The Willing-Unwilling: A Cross-Sectional Study to Explore Health Workers' Perceptions About the COVID-19 Vaccine

Background Health workers (HWs) are considered the most influential promoters of immunization. This notion, however, was challenged during COVID-19 when health workers in several countries asked for more information before supporting mass vaccination. In Pakistan, many health workers registered in the system but were delaying their vaccination during the early days. We conducted this study to assess the acceptance of the COVID-19 vaccine along with the reasons for delays or refusals among health workers in Pakistan.  Methods From a pool of 20,000 health workers registered to receive the vaccine, we called 500 randomly selected health workers (doctors, nurses, community health workers, pharmacists) via phone. Overwhelmed by their work during the pandemic, only 234 could complete the survey. The survey was done in the early weeks of the COVID-19 vaccine rollout (February-March 2021) to inform the policy. Results About 3/4^th of participants although willing, but were yet to vaccinate because 69 (39%) were busy in clinical duties, 28 (16%) were wary of its use in pregnancy or lactation, 23 (14%) had not received the text message with logistic details, 14 (8%) had a long distance from their vaccination center, 12 (7%) were currently having COVID-19 infection, while remaining 15-20% had a co-morbidity, were currently suspecting COVID-19 infection, or had just recovered from it. Chi-square tests did not reveal any significant association between gender and job designation with willingness. Conclusion Health workers have a high acceptance of new vaccines, yet policymakers must not expect that health workers will always be uniformly supportive of new vaccines. Health system strategies must include an ongoing process of documenting the information needs, questions, and apprehensions of health workers and addressing them in real time.