As COVID-19 vaccines became available, countries put the vaccination of healthcare workers as a priority, due to the importance of their protection. The attitudes of healthcare workers towards vaccination can strongly affect their decision of vaccine intake as well, the opinion and attitude of the general population towards vaccination (Paudel et al. 2021).
Regarding the acceptability of the COVID-19 vaccine among physicians, the present study showed that only 24.3% of the included physicians accepted to take the vaccine when available while 36.7% of them refused to take it and 39% would wait for a review before deciding to take it.
Comparable findings were reported by another study done in Egypt by Fares et al., as they found that 21% of HCWs were willing to take the COVID-19 vaccine and 28% were not willing while the largest percentage of their participants were found undecided (51%) (Fares et al.2021).
Nearly similar findings were found in other countries in Africa by Nzaji et al. as they found in their study in the Democratic Republic of Congo that about 28% of HCWs were willing to take the COVID-19 vaccines when available (Nzaji et al. 2020).
However, in Ghana, Agyekum et al., found that39.3%of HCWs accepted to get the COVID-19 vaccines while more than half of them indicated non-acceptance (Agyekum et al. 2021).
In Saudi Arabia, Qattan et al., in their study found that more than half of their healthcare workers were willing to take the COVID-19 vaccine if it is provided free by their government, while 49.48% were not willing (Qattan et al. 2021).
A lower percent of vaccine refusal was reported in the United States, as Shekhar et al., in their study reported that only 8% of HCWs refused to be vaccinated, with a higher percentage of them accepted to take the vaccine (36%) while the greatest percent was the HCW who waited for a review before being vaccinated (56%) (Shekhar et al. 2021). Nearly similar percent of vaccine acceptance was reported by Paudel et al., in Nepal (38.3% of their participants) (Paudel et al. 2021).
A higher percent of COVID-19 vaccines acceptance was detected in the United States as Shaw et al. found that 58% of HCWs accepted to get the vaccine if available (Shaw et al. 2021).
Also, in Canada and Belgium, the level of COVID-19 vaccine acceptance was high in 48.6% of the physicians, 23 % showed moderate acceptance while only 28.4% showed hesitancy towards vaccination (Verger P et al.2021). A much higher rate of physicians' acceptance was recorded by an Canadian study, as Dzieciolowska et al., found that 80.9% accepted to take the vaccine while only 19.1% refused (Dzieciolowska et al. 2021).
According to the authors’ point of view, these differences in willingness to take COVID-19 vaccines among different countries may be attributed to the high prevalence of conspiracy theories about COVID-19 as it was intentionally introduced into the world to get benefits on developing vaccines for it. Also, the spread of misinformation about the quality and safety of COVID-19 vaccines especially among developing countries affect the level of vaccine acceptance among people including physicians and other healthcare workers.
The current study showed that 19.2% of the included physicians were diagnosed with COVID-19 and 41.6% had a family member diagnosed with COVID-19. Comparable results were reported by Qattan et al., in their study among HCWs in Saudi Arabia (Qattan et al. 2021).
Lower percent of HCWs who were diagnosed or had family members diagnosed with COVID-19 were reported by Paudel et al., in Nepal (13.9% and 9% respectively) and by Shekhar et al., in United States (2.6% and 13% respectively) (Paudel et al. 2021 and Shekhar et al. 2021). On contrary, Fares et al., in their study in Egypt, found that more than one-third of their HCWs were previously diagnosed with COVID-19 (Fares et al. 2021).
Regarding how the Egyptian physicians perceived the risk of acquiring COVID-19 during the next year, more than half of our included physicians believed that they may get the disease but with mild symptoms that may not require hospitalization. On the other hand, 9.8% were sure that they will not get COVID-19 and only 1.3% believed that they will get a serious disease that may require admission to the intensive care unit.
In the United States, Shekhar et al.2021 found that the majority of their participants thought that they are at risk to get COVID-19 with a higher percentage than ours of HCWs (21%) who thought that they may be at risk of getting a serious disease that may require hospitalization with less than 8% were confident that they will not get COVID-19 (Shekhar et al. 2021). Furthermore, in Saudi Arabia, Qattan et al. 2021 found that the majority of HCWs believed that COVID-19 poses a significant risk to the people of Saudi Arabia (Qattan et al.2021). These findings may explain the reported higher level of vaccine acceptance among HCWs in the United States and Saudi Arabia more than in Egypt.
The current study showed that 32.5% of physicians were directly taking care of COVID-19 patients, while about half of the HCWs in the study of Shekhar et al., had taken care of COVID-19 patients directly (Shekhar et al. 2021).
As regards the sociodemographic characteristics of recruited physicians as predictors for vaccine acceptance, the current study found that the level of COVID-19 vaccine acceptance was higher among the younger physicians, males, married ones, and those who live in urban areas with statistically significance (54%, 43.3%,40%, and 40% respectively).
