Highlights
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Analysing the context in which health professionals accept influenza vaccination.
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The analysis will help develop strategies to promote vaccination.
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Reasons for acceptance or refusal of the influenza vaccine in the COVID-19 context.
Keywords: Human influenza; Influenza vaccines; COVID-19 vaccines; COVID-19, attitudes; Vaccination coverage
Abstract
Background
With the outbreak of the SARS-CoV-2 pandemic, the uncertainty about the real impact of coinfection with other viruses, and the increased risk of mortality in the case of coinfection with the influenza virus, health authorities recommended an increase in influenza vaccination coverage among at-risk groups to minimize the possible impact on individuals and the healthcare system. Recommendations for influenza vaccination during the 2020–2021 campaign in Catalonia were focused on increasing vaccination coverage, especially for social and healthcare workers, elderly people and at-risk individuals of any age. The objectives for the 2020–2021 season in Catalonia were to reach 75 % for the elderly and for social and healthcare workers, and 60 % for pregnant women and at-risk groups. In the case of healthcare professionals and those over 65 years of age, the target was not met. Vaccination coverage reached 65.58 % and 66.44 %, respectively (in the 2019–2020 campaign it was 39.08 %).
Analysing and following up on the background and context in which health professionals accept influenza vaccination will help develop strategies for long-term influenza vaccination campaigns. The present study looks at healthcare professionals in a specific territory where the reasons for acceptance or refusal of the influenza vaccine during the 2021–2022 vaccination campaign, as well as the reasons for acceptance or refusal of the COVID-19 vaccine, were analysed by means of an online survey.
Methods
Calculations suggested that a random sample of 290 individuals would be sufficient to estimate, with 95% confidence and a precision of +/- 5 percentage units, a population percentage that was expected to be around 30%. The required replacement rate was 10%.
The R statistical software (version 3.6.3) was used for the statistical analysis. Confidence intervals were 95 % and contrasts with a p-value of < 0.05 were considered significant.
Findings
Of the 1921 professionals to whom the survey was sent, 586 (30.5%) responded to all the questions. 95.2% of respondents were vaccinated against COVID-19 and 66.2% against influenza.
It was observed that the relationship between sociodemographic characteristics and the decision to get vaccinated was different for influenza and COVID-19. The reasons for accepting the COVID-19 vaccine with the highest percentage were firstly protecting family (82.2%), self-protection (74.9%) and also protecting patients (57.8%). Otherwise, other reasons not described in the survey (50%) and mistrust (42.3%) were the reasons for rejecting the COVID-19 vaccine.
Regarding influenza, the most relevant reasons for which professionals got vaccinated were self-protection (70.7%), protecting family (69.7%) and protecting patients (58.4%). Reasons for refusing the influenza vaccine were reasons not mentioned in the survey (29.1%) and the low probability of suffering complications (27.4%).
Interpretation
Analysing the context, territory, sector, and the reasons for both accepting and refusing a vaccine will help develop effective strategies. Although vaccination coverage against COVID-19 was very high throughout Spain, a marked increase in influenza vaccination in the context of COVID-19 was observed among healthcare professionals in the Central Catalonia region compared to the previous pre-pandemic campaign.
Introduction
Since the outbreak of the SARS-CoV-2 pandemic, all organisations, such as the World Health Organisatoin (WHO), focused their efforts on controlling and stopping the spread of the virus [1]. As such, every-one paid attention to the proposed measures, including hand washing, masks or the development of vaccines, to try to reduce the associated comorbidity.
The rapid development of vaccines to combat COVID-19, different vaccines approved for the same use with different effectiveness rates, potential side effects, and the effectiveness of vaccines towards emerging variants were reasons for intensifying public concerns and different attitudes towards vaccines throughout the pandemic [2], [3], [4]. A study by Andres et al. showed that the perception of the usefulness of the vaccine, a favourable social influence and the perception of risk were variables that significantly influenced the intention to get vaccinated [5]. A survey of 5,234 healthcare professionals in France determined that items related to social conformity and trust in the system contributed to explaining the intention to get vaccinated against COVID-19 [6]. Saüch et. al. showed that the main reasons for the population deciding to get vaccinated were the fear of infecting family or of being infected themselves [7]. Similarly, Moirangthem et al. showed that one of the main reasons for health professionals’ intention to get vaccinated against COVID-19 was also for their family, apart from believing that the vaccine provided more benefits than risks and that there was no perceived fear of side effects [6]. Despite these doubts, vaccination coverage against COVID-19 was very high worldwide: 66.3 % of the world population has received at least one dose of the vaccine the number increases to 88.24 % for Spain [8].
