COVID-19 vaccination refusal and suspension of work among healthy healthcare personnel in Italy: A cross-sectional study of their knowledge and attitudes toward vaccinations.

Despite the initial optimistic projections from various countries and the evidence that vaccination against coronavirus disease 2019 (COVID-19) reduces the associated hospitalization rates and mortality, vaccine hesitancy and refusal among healthcare personnel (HCP) became a major public health concern globally. The aim of this survey was to estimate the knowledge about the Italian Vaccination Plan for HCP and attitudes about occupational vaccinations for HCP among Italian HCP who refused COVID-19 vaccination and were suspended from work. A total of 52 HCP participated in the study. Nurses were the prevalent profession among vaccination refusers. About COVID-19, 24 (26.2%) of all responders have been involved in COVID-19 care and 21 (40.4%) had a history of COVID-19. None had received influenza and pneumococcus vaccination in the past. Knowledge of vaccinations recommended for HCP was high, ranging from 75% to 98% by vaccine. Instead, all HCP were against any mandatory vaccination policy for all HCP. Finally, most HCP questioned the expected benefits and safety of vaccines in general, raised issues of mistrust of information provided for authorities and of compliance with their HCP' vaccination recommendations. Our study indicates good knowledge of occupational vaccinations but strong anti-vaccination beliefs among Italian HCP who refused COVID-19 vaccination and were suspended from work.

Evaluation of Cardiovascular Activity and Emotional Experience in Healthcare Workers (HCWs) Operating in COVID-19 Wards.

The new 2019 coronavirus or SARS-CoV-2 has been the first biological agent to generate, in this millennium, such a global health emergency as to determine the adoption of public health measures. During this sanitary emergency, the emotional experience of healthcare workers (HCWs) has been hugely tested by several factors. In fact, HCWs have been exposed to greatly tiring physical, psychological and social conditions. The authors investigated the cardiocirculatory activity of a group of HCWs as well as how they perceived stress while working in COVID-19 wards. In particular, every HCW underwent a medical check, an electrocardiographic base exam, systolic and diastolic pressure measurement, and cardio frequency measurement. Furthermore, each HCW was provided with a cardiac Holter device (HoC) and a pressure Holter (Hop). Some psychological factors were considered in order to quantify the stress perceived by each HCW while at work through the administration of two questionnaires: the "Social Stigma towards Patients due to COVID Scale (SSPCS)" and the "Professional Quality of Life Scale (ProQOL)". The HoC and HoP analysis results for HCWs working in COVID-19 OU wards showed significant variations in cardiocirculatory activity. From the analysis of the SSPCS questionnaire answers, it is clear that all of them showed a sense of duty towards their patients. The analysis of the ProQOL questionnaire answers showed that the prevailing attitude is fear; however, HCWs did not absolutely discriminate against those who had COVID-19 nor did they refuse to help those in need. Continuous monitoring of these employees, also carried out through occupational medicine surveillance, allows for the detection of critical conditions and the implementation of actions aimed at preventing chronic processes.

Vaccination policies for healthcare personnel: Current challenges and future perspectives.

Healthcare personnel (HCP) are at occupational risk for acquisition of several vaccine-preventable diseases and transmission to patients. Vaccinations of HCP are justified to confer them immunity but also to protect susceptible patients and healthcare services from outbreaks, HCP absenteeism and presenteeism. Mandatory vaccination policies for HCP are increasingly adopted and achieve high and sustainable vaccination rates in short term. In this article we review the scientific evidence for HCP vaccination. We also address issues pertaining to vaccination policies for HCP and present the challenges of implementation of mandatory versus voluntary vaccination policies. Finally, we discuss the issue of mandatory vaccination of HCP against COVID-19.

Health Occupation and Job Satisfaction: The Impact of Psychological Capital in the Management of Clinical Psychological Stressors of Healthcare Workers in the COVID-19 Era.

