Attitudes towards COVID-19 vaccination amongst essential workers

The sudden outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in the ongoing coronavirus disease 2019 (COVID-19) pandemic that has claimed more than 4.9 million lives worldwide. In response to this pandemic, scientists have been developing COVID-19 vaccines. Many have received Emergency Use Authorization (EUA) from various global regulatory bodies such as the USA’s Food and Drug Administration (FDA). Subsequently, in many countries, vaccination programs have commenced. In the USA, the vaccination program began in mid-December 2020.

Study: COVID-19 Vaccine Perceptions and Uptake in a National Prospective Cohort of Essential Workers. Image Credit: BaLL LunLa/ Shutterstock

Essential workers, including first responders, healthcare personnel (HCP), and other frontline workers (FW), are at a high risk of COVID-19 infection as they are in close contact with patients infected with the virus. Hence, they were prioritized to receive the COVID-19 vaccine by the Centers for Disease Control and Prevention (CDC) advisory committee on immunization practices.

Vaccine hesitancy among essential workers

Recent surveys have shown that the initial high demand for the COVID-19 vaccines has decreased significantly. Previous studies have indicated that rates of willingness to receive the COVID-19 vaccine had ranged between 40% and 75% in the US. These studies also reported that among the essential workers, FW and the first responders showed lower vaccine acceptance rates than HCP.

Why are people hesitant to receive COVID-19 vaccines?

Some of the reasons for vaccine hesitancy include the novelty of the COVID-19 vaccines, concern about the negative side effects post-vaccination, and distrust in the government. However, how an individual’s intention to get vaccinated has evolved, with more information on the outcomes of COVID-19 disease and the risks and benefits of vaccinations, is not clear.

It is important to understand three factors associated with vaccination: knowledge, attitudes, and practices (KAP). These factors could indicate the acceptability of vaccines and help formulate strategies to improve vaccine uptake rate. A new study, published on the medRxiv* preprint server, has addressed these gaps in knowledge regarding the uptake of COVID-19 vaccines among essential workers. The authors of this study included a multi-center prospective cohort of essential workers to assess KAP and its impact on vaccine uptake over time.

About the study

This study was introduced in July 2020, and the HEROES-RECOVER cohort provided socio-demographics and COVID-19 vaccination data. HEROES-RECOVER studies contain a national network of prospective cohorts comprising data on individuals (HEROES), who are HCP, first responders, and FW, and available epidemiological studies on SARS-CoV-2 among the essential workers (RECOVER) in the US. Hence, this cohort provided the researchers with a unique opportunity to investigate COVID-19 KAP longitudinally in a large population that included a total of 4,803 essential workers.

Researchers observed that KAP responses were strongly correlated with the inclination to be vaccinated. This study cohort largely showed positive attitudes toward the COVID-19 vaccine compared to other national cohorts. Vaccine reluctance was found among individuals who had concerns about the safety and effectiveness of the vaccine. Among all groups, first responders and participants who recovered from SARS-CoV-2 infection were more reluctant to receive the COVID-19 vaccine. 22% of participants who recovered from SARS-CoV-2 infection did not believe that the COVID-19 vaccine was effective compared with uninfected participants.

The highest percentage of vaccine hesitancy was found in first responders, especially with non-firefighter subcategories. Interestingly, a quarter of the reluctant population received the first dose of vaccine by May 2021. Researchers believe that more studies must be conducted to emphasize the importance of vaccinating individuals who recovered from the COVID-19 infection. This knowledge would help reduce vaccine hesitancy in this group.

Limitations of the study

The current study has many limitations; firstly, the follow-up surveys were spread for about six weeks because of the site’s IRB timelines. As the volume of information on COVID-19 disease and vaccines increased quickly, participants’ access to meaningful information enhanced during the study period, which influenced their ideas on vaccines over time. Another limitation associated with this study is that all KAPs are self-reported, and therefore, there is a possibility of incongruences between perceived knowledge and actual level of knowledge.

Although scientists are confident of capturing KAPs successfully in the study cohort, during the study period, there is a chance of evolution of KAPs with passing time as the COVID-19 vaccine is new. Another shortcoming of this study is that the authors failed to capture the mechanisms that influence the changes in KAPs. Therefore, it was difficult to assess why some KAPs changed between the two follow-up surveys. Researchers assumed that this might be because of the increasing evidence of more individuals who received the COVID-19 vaccine, and among them, only a few experienced serious side effects. Further, the quality and accessibility of information improved disease/vaccine literacy.


The current study on COVID-19 vaccine KAP responses by essential healthcare workers showed that although the rate of vaccine hesitancy was initially high, it decreased over time. The authors suggested that targeting messages about the safety and effectiveness of the COVID-19 vaccine would significantly increase vaccine uptake among reluctant individuals.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Lutrick, K. et al. (2021) “COVID-19 Vaccine Perceptions and Uptake in a National Prospective Cohort of Essential Workers”. medRxiv. doi: 10.1101/2021.10.20.21265288.

Content Source:

Gemma Wilson

Gemma is a journalism graduate with keen interest in covering business news – specifically startups. She has as a keen eye for technologies and has predicted quite a few successful startups over the last couple of years.

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