ABSTRACT
Objectives: The disruptions wrought by COVID-19 have spurred the development of vaccines at a pace unprecedented in global history. We have witnessed vaccine development from in vivo testing to population-wide implementation in just under 1 year. Singapore's vaccination rate of 80%, attained at the start of September 2021, marks a milestone. It signals that plans to shift from a "zero transmission” approach to an endemic "living with COVID-19” approach is headed in the right direction, albeit cautiously and with some uncertainty. Although we ask ourselves at what rate our society should be reopened, we acknowledge that such questions are not easily answered because newer variants are proving more transmissible and, possibly, vaccine resistant compared to earlier variants. Methods: COVID-19 vaccination milestones were plotted. A timeline was used to map key events of Singapore's vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites, and measures implemented to encourage vaccine uptake. These factors were compared with Singapore's vaccination rate from December 2020 to early September 2021. Results: The successful vaccination strategy in Singapore has been explored in 4 main areas: good leadership and evidence-based decision making, use of communications, utilizing existing logistics, and an ever-ready primary care. Conclusions: As we transition to our second year of combating COVID-19, emerging variants, spread despite vaccination, and the contesting voices of antivaxxers pose new challenges. Vaccine-generated immunity is only one, albeit an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support, and strengthened social responsibility. As providers of vaccination and translators of upstream evidence and policy decisions in the community, primary care providers should be involved early in decision making regarding interventions in the community because they can foresee challenges on the ground. Let us put our continued trust in primary care providers to contribute to making Singapore a COVID-19–resilient nation.
ABSTRACT
Objectives: COVID-19 booster uptake has remained poor among healthcare workers (HCWs) despite evidence of improved immunity against the SARS-COV-2 δ (delta) and ο (omicron) variants. Although most studies have used a questionnaire to assess hesitancy, we aimed to identify factors affecting booster hesitancy by examining actual vaccine uptake across time. Methods: COVID-19 vaccination database records were extracted for HCWs working at 7 Singaporean public primary-care clinics between January and December 2021. Data included sex, profession, place of practice, vaccination type, and dates. Time to booster was calculated from the date of vaccination minus the date of eligibility. The χ2 test was used to compare the relationship between first dose and booster hesitancy. The Kaplan-Meier method and the log-rank test were used to evaluate differences in cumulative booster uptake. Multivariate Cox regression was used to investigate predictors of timely booster vaccination. The vaccination rate was charted across time and was corroborated with media releases pertaining to legislative changes. Results: Of 891 primary-care HCWs, 877 (98.9%) were fully vaccinated and 73.8% of eligible HCWs had taken the booster. HCWs were less booster hesitant (median, 16 days;range, 5–31.3) compared to the first dose (median, 39 days;range, 13–119.3). First-dose–hesitant HCWs were more likely to be booster hesitant (OR, 3.66;95% CI, 2.61–5.14). Adjusting for sex, workplace, and time to first dose, ancillary HCWs (HR, 1.53;95% CI, 1.03–2.28), medical HCWs (HR, 1.8;95% CI, 1.18–2.74), and nursing HCWs (HR, 1.8;95% CI, 1.18–2.37) received boosters earlier than administrative staff. No temporal relationship was observed for booster uptake, legislative changes, or COVID-19 case numbers. Conclusions: Vaccine hesitancy among HCWs had improved from first dose to booster, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging, and strategic legislation might help reduce delayed booster vaccination. This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on December 28, 2021 (Reg No. 2021/01120).