The COVID-19 pandemic greatly impacted global health. Frontline healthcare workers involved in the response to COVID-19 faced physical and psychological challenges that threatened their wellbeing and job satisfaction. The pandemic crisis, alongside pre-existing critical issues, exposed healthcare workers to constant emotional fatigue, creating an increased workload and vulnerability to stress. Maintaining such stress levels increased their levels of anxiety, irritability and loneliness. Evidence shows that the Psychological Capital (PsyCap) was a strong protective factor against these stressors. The aim of this study was to analyze the level of job satisfaction among health workers facing the COVID-19 pandemic. The possible antecedent factors to satisfaction and the role that PsyCap plays in preserving and fostering higher levels of job satisfaction were investigated. A total of 527 healthcare workers from different areas of Italy were recruited for the study. The results revealed that psychological stress factors have a considerable impact on job satisfaction. All four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and Irritability) had the potential to decrease job satisfaction. Loneliness had a more significant effect than other factors assessed in this study. Moreover, the results showed how PsyCap could decrease the effects of psychological stressors on job satisfaction. Consistent with previous studies, our findings show that PsyCap could alleviate negative impacts in work-related circumstances.

Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19.

In Italy, following the start of the SARS-CoV-2 vaccination campaign, community pharmacies (CPs) were recruited on a voluntary basis in order to administer COVID-19 vaccines as part of their activities. The aim of the present study was to investigate the knowledge, attitudes, and practices regarding SARS-CoV-2 infection prevention, and vaccine acceptance/hesitancy towards COVID-19 and influenza vaccinations among the community pharmacists operating in the Palermo Province. A cross-sectional study was conducted, with two different questionnaires administered before and after the conduction of the vaccination campaign against SARS-CoV-2 at the COVID-19 vaccination center of the Palermo University Hospital (PUH). The baseline survey showed that 64% of community pharmacists (CPs) declared that they planned to vaccinate against SARS-CoV-2, and 58% were vaccinated against influenza during the 2020/2021 season. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines (adjOR 1.76; CI 1.11-2.80), fear of contracting SARS-CoV-2 infection (adjOR 1.50; CI 1.06-2.11), considering COVID-19 vaccination to be the best strategy to counteract SARS-CoV-2 (adjOR 1.79; CI 1.39-2.29), and adherence to influenza vaccination during the 2020/2021 season (adjOR 3.25; CI 2.23-4.25). The adherence among CPs of the Palermo Province to COVID-19 vaccination was 96.5%. From the post-vaccination survey, the main reasons for changing opinions on vaccination adherence were the introduction of mandatory vaccinations, fear of contracting COVID-19, and limitations on work activities in the case of vaccine refusal. The achievement of very high COVID-19 vaccination coverage rates among healthcare professionals (HCPs) in the present study was mainly due to the mandatory vaccination policies; nevertheless, a willingness for COVID-19 vaccination was relatively high among pharmacists before the beginning of the vaccination campaign. HCPs and CPs should receive training on vaccination, which is recommended in the national immunization plan and is also suggested by the respondents in our study, in order to routinely re-evaluate their own vaccination profiles, as well as those of their patients.

COVID-19 Pandemic: New Prevention and Protection Measures

As of the end of February 2021, more than 420,000,000 confirmed cases of COVID-19 have been reported worldwide, with 5,856,224 deaths. Transmission of the different genetically engineered variants of SARS-CoV-2, which have been isolated since the beginning of the pandemic, occurs from one infected person to another by the same means: the airborne route, indirect contact, and occasionally the fecal–oral route. Infection is asymptomatic or may present with flulike symptoms such as fever, cough, and mild to moderate and severe respiratory distress, requiring hospitalization and assisted ventilation support. To control the spread of COVID-19, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have indicated that the appropriate use of personal protective equipment (PPE), as well as the adoption of effective hygiene systems, is one of the primary prevention measures for the entire population. Companies and institutions around the world are therefore trying to find the best ways to reorganize their operations, minimizing the risk of infection among their employees, in order to protect their health and prevent internal outbreaks of SARS-CoV-2, including through the development of new technologies that could also be an innovative and driving factor for the relaunch of companies in a more sustainable, ethically correct, and safe for the health of employees perspective. On the basis of the above premises, in view of the coexistence with SARS-CoV-2 that will most likely accompany us in the coming years, and in view of the vaccination campaign adopted worldwide, the purpose of our narrative review is to update the previous operational protocols with the latest scientific knowledge to be adopted in the workplace even when the emergency crisis is over.

