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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 102-110

Knowledge, acceptance, and hesitancy of COVID-19 vaccine among health care workers in Nigeria


1 Department of Radiology, Faculty of Clinical Sciences, College of Medicine Sciences, Rivers State University/Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
2 St. Clarex Intensive Medical Services, Abuloma Road, Port Harcourt, River State, Nigeria
3 Department of Internal Medicine, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
4 Department of Paediatrics, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Date of Submission24-Jan-2021
Date of Acceptance01-Apr-2021
Date of Web Publication02-Jun-2021

Correspondence Address:
Dr. Ebbi Donald Robinson
Department of Radiology, Faculty of Clinical Sciences, College of Medicine Sciences, Rivers State University & Department of Radiology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_4_21

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  Abstract 

Introduction: Health Care Workers are major influencers in vaccination, thus their acceptance or hesitancy to the covid-19 vaccine would either aid its acceptance among the populace. Materials and Methods: The study was a cross-sectional survey using a self-administered questionnaire from December 15, 2020 to January 10, 2021 among healthcare providers living in Nigeria. The questionnaire was made up of segments that include demographics information, knowledge of the COVID-19 vaccine, its acceptance or hesitancy. The questionnaire was fashioned using Likert scale multiple questions of three options: YES, NO, and I Don’t know (No opinion) and Aware, Somewhat aware, and Not aware. Data collected were entered into the spreadsheet using IBM SPSS version 22.0 statistical software and analyzed with descriptive statistics. The results were presented as percentages, frequency, tables, and figures. Results: A total of 1094 responses were retrieved. The majority are males (56.67%) with 36.93% of the respondents aged 30–39 years. PHC Worker forms 14.90% of the respondents and social media was the greatest source of information. A percentage of 45.74% have no confidence in the vaccine and 39.68% rejecting, the majority been males (47.38%). The reasons for hesitancy are concerns of effectiveness, side effects, fear of the unknown, and safety. The highest rejection was by Dental Technicians (53.03%) while the highest acceptance was Medical consultants (72.22%). Conclusion: The study shows that about 3 out of every 10 health workers showed COVID-19 vaccine hesitancy for various reasons. The study recommends effective education, training, and public enlightenment to change the narrative.

Keywords: COVID-19 vaccine, COVID-19 vaccine acceptance, COVID-19 vaccine hesitancy, healthcare workers, medical practitioners, Nigeria


How to cite this article:
Robinson ED, Wilson P, Eleki BJ, Wonodi W. Knowledge, acceptance, and hesitancy of COVID-19 vaccine among health care workers in Nigeria. MGM J Med Sci 2021;8:102-10

How to cite this URL:
Robinson ED, Wilson P, Eleki BJ, Wonodi W. Knowledge, acceptance, and hesitancy of COVID-19 vaccine among health care workers in Nigeria. MGM J Med Sci [serial online] 2021 [cited 2021 Oct 21];8:102-10. Available from: http://www.mgmjms.com/text.asp?2021/8/2/102/317449




  Introduction Top


Coronavirus disease (COVID-19) is a global pandemic that is highly contagious and has led to increased morbidity and mortality.[1],[2] It is a respiratory tract infection that is caused by a novel coronavirus (SARS-CoV-2).[1],[2] The virus has now affected virtually every country across the world and the number of deaths continues to rapidly increase.[3] Following the negative impact on health, measures are been put in place to curb the spread of this pandemic with 92,506,811 confirmed cases and about 2,001,773 mortalities as of January 16, 2021.[4] In Nigeria, 108,943 cases have been confirmed with 1,420 deaths reported across 35 states of Nigeria.[5]

Vaccines contain only a part of the same disease-causing agent that has been killed or made inactive to cause sickness.[6] Most viral diseases have no cure including the COVID-19 disease[7] and because there is no scientifically proven cure for COVID-19, have led to the critical search for a means to salvage the world from this scourge. The result was a vaccine against the disease with the belief that vaccination has saved millions of lives globally[8] against diseases that have no cure. Vaccination has prevented 2–3 million deaths annually from diphtheria, tetanus, pertussis, influenza, and measles.[8] The need for COVID-19 vaccination cannot be overemphasized, because the administration of vaccines is the most effective measure of combating infectious diseases,[7] nonetheless, for over a long time vaccination has been thought to pose a threat to healthy living with unnecessary criticisms by elites, specifically in the western part of the world.[9],[10],[11]