In contrary to our findings, Dzieciolowska et al. found that the level of COVID-19 vaccine was higher among Canadian physicians aged more than 50 years, while they agreed with ours regarding the gender of physicians with high vaccine acceptance (Dzieciolowska et al. 2021).
Also, Shekhar et al. 2021 in the United States reported figures that contradict our age group of physicians with high vaccine acceptance.They found that the acceptance of vaccination against COVID-19 increased with increasing age as 47% aged more than 70 years old. But they agreed with our findings as they found that male HCWs and those in urban areas had higher acceptance of the vaccine (Shekhar et al. 2021).
Also, gender was detected as a predictor of the level of COVID-19 vaccine acceptance among physicians and other healthcare workers in Saudi Arabia as Qattan et al.2021 found that more males (72.19%) accepted to be vaccinated when available than females but at the same time they didn't find any significant difference among different age groups (Qattan et al. 2021). The same findings were reported by two similar studies conducted in Egypt and Ghana (Fares et al. 202 ; Agyekum et al. 2021).
The higher likelihood for male physicians to accept to take COVID-19 vaccine than females could be explained by the authors due to the increased perception of males about the risk of the disease more than females
Regarding the place of work, the present study found that the COVID-19 vaccine acceptance was higher among frontline physicians and of primary surgical and surgical subspecialty with statistical significance (40.5%, 54.7% respectively). The same findings were found in Saudi Arabia by Qattan et al.2021 (Qattan et al. 2021). This could be due to the perceived risk of contagion infection between frontline HCWs is high rather than their colleagues in other departments.
In contrary to our results, Dzieciolowska et al. didn’t find any association between the COVID-19 vaccine acceptance and the type of workplace (Dzieciolowska et al.2021).
Moreover, in the present study, all physicians who thought that they will acquire severe COVID-19 symptoms that may need admission to the intensive care unit were willing to get COVID-19 vaccine while the refusal rate was highest among those who believed that they are immune as they already get the disease (41%).
On contrary, Shekhar et al..2021 reported that only 36% of their HCWs who found themselves at risk to get severe COVID-19 that may require entrance into the intensive care unit were willing to be vaccinated while the highest percent of vaccine refusal was among HCWs who were sure that they won’t get COVID-19 (Shekhar et al. 2021).
Qattan et al.2021 in Saudi Arabia, found that physicians and other HCWs with low or very low concern about getting COVID-19 infection were less willing to get the vaccine (Qattan et al. 2021).
In the present study, we found that physicians who got the influenza vaccine in the last year accepted to take the vaccine more than those who didn't. As well, the absence of medical co-morbidities, obesity, and smoking were associated with higher vaccine acceptability. Similar results were reported by Qattan et al.2021 in their study (Qattan et al. 2021), whereas nearly similar findings were found in a study done by Shekhar et al.2021 except in the effect of smoking as they found that more than half of HCWs wither smokers or non-smokers wait for a review before deciding to et COVID-19 vaccine (Shekhar et al. 2021).
Regarding the reasons for not accepting to get COVID-19 vaccine, the present study found that the most frequent reasons for vaccination unacceptability among the included Egyptian physicians were; fear of adverse side effects as it was reported by more than half of physicians followed by, the short duration of clinical trials performed on the vaccine then, concerns about the vaccine safety and efficacy were reported by only one-third of physicians.
Similar findings with the same order of reasons of unacceptance were reported by Qattan et al.2021 in their study among HCWs in Saudi Arabia (Qattan et al. 2021).
This was also in agreement with Fares et al., findings in Egypt, as they found that lack of enough clinical trials done on the vaccine before its use was reported as the main cause of vaccine refusal in 92.4% of their participants and fear of its unexpected side effects was in 91.4% of them. Also, the unknown level of its protection or immunity duration and the rumors about the type of available vaccines in Egypt has participated in hindering vaccination acceptance (Fares et al. 2021).
In the United States, Shekhar et al.2021 found that the most frequent concerns were worries about the vaccine efficacy, side effects, and rapidity of its development. Moreover, some HCWs showed poor trust in the government and regulatory authorities and, also in justification of prescribing the vaccine (Shekhar et al. 2021).
Concerns about vaccines' safety, effectiveness, and duration of clinical trials and testing were also reported as common reasons for vaccination hesitancy or unacceptance in other studies done in Australia and United States (Dodd et al., 2021 and Pogue et al., 2020).
All these findings suggest the importance of dissemination of true information about COVID-19 vaccines through medical agencies, governmental authorities, and professional societies, to increase vaccine acceptance and its uptake by physicians and other HCWs (Shekhar et al. 2021).