Vaccination coverage rates and attitudes towards mandatory vaccinations among healthcare personnel in tertiary-care hospitals in Greece.

OBJECTIVES: Our aim was to estimate vaccination and susceptibility rates against vaccine-preventable diseases among healthcare personnel (HCP) in eight hospitals. METHODS: Cross-sectional survey. RESULTS: A total of 1284 HCP participated (physicians: 31.3%, nursing personnel: 36.6%, paramedical personnel: 11.1%, administrative personnel: 13.2%, supportive personnel: 7.3%). Vaccination rates were 32.9% against measles and mumps, 38.1% against rubella, 5.7% against varicella, 9.2% against hepatitis A, 65.8% against hepatitis B, 31.8% against tetanus-diphtheria, 7.1% against pertussis, 60.2% against influenza, and 80.1% against COVID-19. Susceptibility rates were as follows: 27.8% for measles, 39.6% for mumps, 33.4% for rubella, 22.2% for varicella, 86.3% for hepatitis A, 34.2% for hepatitis B, 68.2% for tetanus-diphtheria, and 92.9% for pertussis. Older HCP had higher susceptibility rates against mumps, rubella, varicella, hepatitis A, hepatitis B, tetanus-diphtheria, and pertussis (p-values <0.001 for all). Mandatory vaccinations were supported by 81.85% of HCP. CONCLUSIONS: Although most HCPs supported mandatory vaccinations, significant vaccination gaps, and susceptibility rates were recorded. The proportion of susceptible HCP to measles, mumps, rubella, and varicella has increased in the past decade, mostly because of reduction in acquired cases of natural illness. Vaccination programs for HCP should be developed. A national registry to follow HCP's vaccination rates is urgently needed.

The Italian Version of the Adult Vaccine Hesitancy Scale (aVHS) for the Working-Age Population: Cross-Cultural Adaptation, Reliability, and Validity.

The adult Vaccine Hesitancy Scale (aVHS) is valid and reliable for evaluating attitudes toward vaccine preventable diseases (VPDs). The aim of the present study was to evaluate the cross-cultural adaptation, reliability, and validity of the Italian version of the aVHS. After cross-cultural adaptation of the aVHS, internal consistency (IC), intra-class correlation (ICC), and content validity (S-CVI) were evaluated through a survey on 160 workers. Results of the ICC were analyzed on questionnaires administered twice at a distance of two months and revealed a satisfactory reproducibility (0.87). The IC of the aVHS was assessed by the Cronbach alpha coefficient test, with a result of 0.94, demonstrating an excellent IC reliability. The S-CVI calculated for the total scale was 0.97. The aVHS is a valid and reliable tool for evaluating vaccine hesitancy toward adult vaccinations. We suggest the use of this scale in upcoming surveys on opinions and perceptions of adult vaccinations.

SARS-CoV-2 mRNA Vaccine Breakthrough Infections in Fully Vaccinated Healthcare Personnel: A Systematic Review.

The number of people vaccinated against COVID-19 increases worldwide every day; however, it is important to study the risk of breakthrough infections in vaccinated individuals at high risk of exposure such as healthcare personnel (HCP). A systematic literature review (SLR) applying the PRISMA declaration and the PECOS format using the following entry terms was used: "Health Personnel OR Healthcare Worker OR Healthcare Provider OR Healthcare Personnel AND breakthrough OR infection after vaccine*". The research was carried out utilizing the following databases: SCOPUS, PubMed, Embase, and Web of Sciences. An overall very low incidence of post-vaccination breakthrough infections was found, ranging from 0.011 to 0.001 (per 100 individuals at risk). Our findings further support the published high effectiveness rates of mRNA vaccines in preventing SARS-CoV-2 infections among fully vaccinated HCP. Additional studies are needed to define the duration of the vaccine-induced protection among HCP.