Various concerns have emerged about the inefficacy of vaccines due to technology used in the production of the vaccine, development of biological response, as well as long-term side effects.[12] The criticisms and concerns have led to opposition to vaccine acceptance leading to vaccine hesitancy, which may result in to increase or rise in the outbreak of infectious disease.[13],[14] There is a need for the administration of the vaccine to prevent COVID-19 infection as well as put to an end to the pandemic. Pfizer and BioNTech were the first companies to indulge in the production of coronavirus vaccine; BNT162, thereafter, Moderna embarked on the production of COVID-19 vaccine named mRNA-1273.[15]

Various vaccines have their mechanism of action, mRNA vaccine does not contain antigens rather it has a blueprint for the antigen in the form of genetic material. However, in Pfizer’s and Moderna’s vaccines, the mRNA provides the genetic information which aids the synthesization of spike protein that the SARS-CoV-2 virus attaches to and infects human cells, COVID-19 vaccine is administered via the muscle (myocyte).[15] The efficacy of the vaccine is about 95% with two doses taken 21 days apart while the efficacy is about 52.4% when only a single dose is received.[16] Like every other pharmaceutical product, the safety and side effects are always a concern. Notwithstanding, the 95% efficacy of the mRNA COVID-19 vaccine, various side effects such as pain, erythema, swelling, and systemic reaction were observed in the subject.[17]

Healthcare Workers are major influencers in vaccination, thus the acceptance or hesitancy of the COVID-19 vaccine among health care workers would either aid the acceptance or rejection of vaccines within the populace. The vaccines are meant to be taken by health care workers, elderly persons, and other more vulnerable individuals before their distribution to the general citizenry. Studies have shown negative attitude and vaccine hesitancy of health care workers on the recommendation of vaccine to patients.[18] A study conducted in Europe has revealed worries by health care workers on side effects over the production of COVID-19 vaccine with a view of no effective vaccination education.[19] Similarly, 16–43% of health care workers refused to recommend the vaccine to patients.[20],[21]

The hesitancy on vaccination is mostly seen among health care workers, and this has posed a major challenge encountered by public health experts globally, which is a result of lack of trust and safety of the vaccine. A study conducted in Congo among 613 Health care workers, revealed that 99.3% were knowledgeable about COVID-19, but only 27.7% expressed their acceptance to receive COVID vaccine if readily available, and the willingness to accept the vaccine was common among male Health Care workers.[22] A review in Los Angeles reported unwillingness of 47.3% of Health care workers to participate in vaccine trials, with 35% complaining of the effect of the vaccine.[23] A study conducted in Yemen revealed that 51.4% males and 55.3% females, the larger population was physicians, while the others were nurses; the physician group had better knowledge and self-preparedness to accept the COVID-19 vaccine.[24]

As at the time of this study, there was no production of COVID-19 vaccine by either pharmaceutical company or scientist in Nigeria as we are on the queue waiting to purchase the vaccine from other countries of the world specifically, the western world. There is a paucity of data or studies conducted to ascertain knowledge, acceptance, and hesitancy of covid-19 vaccine among health care workers in Nigeria. The study is thus aimed to ascertain knowledge, acceptance, and hesitancy among health care workers with respect to COVID-19 vaccination.