With the emergence of the pandemic, the uncertainty about the real impact of coinfection with other viruses, and the increased risk of mortality in the case of coinfection with the influenza virus, health authorities recommended an increase in influenza vaccination coverage among at-risk groups to minimize the possible impact on individuals and the healthcare system [9], [10]. For this reason, recommendations for influenza vaccination during the 2020–2021 campaign in Catalonia were focused on increasing vaccination coverage, especially for social and healthcare workers, elderly people and at-risk individuals of any age [11]. The objectives for the 2020–2021 season in Catalonia were to reach 75 % for the elderly and for social and healthcare workers, and 60 % for pregnant women and at-risk groups [11]. In the case of healthcare professionals and those over 65 years of age, both fell short of the target. Vaccination coverage reached 65.58 % and 66.44 % respectively, despite having achieved an increase compared to the previous campaign (in the 2019–2020 campaign it was 39.08 %) [12]. In the case of pregnant women, the target was reached with 62.30 %.
Analysing and following up on the background and context (such as that of COVID-19) in which health professionals accept influenza vaccination will help develop strategies for improving long-term influenza vaccination campaigns.
In this context, in 2020, the Territorial Management of the Catalan Institute of Health (ICS) of Central Catalonia initiated a project with the aim of analysing whether they had been vaccinated against influenza in the previous campaign in the pre-pandemic stage (2019–2020), and what their intention was for the next campaign (2020–2021) [13]. In this preliminary study, a survey was carried out among all the professionals of the ICS of Central Catalonia. Of the 610 participants, 65.7 % intended to get vaccinated against influenza in that campaign, while 11.1 % did not know or did not respond. Intention to get vaccinated was associated with professional category and number of years of professional practice, as well as with vaccination history, physical presence on duty, and the perception of whether their dependents were at risk of falling ill. In order to be able to develop strategies focused on increasing vaccination coverage in this sector and particular region taking into account the new situation of the COVID-19 pandemic, during the 2021–2022 campaign, the survey was once again given to all professionals to find out if they had been vaccinated against influenza in the previous campaign (2020–2021) and the reasons why they had accepted or refused the vaccine. In addition, as during 2021 the COVID-19 vaccination campaign was initiated and influenza vaccination coverages had increased, possibly due to the pandemic [14], [15], the opportunity was taken to ask whether they had been vaccinated and the reasons which had led them to accept or refuse this vaccine.
Methods
Study design
A cross-sectional study to observe the reasons for acceptance or refusal of the influenza vaccine during the 2020–2021 vaccination campaign, as well as the reasons in relation to the COVID-19 vaccine, by means of an online survey aimed at ICS professionals in Central Catalonia. The survey (Annex I) is based on a previous survey conducted by Apiñaniz to study the acceptability of an influenza A (H1N1) vaccine [16].
Sample
The scope of the study is all ICS professionals belonging to the Central Catalonia Health Region, which includes the counties of Anoia, Bages, Berguedà, Moianès and Osona. The study period coincided with the influenza vaccination campaign, from October 2021 to the first quarter of 2022. A total of 1,921 professionals were invited to take the survey via corporate email. In order to achieve a high response rate, the invitation was sent up to three times. The first on 18 November 2021, the second on 24 November and the last reminder was sent on 15 December 2021.
Inclusion criteria were as follows: 1) Categories from: Group A1 (general practitioners, paediatricians, dentists, pharmacists, and senior technicians), Group A2 (nurses, midwives, social workers, and management technicians), Group C1 (administrative employees, and technical specialists), Group C2 (pharmacy technicians, nursing assistants, administrative assistants, drivers, and maintenance personnel) and Group GP (janitors or others).