Survey on COVID-19-related mortality associated with occupational infection during the first phase of the pandemic: A systematic review

According to the Centre for Disease Control and Prevention in 2020, a cluster of pneumonia cases of unknown etiology caused by the severe acute respiratory syndrome (SARS)-coronavirus 2 was reported in Wuhan, China. The present review examined the literature to reveal the incidence of novel coronavirus-2019 disease (COVID-19) infections, underlying comorbidities, workplace infections and case fatality rates. A review was performed to identify the relevant publications available up to May 15, 2020. Since the early stages of the COVID-19 outbreak, the case fatality rate among healthcare workers (HCWs) has stood at 0.69% worldwide and 0.4% in Italy. Based on the current information, most patients have exhibited good prognoses in terms of after-effects or sequelae and low mortality rate. Patients that became critically ill were primarily in the elderly population or had chronic underlying diseases, including diabetes and hypertension. Among all working sectors, HCWs, since they are front-line caregivers for patients with COVID-19, are considered to be in the high-risk population. Increased age and a number of comorbidity factors have been associated with increased risk of mortality in patients with COVID-19. The most frequent complications of COVID-19 reported that can cause fatality in patients were SARS, cardiac arrest, secondary infections and septic shock, in addition to acute kidney failure and liver failure. Overcoming the COVID-19 pandemic is an ongoing challenge, which poses a threat to global health that requires close surveillance and prompt diagnosis, in coordination with research efforts to understand this pathogen and develop effective countermeasures. [ FROM AUTHOR] Copyright of Experimental & Therapeutic Medicine is the property of Spandidos Publications UK Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Alcohol Abuse and Insomnia Disorder: Focus on a Group of Night and Day Workers.

The sleep-wake cycle plays a fundamental role in maintaining the physiological balance of our body. Its alteration favours the genesis of several organic alterations and diseases including sleep disorders and the consumption of several substances of abuse. It has been reported that the work activity, especially that carried out during the night, is able to influence the sleep-wake cycle, promoting the development of insomnia, which, in turn, would subject the worker to a stressful condition such as to encourage adverse behaviour such as the use/abuse of psychotropic substances. Based on the above premises, the aim of our research was to evaluate, in night workers: (i) the pattern of consumption of alcoholic beverages; (ii) the presence of insomnia; and (iii) the possible correlation between alcohol consumption and insomnia disorder. We used the AUDIT-C test (the abbreviated version of the Alcohol Use Disorders Identification Test) and the Insomnia Severity Index to assess alcohol consumption and insomnia disorder, respectively. All questionnaires were completed by workers of both sexes belonging to different types of work activities, exclusively day or night. The results of our research show a higher propensity of night workers to consume alcoholic beverages than those who work during daytime hours, often in binge-drinking mode. In addition, an increase in the amount of alcohol consumed was found to be related to insomnia disorder, especially in night workers. This study provides further awareness of the importance of the negative impact of alcohol consumption on sleep quality in night workers.

How to investigate human health effects related to exposure to mixtures of per- and polyfluoroalkyl substances: A systematic review of statistical methods.

BACKGROUND: Humans are exposed to several per- and polyfluoroalkyl substances (PFAS) daily; however, most previous studies have focused on individual PFAS. Although attention to effects of exposure to mixtures of PFAS has grown in recent years, there is no consensus on the appropriate statistical methods that can be used to assess their combined effect on human health. OBJECTIVES: We aim to perform a comprehensive review of the statistical methods used in the existing studies which evaluate the association between exposure to mixtures of PFAS and any adverse human health effect. METHODS: The online databases PubMed, Embase and Scopus were searched for eligible studies, published during the last ten years (last search performed on April 08, 2021). Covidence software was used by two different reviewers to perform a title/abstract screening, followed by a full text revision of the selected papers. RESULTS: A total of 3640 papers were identified, and after the screening process, 53 papers were included in the current review. Most of the studies were published between 2019 and 2021 and were conducted mainly in North America and Europe; more than half of the studies (28 out of 53) were conducted on mother and child pairs. WQS (Weighted Quantile Sum) Regression and BKMR (Bayesian Kernel Machine Regression) were used in 36 out of 53 papers to model mixtures' effects. Health outcomes included in the studies are immunotoxicity (n = 8), fetal development (n = 7), neurodevelopment (n = 9), reproductive hormones (n = 6), thyroid hormones (n = 7), outcomes related to metabolic pathways (n = 16). CONCLUSION: Studies on human exposure to PFAS as complex mixtures and health consequences have substantially increased in the last few years. Based on our findings, we propose that addressing risk from PFAS mixtures will likely require combinations of approaches and implementation of constantly evolving statistical methods. Specific guidelines and tools for quality assessment and publication of mixture observational studies are warranted.

