Vaccine hesitancy: What is it and how is it impacting long-term care?

Do you know someone who is on the fence about getting the coronavirus vaccine, or continues to delay the decision to get it? Delaying acceptance of vaccines or outright refusing them, despite their availability, is called vaccine hesitancy. While many people in Canada feel that vaccination should be a personal choice, it can be increasingly controversial when healthcare workers are vaccine hesitant and choose to remain unvaccinated.

Is vaccine hesitancy an issue in long-term care homes?

To get a clearer picture on vaccine hesitancy in healthcare, it helps to consider the disparity in vaccination rates between different healthcare roles. Among physicians, for instance, reports indicate that 96% have been vaccinated. However, this number drops significantly in the United States– to less than 50% – among nurses and senior living aides. Canada lacks detailed information on the vaccination of healthcare workers, but it is estimated that 1 in 10 are still unvaccinated, and the rate of immunization among long-term care staff lags behind that of residents. Such rates are particularly surprising when you consider the fact that long-term care facilities experienced the most severe impact during the first wave of the coronavirus pandemic. In Canada, research shows that more than 80% of all reported deaths from COVID-19 from March to August 2020 occurred in long-term care facilities.

While seniors remain the most at-risk population for COVID-19, healthcare workers in younger demographics are far from immune. The Canadian Institute for Health Information indicates that over 90,000 healthcare workers have been infected with COVID-19 since the beginning of the pandemic, 43 have died, and Personal Support Workers are 3.1 times more likely to be infected with COVID-19 than physicians and nurses.

Why are healthcare workers vaccine hesitant?

While vaccination efforts have been effective in reducing the spread of the coronavirus, the far more virulent Delta is once again causing outbreaks among patients in long-term care homes, mainly due to unvaccinated healthcare workers. With all the evidence in favour of vaccination, why are long-term care employees remain vaccine hesitant?

Studies of the issue indicate various rationales. Some believe that the vaccines are unsafe, believing they were developed in a compressed timeline and rushed to deployment without undergoing sufficient testing. Others favor natural or physiological immunity over vaccines – either from previous infection or by achieving herd immunity in the general population. Media misinformation has lowered levels of public trust, with some people's views on COVID-19 and vaccination shaped entirely by social media rather than credible news sources. Still others distrust the government and their recommendations, and assert their personal freedom and autonomy in refusing vaccination. Some believe the threat of the disease has been exaggerated by governmental health authorities. In some countries, including Canada, the availability of different types and brands of vaccines, reporting about them and the change in health policy around them, caused some people to lose confidence in the process and to refuse any and all available options, whether AstraZeneca, or the mRNA options, Pfizer or Moderna.

How does vaccine hesitancy among staff impact long-term care facilities?

Whatever the rationale, there is growing concern about unvaccinated healthcare workers from patients and the public. Despite the success of vaccination efforts over the past several months, cases are once again rising due to the much more virulent Delta variant, and outbreaks are occurring in long-term care homes. A recent outbreak at an Alberta continuing-care home put three units on lockdown, and families of patients were dismayed to learn that many of the patient care staff looking after their vulnerable relatives had chosen not to fully immunize.

In the court of public opinion, the general feeling is that professional and social responsibility should take precedence over personal freedoms in the healthcare context. This view is supported by many medical ethicists. Healthcare workers should be vaccinated to reduce the chances of spreading the virus to especially vulnerable populations, the elderly, ill and immunocompromised patients and residents, as well as to other healthcare staff and their families.  

What is the healthcare industry doing to address vaccine hesitancy?

Since having vaccinated employees is the best way to protect patients and staff and prevent outbreaks, healthcare facilities and long-term care homes are working on strategies for getting vaccine hesitant workers to stop delaying, visit the vaccination clinic and receive the jab. Some, like Houston Medical in Texas, are choosing to making vaccination mandatory for staff. That decision, in June 2021, resulted in vaccination refusals by 150 employees, who then either resigned or were fired. Many organizations are exploring strategies that actively encourage vaccination through access, education, or incentives, but are not making it mandatory. The Ontario provincial government, for instance, as part of new mandated immunization policies for staff, is requiring all unvaccinated healthcare workers to participate in an educational program on the benefits of vaccination, unless they cannot be vaccinated for a medical reason.

Whatever the strategy, the healthcare industry is working to curb vaccine hesitancy among workers, as vaccination is proving essential to reducing COVID-19 spread, infections and deaths.