Discussion

We identified COVID-19 vaccine hesitancy among nearly 20% of our children’s hospital work force. Vaccine hesitancy was more prevalent among members of our work force who identify as female, black, and/or Hispanic/Latinx. These race- and ethnicity-related associations have been described for COVID-19 vaccination ^{Reference Khubchandani, Sharma, Price, Wiblishauser, Sharma and Webb3} and are particularly concerning given the disproportionate impact of COVID-19 incidence and severity in black and Hispanic/Latinx populations in the United States. ^{Reference Stokes, Zambrano and Anderson4} Not surprisingly, vaccine hesitancy was associated with less concern about personal risk of severe COVID-19. Unexpectedly, vaccine hesitancy was 3 times more prevalent among individuals who identify themselves as having high-risk medical conditions, further highlighting the need for vaccine advocacy efforts among vulnerable patient populations. We identified specific COVID-19 concerns, especially concerns about vaccine safety related to novelty and speed of the clinical development process. Those expressing vaccine hesitancy identified their own medical doctor and national and local experts as trustworthy sources who can influence their vaccine decisions. Notably, social media was not valued as a tool for vaccine information, which is reassuring given the role of social media in disseminating vaccine misinformation. ^{Reference Puri, Coomes, Haghbayan and Gunaratne5}

These data have equipped our COVID-19 response team with knowledge to develop targeted vaccine education and advocacy strategies. With these data, we have planned the following 5-part program for our work force: (1) small group discussions with members of our environmental services, security, and food services department employees led by infectious diseases experts and physician leaders who identify as black and/or Hispanic/Latinx; (2) website link with answers to frequently asked questions that is accessible by smartphone; (3) vaccine information brochures in Spanish and English; (4) regular e-mail updates and virtual town hall meetings with question and answer sessions; and (5) videos of hospital clinical and administrative leaders receiving and discussing their decision to receive the vaccine. We plan additional advocacy and education efforts for the community.

Although this survey was performed after vaccine safety and efficacy data were available and initiation of hospital vaccine education efforts, the frequency of vaccine hesitancy was similar to the 22% vaccine hesitancy prevalence among nearly 2,000 non–healthcare workers in the United States who were surveyed prior to authorization of COVID-19 vaccines in the United States. ^{Reference Khubchandani, Sharma, Price, Wiblishauser, Sharma and Webb3} Although the survey was limited to a single pediatric center, this frequency of hesitancy may suggest that our data may be generalizable beyond our center.

This study has several limitations. Although the response rate was robust, we failed to receive responses from approximately one-third of our workforce. Because this survey was anonymous, we were unable to determine the characteristics of nonrespondents compared to respondents. The survey was completed immediately after the authorization of COVID-19 vaccine in the United States. It is unclear whether ongoing vaccine experience and uptake have impacted vaccine hesitancy since that time.

In summary, through an electronic survey of our children’s hospital workforce, we identified characteristics associated with vaccine hesitancy and identified specific concerns and communication preferences of our vaccine hesitant staff. These data have guided development of targeted vaccine education and advocacy strategies to improve the health of our workforce and safety of our healthcare environment.