Home Working and Physical Activity during SARS-CoV-2 Pandemic: A Longitudinal Cohort Study.

BACKGROUND: Due to the SARS-CoV-2 pandemic, human lifestyles and occupational settings have changed in the workplace. This survey explores associations of home working employment and related physical activity (PA-MET min/week). METHODS: A longitudinal cohort study was conducted between March 2020 and March 2021. A standardized method for assessing PA and sedentary time, the Italian version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF), was used through the Microsoft Forms® platform for self-administering the questionnaire. Baseline data were collected, and four follow-ups were performed; a full calendar year was observed. RESULTS: In total, 310 home workers were recruited in this investigation. The average body mass index (BMI- kg/m2) was 21.4 ± 4.2 at baseline. The value increased at the first follow-up and fluctuated in the other recalls. The t-test of MET values of the four activities (Total PA, Vigorous-intensity activity, Moderate-intensity activity, Walking) show similar results; the total PA, at baseline 275.7 ± 138.6, decreased statistically significantly at the first (198.5 ± 84.6), third (174.9 ± 98.4), and fourth (188.7 ± 78.5) follow-ups, while it increased statistically significantly at the second follow-up (307.1 ± 106.1) compared to the baseline. Sedentary time was constant until the second follow-up, while it increased statistically significantly at the 3rd and 4th follow-up. CONCLUSION: workers involved reduced and reorganized their PA during this pandemic year. Each business company should intervene to improve the PA levels of workers and reduce sedentary behavior in the workplace.

Survey on COVID-19-related mortality associated with occupational infection during the first phase of the pandemic: A systematic review.

According to the Centre for Disease Control and Prevention in 2020, a cluster of pneumonia cases of unknown etiology caused by the severe acute respiratory syndrome (SARS)-coronavirus 2 was reported in Wuhan, China. The present review examined the literature to reveal the incidence of novel coronavirus-2019 disease (COVID-19) infections, underlying comorbidities, workplace infections and case fatality rates. A review was performed to identify the relevant publications available up to May 15, 2020. Since the early stages of the COVID-19 outbreak, the case fatality rate among healthcare workers (HCWs) has stood at 0.69% worldwide and 0.4% in Italy. Based on the current information, most patients have exhibited good prognoses in terms of after-effects or sequelae and low mortality rate. Patients that became critically ill were primarily in the elderly population or had chronic underlying diseases, including diabetes and hypertension. Among all working sectors, HCWs, since they are front-line caregivers for patients with COVID-19, are considered to be in the high-risk population. Increased age and a number of comorbidity factors have been associated with increased risk of mortality in patients with COVID-19. The most frequent complications of COVID-19 reported that can cause fatality in patients were SARS, cardiac arrest, secondary infections and septic shock, in addition to acute kidney failure and liver failure. Overcoming the COVID-19 pandemic is an ongoing challenge, which poses a threat to global health that requires close surveillance and prompt diagnosis, in coordination with research efforts to understand this pathogen and develop effective countermeasures.

Considerations on the Update of the Risk Assessment Document During the Pandemic State by COVID-19 in Italy.

Immediately after the outbreak of the SARS-CoV-2 epidemic (which had risen to the level of a pandemic according to the World Health Organization), the question arose whether or not to update the risk assessment, which, as required by Legislative Decree 81/2008, with the consequent updating of the prevention measures. In light of these forecasts, we asked ourselves whether the risk of coronavirus infection should be taken into account by the employer by updating the risk assessment or not. An in-depth analysis of current legislation has led to the conclusion that the biological risk from SARS-CoV-2 is to be considered specific only in health-related activities, in other activities it can be considered exclusively generic or generic aggravated. The Risk Assessment Document can therefore only be integrated.

What Prompts Doctors to Recommend COVID-19 Vaccines: Is It a Question of Positive Emotion?

