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Since the emergence of SARS-CoV-2, healthcare workers have been on the frontline caring for COVID-19 patients, and consequently are at high risk of becoming infected with the virus and spreading it to others. "Healthcare workers are three times more at risk of getting COVID-19 than the general population"(Maraqa et al., 2021). Ending the pandemic rests partly on a large uptake of COVID-19 vaccines, with a goal of reaching herd immunity.  Being first in line to be vaccinated makes some healthcare personnel hesitant to get the vaccine.

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Goal: Increase vaccination rates.

"Every year in the United States, many people get diseases that vaccines can prevent. Healthy People 2030 focuses on preventing infectious diseases by increasing vaccination rates" (U.S. Department of Health and Human Services, n.d.)

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-Healthcare workers, including clinical and non-Clinical personnel, in a healthcare system, inpatient and ambulatory care setting,  in the Midwest.

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The goal of this project is to decrease vaccine hesitancy among healthcare workers at the hospital I work for.

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Evaluation will include comparing the percentage of total employees vaccinated on a weekly basis. This will be completed by having a COVID-19 Dashboard that drills down to department level. At this time the COVID-19 vaccine is not mandatory so the access to this dashboard will be limited to Employee Health staff.   This will help determine the need for additional interventions to be deployed.

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#1)   Increase the total percentage of employees who  received their COVID-19 vaccine to reach a goal of 75% of all staff vaccinated.

#2) Increase accessibility of the COVID-19 vaccine to employees.

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Evaluation will include monitoring the number of COVID-19 vaccines given on a weekly basis at each Employee Health and OccMed clinic.

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There are six identified steps to build vaccine confidence which decreases vaccine hesitancy, increasing vaccine uptake.
"1) Encourage senior leaders to be vaccine champions
2) Host discussions where personnel at different levels can provide input and ask questions
3) Share key messages with staff through emails, breakroom posters, and other channels
4) Educate healthcare teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to others about the vaccines
5) Educate non-medical staff about the importance of getting vaccinated
6) Make the decision to get vaccinated visible, and celebrate it"  (Center for Disease Control, 2021).

By implementing these interventions  two of the three identified factors contributing to vaccine hesitancy are addressed.  Applying the HBM  while implementing specifically Intervention #2 will allow for education on the risk of disease and transmission which will result in an increased knowledge of susceptibility to the illness. Allowing discussion will identify barriers, both perceived and actual, by allowing for increased knowledge for those who are  hesitant. Allowing time for questions to be answered breaks down barriers by discussing the facts or myths.

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Share clear, complete, and accurate messages about COVID-19 vaccines and take visible actions to build trust in the vaccine, the vaccinator, and the system in coordination with federal, state, and local agencies and partners.
Action Steps:

Communicate transparently about the process for authorizingexternal icon , approving, making recommendations for, monitoring the safety of, distributingexternal icon , allocating, and administering COVID-19 vaccines, including data handling.

Provide regular updates on: benefits, safety, side effects and effectiveness; clearly communicate what is not known.

Proactively address and mitigate the spread and harm of misinformation via social media platforms, partners, and trusted messengers.

Empower Healthcare Personnel

Promote confidence among healthcare personnel* in their decision to get vaccinated and to recommend vaccination to their patients.
Action Steps: *Personnel = All staff working in healthcare settings, including physicians, PAs/NPs, nurses, allied health professionals, pharmacists, support staff, and community health workers.

Engage Communities and Individuals

Engage communities in a sustainable, equitable, and inclusive way-using two-way communication to listen, build trust, and increase collaboration.
Action Steps:

Empower vaccine recipients to share their personal stories and reasons for vaccination within their circles of influence.

Work with health departments and national partners to engage communities around vaccine confidence and service delivery strategies, including adaptation of vaccination provider sites to meet community needs.

Collaborate with trusted messengers-such as faith-based and community leaders-to tailor and share culturally relevant messages and materials with diverse communities.

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Vaccinate with Confidence COVID-19 Vaccines Strategy

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Share clear, complete, and accurate messages about COVID-19 vaccines and take visible actions to build trust in the vaccine, the vaccinator, and the system in coordination with federal, state, and local agencies and partners. Action Steps: Communicate transparently about the process for authorizingexternal icon , approving, making recommendations for, monitoring the safety of, distributingexternal icon , allocating, and administering COVID-19 vaccines, including data handling.

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The COVID-19 vaccine is an example of primary prevention, “prevention measures that prevent the onset of illness or injury before the disease process begins” (Baker). HBM was developed in the 1950’s to understand preventive health behavior.  “Major concepts of HBM include perceived susceptibility to illness and severity of the illness, along with perceived benefits and barriers to preventive or treatment actions (Frenn and Whitehead, 2021 p. 39).