2) Have an indication for influenza vaccination due to belonging to the group of health professionals. 3) Agree to participate in the study voluntarily, with informed consent and by responding to the self-administered online questionnaire distributed through corporate email.
Statistical analysis
The survey was sent to all ICS professionals belonging to the Central Catalonia Health Region, in particular to 1921 professionals.
The data derived from the survey responses was used to perform a descriptive statistical analysis. Categorical variables were described by absolute frequencies and percentages. Continuous variables were described with the mean and standard deviation. To relate two categorical variables, the X2 test of independence was used. Logistic regression was adjusted to determine the effect of sociodemographic variables on influenza and COVID-19 vaccination. The results of the logistic regression were represented by the Odds Ratio and its confidence interval.
The R statistical software (version 3.6.3) was used for the statistical analysis. Confidence intervals were 95 % and contrasts with a p-value lower than 0.05 were considered significant.
Results
Of the 1921 professionals to whom the survey was sent, 586 (30.5 %) completed it. Table 1 shows the sociodemographic characteristics of said professionals. The vast majority are female (83.4 %), the mean age of respondents were 46.8 (sd = 11.5), 67.4 % are married or have a partner, and 70.8 % present no risk factors. 87.9 % of respondents do not have physical and/or mental dependent people in their care. Regarding professional categories, the vast majority belong to group A2 (35.0 %) and A1 (27.8 %). Of all the professional categories, the majority do not carry out in-person on-call shifts (56.1 %). We can see that while 38.6 % of the respondents have more than 21 years of experience, 25.3 % have lower than 5.
Table 1.
Description of the sample of professionals who responded to the survey.
| N = 586 | |
|---|---|
| n (%) | |
| Gender | |
| Woman | 489 (83.4 %) |
| Man | 94 (16.0 %) |
| Age | 46.8 (11.5)* |
| < 30 | 204 (27.9 %) |
| [30, 45) | 166 (22.7 %) |
| [45–60) | 279 (38.2 %) |
| ≥60 | 82 (11.2 %) |
| Civil status | |
| Married - couple | 395 (67.4 %) |
| Separated – divorced | 57 (9.73 %) |
| Single | 111 (18.9 %) |
| Widowed | 8 (1.37 %) |
| Others | 15 (2.56 %) |
| Risk factors | |
| No | 415 (70.8 %) |
| Yes | 171 (29.2 %) |
| Professional category | |
| A1 | 163 (27.8 %) |
| A2 | 205 (35.0 %) |
| C1 | 53 (9.04 %) |
| C2 | 162 (27.6 %) |
| GP | 3 (0.51 %) |
| Employment situation | |
| Temporary or substitute | 115 (19.6 %) |
| Permanent | 209 (35.7 %) |
| Interim | 243 (41.5 %) |
| Resident | 19 (3.24 %) |
| Years of professional practice | |
| <5 years | 148 (25.3 %) |
| 5–10 years | 68 (11.6 %) |
| 11–15 years | 66 (11.3 %) |
| 16–20 years | 78 (13.3 %) |
| ≥21 years | 226 (38.6 %) |
| On-call rotation | |
| No | 329 (56.1 %) |
| Yes | 257 (43.9 %) |
| Dependent people | |
| No | 515 (87.9 %) |
| Yes | 71 (12.1 %) |
| Dependent children | |
| No | 387 (66.0 %) |
| Yes | 199 (34.0 %) |
*Mean and standard desviation.
A description of the influenza vaccination in the 2020–2021 campaign and of the first vaccination against COVID-19 of the professionals who responded to the survey is shown in Table 2. In this context, 95.2 % of respondents were vaccinated against COVID-19 and 66.2 % against influenza.
Table 2.