Vaccines are among the most successful and cost-effective public health tools and have greatly contributed to eliminating or controlling several serious vaccine-treatable diseases over the past century. To curb the spread of COVID-19, efficacious vaccination is emerging as essential in mitigating the disease and preventing deaths. Health care workers (HCW) are one of the first groups to receive vaccinations, so it is important to consider their attitudes to COVID-19 vaccination to better address barriers to widespread vaccination acceptance. This study aimed to evaluate variables that are linked with the recommendation of vaccines and intention to take-up vaccination against COVID-19 among the HCWs, in the context of the current pandemic. The study was conducted during the first week of the vaccination campaign dedicated to Italian HCWs, beginning in December 2020, and it involved all doctors in a public hospital in Sicily. The following questionnaires were administered: (1) The perceived vaccine trust questionnaire, measuring the degree of trust in vaccines by healthcare professionals both in general and for the protection of healthcare professionals themselves and patients; (2) the positive and negative affect scale-state (PANAS), for assessing positive and negative emotions in relation to their work as "frontline care providers"; (3) The locus of control of behaviour (LCB) to measure the extent to which subjects perceive responsibility for their personal behaviour (internal vs. external); (4) recommendation vaccines item, referring to the intention to recommend vaccination. The findings suggest that socio-demographic control variables (age, gender, and seniority) showed little or no predictive power in vaccine recommendation, while vaccine confidence, positive emotions, and internal locus of control were excellent predictors of vaccine recommendations by doctors. Younger doctors, both in age and experience, are more confident in vaccines and recommend them more frequently. It is essential to improve institutional communication addressed to doctors to enhance their role as vaccination facilitators.

SARS-CoV-2 Seroprevalence Post-First Wave among Primary Care Physicians in Catania (Italy).

Family physicians or pediatricians and general practitioners (GPs) work in non-hospital settings. GPs usually visit many patients, frequently at their homes, with low potential, if any, to control the work setting. Particularly during the initial phases of the COVID-19 outbreak, they were not informed about the occurrence of SARS-CoV-2-infected patients, with inadequate information regarding the risk, a lack of suitable protective measures and, in some cases, deficient or poor accessibility to personal protective equipment (PPE). During the first wave of COVID-19, primary care physicians were on the front line and isolated the first cases of the disease. The present study aims to estimate the seroprevalence of SARS-CoV-2 in a cohort of 133 GPs working in Catania (Italy) after the first wave of COVID-19. Serological analysis revealed a low seroprevalence (3%) among GPs. The low seroprevalence highlighted in the results can be attributed to correct management of patients by GPs in the first wave. It is now hoped that mass vaccination, combined with appropriate behavior and use of PPE, can help further reduce the risk of COVID-19 disease.

Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece.

BACKGROUND: To investigate intention rates to get vaccinated against COVID-19 among healthcare personnel (HCP) in Greece. METHODS: Cross-sectional survey. RESULTS: The response rate was 14.5%. Of 1521 HCP with a known profession, 607 (39.9%) were nursing personnel, 480 (31.6%) physicians, 171 (11.2%) paramedical personnel, 72 (4.7%) supportive personnel, and 191 (12.6%) administrative personnel. Overall, 803 of 1571 HCP (51.1%) stated their intention to get vaccinated while 768 (48.9%) stated their intention to decline vaccination. Most HCP (71.3%) who reported intent to get vaccinated noted contributing to the control of the pandemic and protecting their families and themselves as their reasons, while the most common reason for reporting intent to decline vaccination was inadequate information about the vaccines (74.9%), followed by concerns about vaccine safety (36.2%). Logistic regression analysis revealed that the probability of intending to get vaccinated increased with male gender, being a physician, history of complete vaccination against hepatitis B, history of vaccination against pandemic A (H1N1) in 2009-2010, belief that COVID-19 vaccination should be mandatory for HCP, and increased confidence in vaccines in general during the COVID-19 pandemic. The following factors were associated with a lower intention to get vaccinated: no vaccination against influenza the past season, no intention to get vaccinated against influenza in 2020-2021, and no intention to recommend COVID-19 vaccination to high-risk patients. CONCLUSION: There is an urgent need to built safety perception towards COVID-19 vaccines and raise vaccine uptake rates by HCP, and thus to protect the healthcare workforce and the healthcare services.