The HBM will be helpful in conniving messages to increase vaccination by increasing benefits while decreasing barriers.  When communicating with employees in person, virtually (email), or via signage (flyers) in an effort to increase utilization, it is essential to include changes of getting sick, how serious the health problem is, what is it in for them if they change, what are the costs, can they actually do the behavior, and what will help remind me to do it? (CommunicateHealth, 2013)

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Kwok (2021) describe vaccine hesitancy as, "a behavior with delay in acceptance or refusal of vaccines despite available services."

In 2019 The World Health Organization (WHO) considered vaccine hesitancy a global threat.

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Contributing Factors of Vaccine Hesitancy 

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Contributing Factors of Vaccine Hesitancy 

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"1)  Individuals may lack confidence in and be fearful towards vaccines, especially with the misunderstanding that vaccines pose a risk of infection
2) Individuals do not perceive a need for a vaccine (e.g. due to under- estimation of disease severity) or do not value the vaccine
3) Individuals or community may have difficulties accessing the vaccine"    (Kwok et al., 2021).

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Kwok (2021) surveyed 1205 nurses regarding the influenza vaccine uptake rate and the proportion intending to take COVID-19 vaccine. results were 49% and 63%, respectively.

Maraqa (2021) examined 1159 healthcare workers on their intention of receiving the COVID-19 vaccine.  37.8% had intentions of getting vaccinated, 31.5% were undecided, and 30.
7% planned to refuse it.

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An identified contributing factor of vaccine hesitancy is accessibility to the vaccine.  To increase accessibility of the COVID-19 vaccine to employees, each new hire will be offered the COVID-19 vaccine at the time of their post offer health assessment. This will ensure all new employees coming into the healthcare system have been given the opportunity to discuss importance and questions associated with the vaccine. Also, Employee Health and OccMed will offer the COVID-19 vaccine in their clinics on a walk-in basis as well as provide an on-site clinic once per week in the hospital, free of charge to employees.

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Baker, J. (n.d.). Disease Prevention and Healthy Lifestyles: Three levels of health promotion/disease prevention. Lumen. https://courses.lumenlearning.com/diseaseprevention/chapter/three-levels-of-health-promotiondisease-prevention/.

Centers for Disease Control and Prevention. (2021, February 22). Vaccinate with Confidence: COVID-19 Vaccines Strategy. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence/strategy.html.

Chevallier, C., Hacquin, A.-S., & Mercier, H. (2021). COVID-19 vaccine hesitancy: shortening the last mile. Trends in Cognitive Sciences, 25, 331–333. https://doi.org/10.31234/osf.io/xchj6

CommunicateHealth. (2013, November 21). Useful Theory: Health Belief Model. CommunicateHealth. https://communicatehealth.com/wehearthealthliteracy/useful-theory-health-belief-model/.

Dadgarmoghaddam, M., Khajedaluee, M., Rezaiyan, M. K., Lightner, A., Heckelsmiller, C., Hagen, E. H., Al-Yousef, H. M., Ali, W., Sales, I., Glascock, M. D., Barker, A., Barbat, I. A., Virag, C., Raven, M., Wittman, R., Everett, M. W., Rowntree, J. E., & Smyth, N. (2020, April 24). Figure 2. The Health Belief Model  . ResearchGate. https://www.researchgate.net/figure/The-Health-Belief-Model_fig2_295839499.

Frenn, M., & Whitehead, D. K. (2021). Health promotion: translating evidence to practice. F.A. Davis Company.

Kwok, K. O., Li, K.-K., WEI, W. I., Tang, A., Wong, S. Y., & Lee, S. S. (2021). Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey. International Journal of Nursing Studies, 114. https://doi.org/10.1016/j.ijnurstu.2020.103854

Maraqa, B., Nazzal, Z., Rabi, R., Sarhan, N., Al-Shakhra, K., & Al-Kaila, M. (2021). COVID-19 vaccine hesitancy among health care workers in Palestine: A call for action. Preventive Medicine, 149. https://doi.org/10.1016/j.ypmed.2021.106618

Paris, C., Bénézit, F., Geslin, M., Polard, E., Baldeyrou, M., Turmel, V., Tadié, É., Garlantezec, R., & Tattevin, P. (2021). COVID-19 vaccine hesitancy among healthcare workers. Infectious Diseases Now. https://doi.org/10.1016/j.idnow.2021.04.001

Shmueli, L. (2021). Predicting intention to receive COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10816-7

U.S. Department of Health and Human Services. (n.d.). Vaccination. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination.

Vergara, R. J., Sarmiento, P. J., & Lagman, J. D. (2021). Building public trust: a response to COVID-19 vaccine hesitancy predicament. Journal of Public Health, 43(2), 291–292. https://doi.org/10.1093/pubmed/fdaa282