Description of the vaccination against influenza 2020–2021 and against COVID-19 (first vaccination) of the professionals who responded to the survey.
| COVID vaccination |
Flu vaccination |
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|---|---|---|---|---|---|---|---|---|
| Yes (n (%)) | No (n (%)) | Did not know (n (%)) | P-valuea | Yes (n (%)) | No (n (%)) | Did not know (n (%)) | P-valuea | |
| Total* | 558 (95.2 %) | 24 (4.1 %) | 4 (0.7 %) | (91,9; 96,3) | 388 (66.2 %) | 190 (32.4 %) | 8 (1.4 %) | (62.2; 70.0) |
| Gender | 0.287 | 0.720 | ||||||
| Woman | 464 (94.9 %) | 23 (4.70 %) | 2 (0.41 %) | 327 (66.9 %) | 156 (31.9 %) | 6 (1.23 %) | ||
| Man | 93 (98.9 %) | 1 (1.06 %) | 0 (0.00 %) | 59 (62.8 %) | 33 (35.1 %) | 2 (2.13 %) | ||
| Age | 0.010 | 0.355 | ||||||
| <30 | 198 (98.5 %) | 2 (1.0 %) | 1 (0.5 %) | 141 (70.1 %) | 56 (27.9 %) | 4 (1.99 %) | ||
| [30, 45) | 159 (95.8 %) | 7 (4.2 %) | 0 (0 %) | 101 (60.8 %) | 62 (37.3 %) | 3 (1.81 %) | ||
| [45–60) | 267 (95.7 %) | 9 (3.2 %) | 3 (1.1 %) | 197 (70.6 %) | 80)28.7 %) | 2 (0.72 %) | ||
| >60 | 73 (89.0 %) | 8 (9.8 %) | 1 (1.2 %) | 56 (68.3 %) | 25 (30.5 %) | 1 (1.22 %) | ||
| Civil status | 0.001 | 0.102 | ||||||
| Married - couple | 383 (97.0 %) | 11 (2.78 %) | 1 (0.25 %) | 275 (69.6 %) | 114 (28.9 %) | 6 (1.52 %) | ||
| Separated – divorced | 51 (89.5 %) | 5 (8.77 %) | 1 (1.75 %) | 37 (64.9 %) | 19 (33.3 %) | 1 (1.75 %) | ||
| Single | 105 (94.6 %) | 6 (5.41 %) | 0 (0.00 %) | 62 (55.9 %) | 48 (43.2 %) | 1 (0.90 %) | ||
| Widowed | 7 (87.5 %) | 1 (12.5 %) | 0 (0.00 %) | 3 (37.5 %) | 5 (62.5 %) | 0 (0.00 %) | ||
| Others | 12 (80.0 %) | 1 (6.67 %) | 2 (13.3 %) | 11 (73.3 %) | 4 (26.7 %) | 0 (0.00 %) | ||
| Risk factors | 1 | <0.001 | ||||||
| No | 395 (95.2 %) | 17 (4.10 %) | 3 (0.72 %) | 251 (60.5 %) | 157 (37.8 %) | 7 (1.69 %) | ||
| Yes | 163 (95.3 %) | 7 (4.09 %) | 1 (0.58 %) | 137 (80.1 %) | 33 (19.3 %) | 1 (0.58 %) | ||
| Professional category | 0.087 | <0.001 | ||||||
| A1 | 156 (95.7 %) | 7 (4.29 %) | 0 (0.00 %) | 130 (79.8 %) | 32 (19.6 %) | 1 (0.61 %) | ||
| A2 | 197 (96.1 %) | 7 (3.41 %) | 1 (0.49 %) | 152 (74.1 %) | 49 (23.9 %) | 4 (1.95 %) | ||
| C1 | 49 (92.5 %) | 3 (5.66 %) | 1 (1.89 %) | 31 (58.5 %) | 22 (41.5 %) | 0 (0.00 %) | ||
| C2 | 154 (95.1 %) | 7 (4.32 %) | 1 (0.62 %) | 74 (45.7 %) | 85 (52.5 %) | 3 (1.85 %) | ||
| GP | 2 (66.7 %) | 0 (0.00 %) | 1 (33.3 %) | 1 (33.3 %) | 2 (66.7 %) | 0 (0.00 %) | ||
| Employment situation | 0.965 | <0.001 | ||||||
| Temporary or substitute | 111 (96.5 %) | 4 (3.48 %) | 0 (0.00 %) | 56 (48.7 %) | 57 (49.6 %) | 2 (1.74 %) | ||
| Permanent | 197 (94.3 %) | 10 (4.78 %) | 2 (0.96 %) | 149 (71.3 %) | 57 (27.3 %) | 3 (1.44 %) | ||
| Interim | 231 (95.1 %) | 10 (4.12 %) | 2 (0.82 %) | 165 (67.9 %) | 75 (30.9 %) | 3 (1.23 %) | ||
| Resident | 19 (100 %) | 0 (0.00 %) | 0 (0.00 %) | 18 (94.7 %) | 1 (5.26 %) | 0 (0.00 %) | ||
| Years of professional practice | 0.130 | 0.019 | ||||||
| <5 years | 146 (98.6 %) | 2 (1.35 %) | 0 (0.00 %) | 79 (53.4 %) | 66 (44.6 %) | 3 (2.03 %) | ||
