Abstract
The COVID-19 new deaths’ highest numbers in Southeast Asia were reported from Indonesia, with 8,784 new deaths. Healthcare workers (HCWs) have several roles in the COVID-19 vaccine implementation. This study aimed to assess COVID-19 vaccine perception and belief among HCWs and identify demographic mapping by using the geographical information system. This study used a quantitative method with cross-sectional design, wherein 112 registered HCWs in the Indonesian hospital and healthcare centre were shared a survey questionnaire using Google Forms® and then visualised it through geographic mapping. The perception of HCWs regarding the COVID-19 vaccine was considered good but in contrast to the belief. There was a significant relationship between age [p value = .021; odds ratio (OR): 2.692; 95% confidence interval (CI): 1.229–5.896] and also HCWs’ workplace (p value = .040; OR: 0.231; 95% CI: 0.0620–0.862) towards the belief of HCWs regarding the COVID-19 vaccine. Developing strategies to decrease HCWs and public hesitation and increase trust is vital for implementing vaccination programmes.
Introduction
According to the latest WHO data as of 27th August 2021, there were 4,470,969 cases of death due to COVID-19, with a COVID-19 confirmed number of 214,468,601 cases (World Health Organization, 2021). WHO reported that the Southeast Asia Region (SEAR) is the third-highest COVID-19 cases with 40.5 million cases, after America (81.7 million cases) and the European Region (63.7 million cases). It was also reported that the Southeast Asia Region has more than 614,000 new cases with the highest number of new cases reported from India (231,658 new cases; 16.8 new cases per 100,000; 10% decrease), Thailand (142,138 new cases; 203.6 new cases per 100,000, a decrease of 6%), and Indonesia (125,102 new cases; 45.7 new cases per 100,000; 34%). Indonesia was reported as the country with the highest number of new deaths at 8,784 new deaths (3.2 new deaths per 100,000, a decrease of 16%) (World Health Organization, 2020).
The President of the Republic of Indonesia has formed a national team for the development of a COVID-19 vaccine. Presidential Decree No. 18/2020 stipulates the determination of the COVID-19 vaccine development team (Kepres, 2020). The President signed and issued a Presidential Regulation (Perpres) on the procurement of vaccines and the implementation of the vaccination programme to tackle the COVID-19 pandemic. The Presidential Regulation stipulates that the government will prepare the procurement and distribution of vaccines as well as the implementation of vaccinations (Perpres, 2020).
Public perception of health and disease prevention is an important factor. General contextual factors such as religion, perceptions of pharmaceutical companies, and social, cultural, and economic conditions also influence vaccine acceptance. People who actively follow recommendations feel that they have felt the benefits and question the risk-to-benefit ratio of using vaccines (Kemenkes et al., 2020).
Immunisation of COVID-19 is carried out on healthy people or those whose disease is under control. To completely break the chain of transmission, it is necessary to immunise around 70% of the target group. Health workers who are currently at the forefront of handling COVID-19 have several roles related to information on the procurement of this COVID-19 vaccine. The high risk of transmission to health workers makes them an example for the community to undergo this COVID-19 immunisation/vaccine. Healthcare workers (HCWs) also participate in the implementation of the COVID-19 vaccine. Information related to the procurement, development and delivery of COVID-19 vaccines to the public is conveyed correctly by health workers following instructions from the Ministry of Health. If there is any questionable information, please refer to an authorised and trustworthy information centre.
The number of vaccinators at the Puskesmas is more than 23 thousand so that with the addition of COVID-19 immunisation services, the ratio of COVID-19 immunisation services will be 1:20. One vaccinator vaccinates 20 people per working day. The expansion of the service network with the private sector will add more sessions to the COVID-19 immunisation service so that it can increase the ratio to 1:40 and even more. Previous experience of MR vaccination campaigns shows that one vaccinator was even able to vaccinate more than 40 people (Ditjen P2P, 2020).
The WHO The Strategic Advisory Group of Experts (SAGE) consensus states that it is currently too limited to recommend the use of a specific vaccine against COVID-19 (as of 7th October 2020). Vaccine supplies are still not immediately available in sufficient quantities to immunise everyone, so three scenarios of vaccine availability need to be considered. The priority group to get the vaccine for the first time is health workers who are at high risk of being infected and transmitting SARS-CoV-2 in the community. The next group is at risk of serious illness or death (comorbid), social/workgroups who are at high risk of contracting and transmitting infections because they are unable to carry out social distancing effectively (public officials) (Kemenkes et al., 2020).
The implementation of the COVID-19 vaccination will begin in early 2021 in stages after BPOM’s approval. COVID-19 immunisation service providers are doctors, nurses, and midwives in health care facilities, both government, private, and academic/educational institutions, Port Health Offices (KKP), TNI, and Polri in the public–private mix (PPM) network (Ditjen P2P, 2020).
Monitoring and mapping, including the readiness of health and medical personnel at health centres and hospitals in the city of Semarang, is very necessary to provide an overview to the community and related institutions in terms of mapping the readiness of health workers as the frontline in implementing the COVID-19 vaccine. This mapping is carried out to optimise the role and function of government health facilities for public health, but there are obstacles in obtaining data that has been done conventionally through the geographic information system (Pangestika et al., 2017).
Methods
This study used the quantitative method. It began with quantitative data collection using an online questionnaire with the Google Form application to hospitals and 37 health centres in Semarang City, where the hospital became a COVID-19 referral. The online questionnaire is addressed to health workers, medical personnel such as doctors and nurses at hospitals and or health centres related to perceptions of readiness as health workers regarding the procurement and administration of COVID-19 vaccines. