highest.

Results

In total, 2,425 employees received a COVID-19 vaccine as of March 10, 2021, resulting in a 71% overall vaccination rate. We observed significant differences in vaccination rates among different demographic groups (Table 1). The odds ratio (OR) for receiving vaccination were significant for those age ≥50 (OR, 1.85), working in a clinical department (OR, 1.19), and white race compared to black race (OR, 4.55). Male sex had an OR of 1.12, but this did not reach statistical significance.

Table 1.

Vaccination Rates of Hospital Employees

Variable	Vaccinated, No. (%)	Unvaccinated, No. (%)	Odds Ratio	95% Confidence Interval	P Value
Total employees	2,425 (71)	976 (29)
Age, years			1.85	1.53–2.24	<.01
≥50	657 (80)	163 (20)
<50	1,768 (69)	813 (31)
Sex			1.12	0.94–1.35	.10
Male	558 (73)	205 (27)
Female	1,867 (71)	771 (29)
Department			1.19	1.01–1.42	.02
Clinical	1,857 (72)	715 (28)
Nonclinical	568 (69)	261 (31)
Race			4.55	3.74–5.52	<.01
White	1,022 (83)	203 (17)
Black or African American	536 (53)	484 (47)

Discussion

Vaccination rates were higher in employees >50 years old and in employees working in clinical areas. This can be explained due to the known higher risk of poor outcomes with COVID-19 in older patients, and due to the higher exposure of employees to COVID-19 patients in clinical settings. The difference in vaccination rates between white employees and black or African American employees is striking. We selected these 2 groups, as they include most employees at our hospital. Media polling reports that low vaccination rates among African Americans are due to limited access to vaccine.[4] However, the historical distrust of the medical community by African Americans is also well documented.[5] Such distrust may be felt by African American healthcare workers as well.

The vaccine has been available to all hospital employees since early January 2021, but access still may be an issue for some. Vaccination is offered during the workday and takes ∼20–30 minutes, which includes an observation of 15 minutes after vaccination. Although vaccination was officially supported and encouraged by hospital administration, some employees may not have been able to take that time off during their shift. Additionally, much of the messaging around our vaccine clinics occurred by e-mail and text-message reminders, and some may not check e-mail routinely or have smartphones.

In total, 71% of hospital employees have received a COVID-19 vaccine. The proportion of the population that must be vaccinated to provide herd immunity to COVID-19 is not yet known[6]; however, experts have speculated that vaccination of up to 80% of the population may be necessary.[7] Strategies to increase vaccination rates must be pursued.

Making the COVID-19 vaccine mandatory would be challenging at present, even in a hospital setting, given that the vaccine has only been approved for emergency use. Comparatively, we do not have a mandatory influenza vaccination policy, yet our influenza vaccination rates are >97%. This has been accomplished by a mandatory declination policy that employees have to either show proof of vaccination, receive the vaccine, or sign a document of declination.[8] Such a strategy could be implemented again to potentially encourage and increase the COVID-19 vaccination rates.