ABSTRACT
Objectives: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary-care healthcare workers (HCWs) remain poorly understood. We sought to identify factors associated with vaccine acceptance and hesitancy among HCWs. Methods: A multicenter online cross-sectional survey was performed across 6 primary-care clinics from May to June 2021, after completion of the vaccination rollout. The following data were collected: demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19, and previous influenza vaccination. HCWs who accepted the vaccine were asked to rank their 5 best reasons for vaccine acceptance. HCWs who were vaccine hesitant completed the 5C scale on psychological antecedents of vaccination. Results: Of 1,182 eligible HCWs, 557 responded (response rate, 47.1%) and 29 were excluded due to contraindications. Among 557 respondents, the vaccine acceptance rate was 94.9% (n = 501) and 5.1% were hesitant (n = 27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk, or previous influenza vaccination. The 3 most common reasons for COVID-19 vaccine acceptance as ranked by 501 HCWs were (1) to protect their family and friends, (2) protect themselves from COVID-19, and (3) the high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCWs. The mean scores for the components of the 5Cs were ‘confidence' (3.96), ‘complacency' (3.23), ‘constraint' (2.85), ‘calculation' (5.79) and ‘collective responsibility' (4.12). Conclusions: COVID-19 vaccine hesitancy is a minute issue among primary-care HCWs in Singapore, where the acceptance rate is 95% with a 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates and acceptance of booster vaccinations with the emergence of the SARS-CoV-2 δ (delta) variant. Trial Registration: This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on April 26, 2021 (Reg No. 2021/00213).
ABSTRACT
Background: COVID-19 booster uptake remained poor among healthcare workers (HCW) despite evidence of improved immunity against Delta and Omicron variants. While most studies used a questionnaire to assess hesitancy, this study aimed to identify factors affecting true booster hesitancy by examining actual vaccine uptake across time. Method: COVID-19 vaccination database records among HCW working at 7 Singaporean public primary care clinics between January to December 2021 were extracted, with gender, profession, place of practice, vaccination type and dates. Time to booster was calculated from the date of vaccination minus date of eligibility. Chi-square test was used to compare relationship between 1st dose and booster hesitancy, Kaplan-Meier method and Log-rank test were adopted to evaluate differences in cumulative booster uptake. Multivariate cox regression was used to investigate predictors for timely booster vaccination. Vaccination rate was charted across time and corroborated with media releases pertaining to legislative changes. Results: 877 of 891 (98.9%) primary care HCW were fully vaccinated, 73.8% of eligible HCW had taken the booster. HCW were less booster hesitant [median 16 (5-31.3) days] compared to the 1st dose [median 39 (13-119.3) days]. 1st dose hesitant HCW were more likely to be booster hesitant (OR=3.66, 95%CI 2.61-5.14). Adjusting for sex, workplace and time to 1st dose, ancillary (HR=1.53, 95%CI 1.03-2.28), medical (HR=1.8, 95%CI 1.18-2.74) and nursing (HR=1.8, 95%CI 1.18-2.37) received boosters earlier compared with administrative staff. No temporal relationship was observed between booster uptake, legislative changes and COVID-19 infection numbers. Conclusion: Vaccine hesitancy among HCW had improved from booster to 1st dose, with timely booster vaccination among medical and nursing staff. Tailored education, risk messaging and strategic legislation might help to reduce delayed booster vaccination.
Subject(s)
COVID-19ABSTRACT
Background: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary healthcare workers (HCW) remain poorly understood. This study aims to identify factors associated with vaccine acceptance and hesitancy among HCW.MethodsA multi-centre online cross-sectional survey was performed across 6 primary care clinics from May to June 2021, after completion of vaccination exercise. Demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19 and previous influenza vaccination were collected. HCW who accepted vaccine were then asked to rank their top 5 reasons for vaccine acceptance; HCW who were vaccine hesitant had to complete the 5C scale on psychological antecedents of vaccination.Results557 out of 1182 eligible HCW responded (47.1%). 29 were excluded due to existing contraindications. Among 557 respondents, vaccine acceptance rate was 94.9% (n=501) and 5.1% were hesitant (n=27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk or previous influenza vaccination. The top 3 reasons for COVID-19 vaccine acceptance ranked by 501 HCW were to protect their family and friends, protect themselves from COVID-19 and due to high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCW. The mean scores for the components of the 5Cs were: ‘Confidence’ (3.96), ‘Complacency’ (3.23), ‘Constraint’ (2.85), ‘Calculation’ (5.79) and ‘Collective responsibility’ (4.12).ConclusionCOVID-19 vaccine hesitancy is a minute issue among Singapore primary HCW, having achieved close to 95% acceptance rate with 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates, and acceptance of booster vaccinations with the emergence of the delta COVID-19 variant.Trial RegistrationThis study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on 26th April 2021 (Reg No. 2021/00213).