  Materials and methods Top


The study was a cross-sectional survey using a self-administered questionnaire, both hard copy and online versions of the questionnaire were used for the survey. The online version of the questionnaire was constructed using a google questionnaire (docs.google.com/forms). Participants were only healthcare providers living in Nigeria. The survey questionnaire was made up of four segments. The first segment is consisting of information about the participants’ sociodemographic variables such as gender, age, and occupation. The second segment consists of background knowledge of the COVID-19, while the third segment assesses the participant’s knowledge about the COVID-19 vaccine and the final segment evaluates the acceptance and hesitancy of the respondents towards the vaccine. The questionnaire was also validated by pretesting it, to ascertain its quality, demographic information, and questions regarding the acceptance and hesitancy regarding the COVID-19 vaccine among health care providers. The questionnaire was fashioned using Likert scale multiple questions of three options; YES, NO, and I Don’t know (No opinion); Aware, Somewhat aware, and Not aware as well as Strongly agreed, Agreed, and Not agreed.

The purpose of the study as enumerated in the questionnaire was disclosed to the participants to obtain informed consent. After obtaining the consent the questionnaires were distributed to the participants in each of the centers and the completed questionnaires were retrieved from the participants immediately while the online version was distributed via emails and social media platforms (WhatsApp) using a link. December 15, 2020 to January 15, 2021 was the duration for the filling and submission of the online version of the questionnaires.

The author(s) ensured that the confidentiality of the information provided by the participants was guaranteed and participation was completely voluntary. The participants were also assured that the information provided was used only for this study. Retrieved questionnaires from non-healthcare workers were excluded. The data collected were entered into the spreadsheet, using IBM SPSS version 22.0 statistical software for windows, and analyzed statistically with descriptive statistics. The results were presented as percentages, frequency, tables, and figures.


  Results Top


A total of 1094 responses were retrieved with a response rate of 96.99%. The majority of the respondents are males accounting for 56.67% and about a quarter (36.93%) of the respondents fall within the age group of 30–39 years [Table 1]. Sociodemographic data shows that the majority (48.26%) of the respondents are residents in the south-south geopolitical zone while 8.96% reside in the north-central part of the country [Figure 1]. More than half of the respondents are educated and hold a Bachelor’s degree (55.67%) while 1.74% had only primary education [Table 2]. As illustrated in [Table 3], medical, paramedical, and ancillary health workers participated in the survey covering a wide range of health care workers. The ancillary health care workers were emergency medical services support staff, hospital porters, ambulance services support staff, and ward maids. General Medical Practitioner accounts for 106 (9.69%), while laboratory scientists, dentist, and resident doctors account for 13.80%, 2.93%, and 12.61%, respectively. The majority of the participants were Primary Healthcare Worker accounting for 163(14.90%) while optometrists were the least 16 (1.46%) as also shown in [Table 3].
Table 1: Age and gender distribution of respondents

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Figure 1: Distribution of respondents according to geopolitical zones

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Table 2: Educational qualification of respondents

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Table 3: Occupation distribution of respondents

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All the respondents have heard about Coronavirus disease (COVID-19), with good knowledge concerning the causative agent, mode of transmission, and means of diagnosis [Table 4]. Most of the respondents are also aware that they are frontline workers except 1.11% as shown in [Table 4]. [Table 5] shows that the majority (97.94%) of the respondents have heard about the COVID-19 vaccine. Their source(s) of information includes radio, television, internet, social media, and through a colleague [Figure 2]. Social media (74.41%) was the greatest source of information concerning the vaccine [Figure 2]. [Table 5] also illustrated that some of the respondents (44.48%) know about the potential side effects of the vaccine been fever, nausea and vomiting, fainting attack, and even death as further shown in [Figure 3].
Table 4: Level of knowledge about the COVID-19 pandemic

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Table 5: Level of knowledge about the COVID 19 vaccine

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Figure 2: Source(s) of information concerning the vaccine

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Figure 3: Perceived side effect of the vaccine

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The proportion of respondents that have confidence in the vaccine account for 532 (49.77%) while 489 (45.74%) does not have confidence in it with the thought that an individual can still be infected even after receiving the vaccine [Table 6]. [Table 6] also demonstrated that 425 (39.68%) of health workers were not willing to accept the COVID-19 vaccine, but 32.52% were resolved to get the vaccine even if it means using their funds.
Table 6: Acceptance and hesitancy towards the COVID 19 vaccine