| 5–10 years | 62 (91.2 %) | 6 (8.82 %) | 0 (0.00 %) | 43 (63.2 %) | 24 (35.3 %) | 1 (1.47 %) | ||
| 11–15 years | 62 (93.9 %) | 3 (4.55 %) | 1 (1.52 %) | 45 (68.2 %) | 21 (31.8 %) | 0 (0.00 %) | ||
| 16–20 years | 76 (97.4 %) | 2 (2.56 %) | 0 (0.00 %) | 55 (70.5 %) | 22 (28.2 %) | 1 (1.28 %) | ||
| ≥21 years | 212 (93.8 %) | 11 (4.87 %) | 3 (1.33 %) | 166 (73.5 %) | 57 (25.2 %) | 3 (1.33 %) | ||
| On-call rotation | 0.289 | <0.001 | ||||||
| No | 316 (96.0 %) | 10 (3.04 %) | 3 (0.91 %) | 190 (57.8 %) | 135 (41.0 %) | 4 (1.22 %) | ||
| Yes | 242 (94.2 %) | 14 (5.45 %) | 1 (0.39 %) | 198 (77.0 %) | 55 (21.4 %) | 4 (1.56 %) | ||
| Dependent people | 0.441 | 0.272 | ||||||
| No | 490 (95.1 %) | 22 (4.27 %) | 3 (0.58 %) | 339 (65.8 %) | 170 (33.0 %) | 6 (1.17 %) | ||
| Yes | 68 (95.8 %) | 2 (2.82 %) | 1 (1.41 %) | 49 (69.0 %) | 20 (28.2 %) | 2 (2.82 %) | ||
| Dependent children | 0.273 | 0.187 | ||||||
| No | 366 (94.6 %) | 19 (4.91 %) | 2 (0.52 %) | 247 (63.8 %) | 135 (34.9 %) | 5 (1.29 %) | ||
| Yes | 192 (96.5 %) | 5 (2.51 %) | 2 (1.01 %) | 141 (70.9 %) | 55 (27.6 %) | 3 (1.51 %) | ||
* The 95% confidence interval has been calculated for the total sample and is indicated in the p-value column.
Chi-square contrast and significant p-values are shown in bold.
We can see that the relationship between sociodemographic characteristics and the decision to get vaccinated was different for influenza and COVID-19.
Regarding COVID-19 vaccination, a significant correlation was found with marital status; that is, married/partnered and single persons got vaccinated more than separated/divorced, widowed or other situations. An inverse correlation was also observed between age and the decision to get vaccinated against COVID-19; the older the professionals are, the less they get vaccinated.
Regarding influenza vaccination, a significant correlation was detected with the associated risk factors, i.e., professionals with risk factors (80.1 %) got vaccinated more against influenza than those without associated risk factors. A significant correlation was also observed with professional category; professionals with a higher professional category got vaccinated more than those with a lower professional category. The other significant correlation was with employment situation, where we can see that the professionals who are doing their residency are the ones who got vaccinated the most (94.7 %), followed by the professionals with a permanent employment contract (71.3 %). Finally, it should be noted that a significant correlation was observed with experience and in-person on-call shifts; those with more experience and who carry out in-person on-call shifts got vaccinated more against influenza.
The survey also asked about the reasons for consciously deciding to accept or refuse vaccination against influenza and COVID-19. The survey included a question on acceptance or rejection with multiple choice responses (Table 3). The research team created the different reasons for acceptance or rejection depending on whether it was for influenza or COVID-19.
Table 3.
