Attitudes Toward Corona Vaccination

Findings of a Nationwide Survey of the General Population and of Medical and Nursing Staff in Germany

Medical and nursing staff have a higher risk than the general population of infecting themselves and others with coronavirus disease 2019 (COVID-19) due to their close contact with patients. Being vaccinated is therefore essential for their own protection as well as for that of their patients—especially those in vulnerable groups. In Germany, facility-related vaccination requirements came into force on 16 March, 2022. We have now examined whether the attitudes of this group towards COVID-19 vaccination differs from those of the general population (and if so, to what extent), and whether possible recommendations for action can be derived from this analysis.

Methods

Between 9 July and 5 August 2021, (BZgA) surveyed i) the general population (via computer-aided web interviews [CAWI] and computer-aided telephone interviews [CATI]) and ii) medical and nursing staff (n = 506) who have patient contact in the outpatient and inpatient areas (via CAWI). Participants were randomly pre-selected by screening from an actively recruited online access panel and then preselected by screening, which was representatively weighted according to occupation and field of activity. Of the staff surveyed, 29% were registered nurses, 13% were medical specialists or medical assistants, 11% were registered geriatric nurses, and 9% were doctors or others (such as rescue service personnel). Their attitudes towards COVID-19 vaccination were collected based on the 5C scale (1), which describes five psychological antecedents for or against vaccination (Table 1). Taking into account their vaccination status, responses from the medical and nursing staff were compared with the non-medical/nursing general population under the age of 66 (n = 1 505). Differences between the unvaccinated medical and nursing staff as the reference group and the three other groups were determined using linear regressions for complex samples and controlled for age, education, and sex (Table 2). Due to the calculation of multiple regressions with the same sample, the 99% confidence interval was conservatively chosen to identify differences.

Table 1

Descriptive mean values with 99% CI for agreement of the respective population groups with statements about the COVID-19 vaccine

Table 2

Comparison of the attitudes towards COVID-19 vaccination among the population groups under consideration

Results

Overall, 82% of the medical and nursing staff had been vaccinated at least once at the time of the survey (40 of 44 doctors surveyed), and 76% had been vaccinated twice. In the general population, the vaccination rate was similarly high (81% had been vaccinated at least once, and 64%, twice). In both the general population and the medical and nursing staff, unvaccinated people had significantly more negative attitudes towards the COVID-19 vaccination than vaccinated people. Irrespective of their vaccination status, medical and nursing staff estimated the effort of receiving a vaccination as lower than the general population (Tables 1 and 2). The attitudes of the unvaccinated medical and nursing staff were somewhat more critical than those of the unvaccinated general population: they had greater concerns about the safety and effectiveness of the COVID-19 vaccine, less trust in decisions made by state authorities, and saw vaccines less as a collective responsibility (even after controlling for the association between lower education and a critical attitude was assessed). The unvaccinated medical and nursing staff as well as the unvaccinated general population believed to the same extent that the COVID-19 vaccine is superfluous, and that SARS-CoV-2 does not pose a major threat (Tables 1 and 2).

Discussion

The vaccination rates in our survey are at a higher level than in the official reporting statistics of Germany at this timepoint. It is possible that people with a positive attitude towards vaccination are more likely to take part in surveys. Nevertheless, the results are suitable for comparing vaccinated and unvaccinated people. Unsurprisingly, unvaccinated individuals expressed significantly more critical attitudes than vaccinated individuals, but unvaccinated medical and nursing staff were even more critical than the unvaccinated general population. However, this group difference is small and could partly be attributed to the different survey methods. Overall, there is a need for specific measures to convince unvaccinated medical and nursing staff of the benefits of vaccination. Obligation to vaccinate alone could create a reactance and reduce the intention to adhere to further protective measures (2). It is important to allay the concerns of unvaccinated medical and nursing staff as they are widely regarded as a trusted source of information (3), and negative attitudes from them could undermine the general public‘s confidence in vaccination (4). As more than half of the medical and nursing staff get information about vaccination from their colleagues (5), it makes sense to discuss their concerns in the work context. In addition to offering information, managers and other persons of trust should create space for personal conversations in which they answer questions, explain the need for being vaccinated in a transparent manner, and motivate vaccination.

Carolin Muschalik, Boris Orth, Christina Merkel, Ursula von Rüden, Freia de Bock

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 24 February 2022, revised version accepted on 14 April 2022.

Translated from the original German by Veronica A. Raker, PhD.

Cite this as:
Muschalik C, Orth B, Merkel C, von Rüden U, de Bock F: Attitudes toward Corona vaccination—findings of a nationwide survey of the general population and of medical and nursing staff in Germany. Dtsch Arztebl Int 2022; 119: 504–5. DOI: 10.3238/arztebl.m2022.0206

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