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Here's why a surprising number of healthcare workers are rejecting the vaccine, despite having witnessed the immense suffering of the COVID-19 pandemic

Business Insider Australia logo Business Insider Australia 17/02/2021 Joshua Zitser, Sophia Ankel
a woman taking a selfie: A nurse administers a dose of the Moderna vaccine in Los Angeles, California. Between 20 and 40% of frontline workers in Los Angeles have refused a shot. A nurse administers a dose of the Moderna vaccine in Los Angeles, California. Between 20 and 40% of frontline workers in Los Angeles have refused a shot.
  • Vaccine hesitancy is above average for healthcare workers working on the frontlines of the pandemic.
  • Insider spoke to three healthcare workers about some of the reasons behind the worrying trend.
  • Experts told Insider having "trusted messengers" in local communities will help tackle the problem.
  • Visit the Business section of Insider for more stories.

Melody Butler worked as a nurse in Long Island, New York, during the 2009 swine flu pandemic.

She was pregnant and reluctant to get a mandatory vaccination. "I came across some information that was rather scary about the vaccine," Butler told Insider. "There were reports online that, supposedly, people were getting really sick from it."

Concerned, she approached a colleague, a clinical nursing educator, to discuss the horror stories she'd come across.

"She was able to debunk them on the spot," Butler said. "She explained why they were wrong and helped me to dive deeper into the websites."

She took the time to point out that credible health organisations or authors with legitimate medical credentials didn't make these websites.

"It really surprised me that I had fallen victim to these manipulative websites," Butler said. "I was embarrassed."

Eventually, Butler made an appointment and got vaccinated. Meanwhile, a pregnant friend could not secure a shot because of supply shortages in upstate New York.

"She caught the H1N1 flu and ended up needing to be admitted to the hospital," she said. "Due to the illness, she ended up losing one of her twins."

It shook Butler. "I could have willingly put myself in a similar situation because of this misinformation online," she said.

Butler was motivated to set up a Facebook group called 'Nurses Who Vaccinate' to supply the correct information to colleagues around the US. The group quickly blew up, recruiting 1,200 members. Its mission is to convert nurses into immunization advocates.

The COVID-19 pandemic has given it a new urgency as a worrying number of healthcare workers are shunning vaccines.

'There are different tiers to vaccine hesitancy'

Surprisingly, vaccine scepticism is higher than average among those working in a healthcare setting.

A Kaiser Family Foundation survey of 1,676 American adults found that 27% respondents were hesitant to get a vaccine. That figure rose to 29% of the respondents who work in a healthcare setting.

A report by the health nonprofit Surgo Ventures spoke to 2,504 healthcare workers, and 15% said they were offered the vaccine and turned it down.

In some states, the numbers are much higher. In Ohio, 60% of nursing-home workers decided against a vaccine in December, Gov. Mike DeWine said.

Up to 40% of frontline workers in Los Angeles have also refused a COVID-19 shot, public-health officials told the Los Angeles Times. In neighbouring Riverside County, this figure rose to 50%.

a person wearing a costume: A vaccination centre in Riverside, California, where up to 50% of frontline workers have refused a COVID-19 shot. A vaccination centre in Riverside, California, where up to 50% of frontline workers have refused a COVID-19 shot.

While these numbers are concerning for public health officials, it is unclear how many healthcare workers are hesitant to take the vaccine imminently and how many are steadfastly anti-vaccine.

"There are different tiers to vaccine hesitancy," Butler said.

Some are reluctant to be in the first round of vaccinations.

"A lot of nurses just want to see everyone get their second shot and make sure they're OK before they feel comfortable getting it," Butler said.

But others are unlikely ever to be convinced to get a shot.

"These people are so married to the anti-vaxx cause that they're not interested in being educated or asking questions."

Conspiracy theories and misinformation

Despite scientific evidence showing vaccines' safety and efficacy, some people eschew the data in favour of baseless claims and discredited myths.

A widely-shared fiction says the shot contains an injectable microchip and suggests Microsoft founder Bill Gates is plotting to use the vaccine to track the locations of the world's population.

a group of people in a room: Tampa residents over the age of 65 waiting for healthcare workers to administer the COVID-19 vaccine. Tampa residents over the age of 65 waiting for healthcare workers to administer the COVID-19 vaccine.