Reasons for acceptance/refusal of influenza vaccine and COVID-19.
| COVID vaccination (n %) | Flu vaccination (n %) | |
|---|---|---|
| Acceptation | ||
| Self-protection | 522 (74,9%) | 350 (70,7%) |
| Ethics | 72 (10,3%) | 175 (35,4%) |
| Family protection | 573 (82,2%) | 345 (69,7%) |
| Others | 24 (3,44 %) | 9 (1,82 %) |
| Recommendations | 285 (40,9%) | 162 (32,7%) |
| Patients’ protection | 403 (57,8%) | 289 (58,4%) |
| Exemplariness | – | 141 (28,5%) |
| Minimize transmission | 311 (44,6%) | – |
| Rejection | ||
| No other pathology | 0 (0 %) | 53 (23,8%) |
| Others | 13 (50,0%) | 65 (29,1%) |
| Natural infection | 6 (23,1%) | 23 (10,3%) |
| Low probability of complications | 2 (7,7%) | 61 (27,4%) |
| Distrust effectiveness | 11 (42,3%) | 28 (12,6%) |
| Fear of side effects | 7 (26,9%) | 33 (14,8%) |
| Others measures | 3 (11,5%) | 36 (16,1%) |
| Relative people | – | 1 (0,45 %) |
| Distrust safety | 0 (0 %) | 11 (4,93 %) |
| Pharmaceutical distrust | 5 (19,2%) | 4 (1,79 %) |
| Distrust management | 6 (23,1%) | 4 (1,79 %) |
| Technology | 1 (3,85 %) | – |
Table 3 shows that the highest percentages of acceptance reasons for the COVID-19 vaccine were protecting family (82.2 %), self-protection (74.9 %) and protecting patients (57.8 %). Otherwise, other reasons not described in the survey (50 %) and mistrust (42.3 %) are the reasons for professionals rejecting the COVID-19 vaccine.
For influenza, the most relevant reasons for which professionals got vaccinated were self-protection (70.7 %), protecting family (69.7 %) and protecting patients (58.4 %). Reasons for refusing the influenza vaccine were reasons not mentioned in the survey (29.1 %) and the low probability of suffering complications (27.4 %).
Logistic regression was performed in Table 4 to measure the effects of sociodemographic variables on vaccination for both influenza and COVID-19. Regarding influenza vaccination, we can see that professionals with risk factors and those carrying out in-person on-call shifts got vaccinated more (OR = 2.4 CI 95 % (1.54–2.89) and 1.7 CI 95 % (1.13–2.85) respectively). We can also see how vaccination decreases as the professional category decreases.
Table 4.
Logistic regression of COVID-19 and flu vaccination.
| COVID-19 vaccination |
Flu vaccination |
|||||
|---|---|---|---|---|---|---|
| OR | 95 % CI | P-value | OR | 95 % CI | P-value | |
| Gender | ||||||
| Man | 6,25 | (1,16; 116,92) | 0,085 | 0,83 | (0,48; 1,45) | 0,503 |
| Age | 0,94 | (0,88; 0,99) | 0,045 | 1 | (0,98; 1,03) | 0,792 |
| Civil status | ||||||
| Separated – divorced | 0,48 | (0,15; 1,80) | 0,248 | 0,82 | (0,42; 1,62) | 0,554 |
| Single | 0,39 | (0,13; 1,28) | 0,102 | 0,65 | (0,38; 1,12) | 0,120 |
| Widowed | 0,22 | (0,03; 4,93) | 0,221 | 0,32 | (0,06; 1,49) | 0,156 |
| Others | 0,35 | (0,04; 7,64) | 0,384 | 1,67 | (0,48; 6,81) | 0,440 |
| Risk factors | ||||||
| Si | 0,90 | (0,35; 2,53) | 0,836 | 2,42 | (1,54; 3,89) | <0,001 |
| Professional category | ||||||
| A2 | 1,45 | (0,44; 4,82) | 0,534 | 0,89 | (0,50; 1,56) | 0,682 |
| C1 | 0,52 | (0,11; 2,89) | 0,416 | 0,48 | (0,23; 1,01) | 0,051 |
| C2 | 0,73 | (0,18; 3,01) | 0,652 | 0,39 | (0,21; 0,73) | 0,003 |