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The majority of the males (47.38%) rejected the vaccine while 62.04% of the females were willing to accept the vaccine [Figure 4], whereas 64.22% of respondents with a postgraduate degree were willing to accept the vaccine while 43.12% of Bachelor degree holders rejected the vaccine [Figure 5]. The reason for rejecting the vaccine includes concerns about its effectiveness, the possible side effects, the fear of the unknown, with the majority concerned about its safety [Figure 6].
Figure 4: Distribution of acceptability or rejection among males and females

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Figure 5: Distribution of acceptability or rejection with respect to educational status of respondents

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Figure 6: Reason for not taking or rejecting the vaccine

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General Medical Practitioner constituted 60 (11.47%) of the population that will accept the vaccine while 35 (8.24%) of them account for the proportion that will reject the vaccine [Table 7]. Laboratory scientists account for 74 (14.45%) and 62 (14.59%) of the population that will be accepted or reject the vaccination, respectively, whereas Primary Healthcare Worker account for 88 (16.83%) of the population that will accept vaccination [Table 7]. Among the healthcare workers, 60 (11.47%) of General Medical Practitioner accepted to receive the vaccine while 35 (8.24%) of them rejected the vaccine, whereas among Pharmacists 25 (45.45%) rejected the vaccine while 12 (21.81%) were indecisive [Table 8]. Among Nurses/Midwives, 62 (11.85%) accepted to take the vaccine while 83 (19.53%) rejected it [Table 8]. The data in [Table 8] also revealed that 74 (49.66%) of Lab Scientists accepted the vaccine, whereas 62 (41.61%) rejected the vaccine. As also illustrated in [Table 8], the highest percentage of rejection was observed among Dental Technicians (53.03%) while the highest percentage of acceptance was observed among Medical Consultants (72.22%).
Table 7: Distribution of acceptance and rejection about vaccine among professions

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Table 8: Distribution of acceptance, and rejection within each professional group

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  Discussion Top


The study was to evaluate the knowledge and perception of the COVID-19 vaccine among health care workers. The coronavirus has infected over 92 million people with the resultant death of about two million people globally.[4] Since there is no known medically proven cure for the disease,[25] scientists have invested greatly in vaccines, and varieties of COVID-19 vaccines are being developed globally to prevent the scourge of the ravaging pandemic.

Out of the 1094 respondents, the majority of the respondents were males accounting for 56.67%. This was contrary to the findings in a global survey of potential acceptance of a COVID-19 vaccine where females constituted 53.5%[26] and a Yemeni study where females were higher (55.3%).[24]

The majority of the respondents in the index study fall within the age group of 30–39 years and most of the respondents are educated and hold at least a Bachelor’s degree. Whereas in the study by Jeffrey et al.,[26] about 36.3% had a university degree and the majority of the respondents fall within the age group of 25 and 54 years constitute 62.4%. The variance in trend between the index study and the study by Jeffrey et al.[26] concerning gender proportion, age grouping, and level of education could be due to disproportionate age grouping and the global distribution of their study. The global distribution and coverage, as well as the higher study population, may have influenced the variations.

Medical practitioners, paramedical and ancillary health workers participated in the survey covering a wide range of health care workers including General Medical practitioners, laboratory scientists, dentists, resident doctors, as well as Primary Healthcare Workers among other healthcare practitioners. All the respondents have heard about Coronavirus disease (COVID-19), with good knowledge about disease causative agent, mode of transmission, and the means of diagnosis of the disease. This is not unexpected of healthcare workers being those in the frontline against the pandemic.