Melissa Anne, a nurse at an assisted living facility in Tampa, Florida, isn't writing them off.

"I leave the door open as a possibility that there may be people with bad intentions behind these vaccines," she told Insider.

Despite social-media giants' policies to crack down on vaccine misinformation, Facebook and Instagram are the breeding grounds for false claims.

For example, last week, a widely-shared Facebook post inaccurately claimed that a doctor's miscarriage resulted from the coronavirus vaccine.

The woman in question, Dr. Michelle Rockwell, said her miscarriage took place before she had been vaccinated.

"How soulless and predatory of someone to take someone's heartbreak and modify it to further their own agenda," she wrote on Instagram. "Misinformation is spread so quickly because people don't pause and think before hitting the share button."

Dr. Georges Benjamin, executive director of the American Public Health Association, told Insider he believed misinformation could be contributing to a lower take-up rate of vaccines.


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'They're waiting until spring'

While some healthcare workers do hold these extreme views, others are hesitant about getting a vaccination so soon into the rollout.

Dr. Stephen Noble, a heart surgeon in Olympia, Washington, is not generally opposed to vaccines.

"I'm not a vaccine denier or anti-vaxxer," he told Insider. "I've vaccinated my kids, and I get vaccinated with the flu vaccine every year."

But Noble said he believes the COVID-19 vaccine rollout started too quickly to instill confidence.

"One of the issues that concern me is that we just don't have long-term data," he said. "The vaccine was supposed to be a three-year study, but somehow, we stopped it at six months and said, 'You know what, this data is good.'"

While Noble is declining the chance to be vaccinated now, he is not ruling it out for the future. He said he was considering getting a shot in the early summer once more data becomes available.

Butler, the founder of Nurses Who Vaccinate, said she believes Noble's views are widely shared and many healthcare workers would eventually come around to the vaccines.

"I know some nurses have a timeline in their head," she said. "They're waiting until spring."

While it is true that the vaccine has been rolled out at an unprecedented pace, experts are seeking to reassure people that corners have not been cut.

"It was not developed too fast. It was developed expediently," Benjamin said. "These vaccines have been under development as a class for many, many years. We were able to pivot to the specific type of vaccine for this particular organism very quickly.

"We know, historically, most of the bad stuff that happens with vaccines occurs in the first few months," he said. "We're outside that window now."

Dr. Hemi Tewarson, a visiting senior policy fellow at the Duke-Margolis Centre for Health Policy, agreed.

"I think there's a real need to make sure that the science is explained in very clear terms," Tewarson told Insider. "The efficacy rate of 95% is fantastic. There were some mild side effects but literally no serious side effects."

Vaccines are the 'best option'

While some healthcare workers will choose to get vaccinated at a future date, others do not see vaccines as the medical solution.

Dr. Jane Orient, the executive director of the politically conservative Association of American Physicians and Surgeons, is adamant that she will never get vaccinated against COVID-19.

"I am just not convinced by the evidence, either for the effectiveness or the safety," she told Insider.

Instead, Orient said we should rely on medication.

"Vaccines are not the only alternative," she said. "There are safe, effective treatments that have been tested for decades on hundreds of millions of people."

Orient said hydroxychloroquine â€" an antimalarial drug â€" should be prescribed for COVID-19 patients.

Hydroxychloroquine became a household name after it was praised by former President Donald Trump, who told reporters he was taking it.

a close up of a device: Former President Donald Trump announced May 18 he had been taking hydroxychloroquine for almost two weeks as a preventative measure against COVID-19. Former President Donald Trump announced May 18 he had been taking hydroxychloroquine for almost two weeks as a preventative measure against COVID-19.

Studies have shown that the drug does not prevent coronavirus infections in people who were recently exposed to the virus. Other studies have shown the drug failed to help hospitalized patients.

In June, the Food and Drug Administration revoked the drug's emergency use authorization after a clinical trial found that the medicine showed no benefit, neither decreasing the likelihood of death nor speeding recovery.