| GP | – | – | – | – | – | – |
| Employment situation | ||||||
| Temporary or substitute | 0,58 | (0,11; 3,57) | 0,539 | 0,74 | (0,35; 1,56) | 0,422 |
| Interim | 1,03 | (0,33; 3,45) | 0,953 | 1,00 | (0,58; 1,71) | 0,997 |
| Resident | – | – | – | 7,06 | (1,14; 138,57) | 0,079 |
| Years of professional practice | ||||||
| <5 years | 1,96 | (0,24; 20,52) | 0,54 | 0,67 | (0,30; 1,47) | 0,318 |
| 5–10 years | 0,30 | (0,05; 1,54) | 0,151 | 0,61 | (0,28; 1,36) | 0,228 |
| 11–15 years | 0,63 | (0,14; 3,52) | 0,571 | 0,58 | (0,27; 1,25) | 0,166 |
| 16–20 years | 1,34 | (0,29; 9,74) | 0,732 | 0,74 | (0,38; 1,45) | 0,372 |
| On-call rotation | ||||||
| Si | 0,30 | (0,10; 0,82) | 0,051 | 1,79 | (1,13; 2,85) | 0,013 |
| Dependent people | ||||||
| Si | 2,09 | (0,54; 13,89) | 0,348 | 1,18 | (0,64; 2,23) | 0,602 |
| Dependent children | ||||||
| Si | 1,76 | (0,59; 6,04) | 0,329 | 1,25 | (0,79; 1,96) | 0,329 |
Reference categories: woman, Married - couple, No risk factors, A1 group, Permanent, > 5 years, No on-call rotation, no dependent people, no dependent children.
Significant p-values are shown in bold.
About the COVID-19 vaccine, only age was found to be significant; results show less vaccination with increasing age (OR = 0.940 % (0.88–0.99)).
Discussion
In order to be able to develop strategies for long-term influenza vaccination campaigns, and to describe the main reasons for acceptance or refusal of the influenza and COVID-19 vaccines, this study analyses the background and context in which health professionals in Central Catalonia accepted both vaccines during a stage of pandemic.
Influenza vaccination coverage for healthcare professionals throughout Catalonia was 30.98 %, and 39.08 % in the rest of Spain [17], [18] during the 2019–2020 campaign. In contrast, the vaccination coverage for health professionals in Central Catalonia who responded to the survey during the same campaign was much higher, at 61.1 %. In the following influenza campaign (2020–2021), data from the Department of Health showed that coverage had increased to 42.5 % and to 66.2 % among the Central Catalonia professionals who responded to the survey, likely due to the lack of knowledge of the possible consequences in case of a possible coinfection with SARS-CoV-2 [9] Both results fell short of the 75 % target set by national and European health authorities for the at-risk groups defined by the WHO [19]. A previous study conducted in the same region and population in the context of the SARS-CoV-2 pandemic found that an increase in vaccination coverage among professionals could be achieved as they had a higher intention to get vaccinated against influenza, despite not reaching the 75 % proposed by the WHO and the ECDC [13]. Although influenza coverage monitoring sources have shown an upward trend, it is necessary to establish strategies to raise awareness and inform health professionals in order to achieve the percentage proposed by the WHO and the ECDC. In this context, the results of the present study and others suggest that the pandemic produced by SARS-CoV-2 has been a catalyst for increasing influenza vaccination [20], [21].