The results obtained from the survey provided pertinent information concerning the level of acceptability of the vaccine. Notwithstanding, that majority (97.94%) of the respondents have heard about the COVID-19 vaccine from the radio, television, internet, and social media; 39.68% of health workers were not willing to accept the COVID-19 vaccine. This trend was similar to a nationwide survey[27] where 61% of the respondents agreed to accept the vaccine and 39.9% were not willing to accept the vaccine. A similar study among health workers revealed that only 27.7% expressed willingness to accept the vaccine.[22] Conversely, a higher percentage (46.8%) agreed to completely accept the vaccine in a global survey.[26] It is also worthy of note that during the vaccine trial, 47.3% of Health care workers were un-willingness to participate in Los Angeles,[23] which is suggestive of hesitancy among the health workers. A similar scenario of hesitancy was seen among health workers in Europe.[19]

The majority of the males (47.38%) rejected the vaccine while 62.04% of the females were willing to accept the vaccine, indicating more female acceptance compared with males. This is contrary to the national survey where the gender divide revealed that more men (78%) were more favorably disposed to accepting the vaccine when compared with females (70%). The finding in the index study was also at variance with a Congolese study with 613 healthcare workers showered that the willingness to accept the vaccine was more among males.[22] The reason for the discrepancies may be attributable to numerical bias on one part and the pattern of data collection involving a mixed professional population on the other part. In the national survey, phone calls were used to interview participants, this could be a source of bias.[27]

Among the healthcare workers, 58.82% of General Medical Practitioner accepted to receive the vaccine while 34.31% of them rejected the vaccine, whereas among Pharmacists, 25 (45.45%) rejected the vaccine while 12 (21.81%) were indecisive. Among Nurses and Midwives, 38.27% accepted to take the vaccine while 51.23% rejected it. About half (49.66%) of the laboratory scientist accepted to receive the vaccine while 41.61% were unwilling. The highest rejection was Dental Technicians (53.03%) while the highest acceptance was Medical Consultants (72.22%).

The index study also observed that the respondents being healthcare workers have good knowledge of the possible side effects of a vaccine ranging from fever, nausea and vomiting, fainting attack, and even death. This is in keeping with the report of minor side effects such as tiredness, muscle pain, fever headache, chills, and joint pain, among others.[17],[28],[29] However, it was worrisome to note the COVID-19 vaccines may be too risky for the very old[30] being the very first set of persons penciled to receive the vaccine with frontline workers. There were 23 mortalities shortly after receiving the first dose of the vaccine,[30] out of which 13 were ascertained by autopsy which suggested that common side effects may have triggered severe side effects in frail elderly people.[30]

The study also revealed that the reason for rejecting the vaccine includes concerns of its effectiveness, the possible side effects, fear of the unknown, and safety concerns. The male predominance of unwillingness to accept the vaccine may also not be unconnected to the misconstrued hypothesis concerning male sterilization,[31],[32] that is trending on various media platforms, academic and non-academic fora. Although there is a report of the virus been isolated from the semen after 6 months following infection[33] and some men would want to preserve their sperm by freezing it before receiving the vaccine.[33] The imbroglio of the effect of the vaccine on sperm and reproduction has not been proven or fully elucidated.[30],[31],[32] A randomization study using 43,548 participants to evaluate the safety and efficacy of two 30-μg doses of BNT162b2 (COVID-19 vaccine) given 21 days apart was compared with placebo.[7] Notwithstanding, the minor adverse effects observed, the study demystified the concerns of safety and efficacy of the vaccine with a 95% protection against the disease in participants aged 16 years and older.[7]

The vaccines are meant to be taken by health care workers and in turn be recommended to patients. However, the index study has shown that about 3 out of every 10 health workers rejected the vaccine. This negative attitude will also send a negative signal to the population. What a double standard when the healthcare workers who will be the ones to administer the vaccine will not want to take the vaccine themselves.


  Conclusion Top


The study has shown that a good number of health care practitioners are not willing to accept the vaccine for various reasons, with a greater number of males rejecting the vaccine. The medical consultants are the group of practitioners with the highest proportion of acceptability. Notwithstanding, the healthcare workers are very knowledgeable about the COVID-19 vaccine, the negative perception of the vaccine will send a negative signal to other people.

Recommendations

It is imperative to commence early education and training of healthcare providers to have in-depth knowledge to allay their fears and concerns. This will help change the narrative and their perception to make them good ambassadors and beacons of advocacy for the vaccine, in other to prevent mortality from the pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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