Tewarson, the health policy expert, said she wants healthcare workers to know that vaccines are the "best option."

"None of us want to go to the hospital and have a risk of death. That's terrible," she said. "So getting the vaccine to enough people is what is really going to prevent that."

While there are some approved treatment options, like monoclonal antibody treatments, Tewarson said these were insufficient to prevent the spread of COVID-19. "Yes, they're good," she said. "But they're just a tool."

Different levels of education and racial disparities

To understand why so many healthcare workers choose not to be vaccinated, people need to recognise the different levels of knowledge within the industry, said Benjamin, the official at the American Public Health Association.

"The knowledge base of a physician or a nurse working in the hospital is different to the knowledge base of a nurse's aide, for example, or someone working in a nursing home," he said.

"A lot of our nursing homes are staffed with a larger degree of people who have less professional training. Not that they're not professionals, but they have less professional training than the nurses in the hospitals," he added.

On top of that, people's experience of the virus has been drastically different.

While nursing-home staffers, for example, have seen the virus affect older populations, nurses in intensive-care units are likely to have seen really sick people of all ages dying every day.

a group of people sitting at a desk: A doctor checks the vital signs of a patient at the Intensive Care Unit of Providence Cedars-Sinai Tarzana Medical Centre in Tarzana, California on January 3, 2021. A doctor checks the vital signs of a patient at the Intensive Care Unit of Providence Cedars-Sinai Tarzana Medical Centre in Tarzana, California on January 3, 2021.

Nursing-home employees have some of the lowest vaccination rates among healthcare workers. A CDC analysis of more than 11,000 long-term care facilities found that about 78% of residents got at least one dose in the first month of vaccinations, but only 38% of staffers did.

"I think that people's perspectives on the disease are different," Benjamin added. "And I think their knowledge base, their core basic health knowledge base is very different. So we need to educate people from where they were and bring them all up to a similar level of knowledge about the risks and benefits of the vaccine."

On top of this, the experience of healthcare workers is also shaped by their backgrounds.

Tewarson said that it "gets more complicated when you break everything down. Like Republicans, rural residents, and people of colour are all showing more hesitancy across the general population... And that certainly also translates to when you're thinking about healthcare workers."

According to a nationwide poll by the Kaiser Family Foundation and The Undefeated, 7 in 10 African Americans believe that people are treated unfairly based on race or ethnicity when seeking medical care.

Noble, the heart surgeon who has turned down the vaccine for now, said: "We live in a system of inequity, social determinants of health, and in a system of institutional racism that lends itself to not listening to black patients and even providers."

"And the healthcare system doesn't appear and respond appropriately. So with the vaccine, you're going to have a hard time trying to convince the public, let alone healthcare providers that work within the system on a day-to-day basis."

How to tackle vaccine hesitancy?

Health systems, medical facilities, and state officials have tried different ways to encourage more healthcare workers to get vaccinated.

Some employers have announced incentives, including cash bonuses, gift cards, raffle tickets, and even free breakfasts at Waffle House.

Others â€" especially those in sectors that have been changed radically by the pandemic â€" have discussed making vaccines mandatory in their workplaces.

Vaccine mandates are not unheard of. According to Johns Hopkins Medicine, 15 states have laws that require healthcare workers to be vaccinated in certain circumstances to keep high-risk patients safe. Most hospitals have made the flu vaccine mandatory.

But mandating the coronavirus vaccine is more complicated, as it's been approved by the FDA for emergency use only, so it is still considered experimental.

Benjamin worries that mandating vaccines could backfire.

"One of the things that I've learned in all my years of practicing health and medicine is that the minute you tell people they have to do something, then people won't do it."

Benjamin said he preferred using the "power of persuasion," putting out "good information" through "trusted messengers."

This is what Butler, the founder of Nurses Who Vaccinate, has done so successfully.

"We're really trying to get ahead of the misinformation. We want people to hear it from us first," Butler said.

"So that's what we're really trying to help our colleagues to be proactive rather than always being defensive," she added.

"When they see their uncle share something on Facebook about the vaccine, they have already heard about it from us, and they're like, 'Oh wait a minute. I know this isn't true.'"

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