The main reasons among healthcare professionals in Central Catalonia for accepting the influenza vaccine were firstly self-protection, followed by protecting family and protecting patients. In contrast, health care professionals at a hospital in Rome [22] indicated that the main reason was because of the similarity of the symptoms to COVID-19. In the same country, the main reasons among healthcare professionals in Italy were that vaccination is the most effective prevention strategy, followed by patient protection [23]. As in a previous study carried out by our group, we can see that, in this last campaign, the professionals who were most vaccinated against influenza are those who have more risk factors (OR = 2.4 (1.54; 2.89)). In addition, those who reported having fewer risk factors listed it as their main reason for rejection [13]. In the context of the outbreak of the pandemic caused by COVID-19, the increase in influenza vaccination among healthcare professionals observed in this study is relevant. Although health authorities recommended an increase in influenza vaccination coverage among healthcare workers, this could also be attributed to a sense of responsibility on the part of healthcare workers. It should be noted that the primary health care centres in COVID-19 were overcrowded, and health care workers were working under high pressure. Likewise, logistic regression showed that the presence of risk factors predisposed professionals to be more likely to get vaccinated against influenza. In this context, vaccination against influenza is highly recommended for all persons with risk factors, as a measure to reduce the associated comorbidity. Although those with concomitant chronic conditions may be more aware of the need for annual vaccination, and therefore more likely to accept the influenza vaccine, there is a need to further inform on the likelihood of becoming infected through their caregiving and infecting the patients they care for. Otherwise, bivariate analysis also showed that professional category had a significant impact on vaccination in the same way as has been shown in other studies [24], [25].
In the region of Central Catalonia, 95.2 % of all professionals surveyed were vaccinated against COVID-19. This percentage was very high compared to other European regions, such as in Central Greece where the vaccination coverage rate against COVID-19 was 74 % [26]. The main reasons for accepting the COVID-19 vaccine were firstly for protecting family, followed by self-protection and protecting patients, the first two coinciding with the results of a study where the main reasons for COVID-19 vaccination were asked for among the general population of our region [7].
This same study found that married or partnered individuals and single individuals were more likely to get vaccinated than those who were separated/divorced, widowed or in other situations. The current study confirmed that in the same region, married or partnered and single professionals were more vaccinated against COVID-19.
However, a significant gradient between age and vaccination against COVID-19 was observed; the older the age, the lower the vaccination coverage. This result coincides with a study on the intention to vaccinate against COVID-19 in the general population in Italy, where they observed an OR = 0.5 (0.43; 0.57) at older than 30, versus the younger population. Although age was one of the main risk factors for hospitalisation and death in cases of SARS-COV-2 infection and was reflected in the vaccination prioritisation strategies [27].
We can also see that a significant reason for refusing the COVID-19 vaccine was mistrust, as other studies have already reported [28], [29]. Although the results show only 4.8 % refusal, communication and education strategies are still needed in order to increase information circulation among the general public and to achieve improvements in vaccination coverage for both influenza and COVID-19 vaccines. According to the results of this study, communication and education strategies in the region of Central Catalonia should focus on young professionals without risk factors and in categories C1, C2 and GP. Raising awareness of protection among patients could be key to increasing vaccination coverage.
Strengths and limitations
The study was carried out in a region of the autonomous community of Catalonia (Spain), specifically in the Catalan Institute of Health of Central Catalonia, and 83.4 % of the people who responded to the survey belonged to the female gender. It is worth taking into account that there may be a bias in the representativeness of the sample. However, of the total of 1921 professionals working in the ICS-Central Catalonia, 78.70 % are female and conducting these surveys in specific settings is interesting when it comes to determining strategies for the next vaccination campaigns.
It should be noted that the participating professionals who responded to the survey may have been motivated by vaccination issues and could represent a certain selection bias. An attempt was made to minimize the issue by sending the voluntary survey to all professionals in the region and reminders sent up to three times.
Conclusions
Analysing the context, territory, sector and reasons for both accepting and rejecting a vaccine is helpful when it comes to developing effective strategies for improving vaccination coverage. In this context, we not only analysed the sociodemographic characteristics that have a significant impact on acceptance or rejection, but we were also able to analyse the explicit reasons why professionals acted in one way or another. For future research, it could consider conducting qualitative studies in order to understand the reasons for refusing the flu vaccination. In this sense, the strategies to increase influenza vaccination coverage will be more targeted and effective. Although vaccination coverage against COVID-19 was very high throughout Spain, a marked increase in influenza vaccination in the context of COVID-19 was observed among healthcare professionals in the Central Catalonia region compared to the previous pre-pandemic campaign.
Data availability
Data will be made available on request.
Ethical considerations
The study protocol was approved by the University Institute for Primary Care Research (IDIAP) Jordi Gol Health Care Ethics Committee (Code 20/177-PCV).
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data availability
Data will be made available on request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data will be made available on request.
Data will be made available on request.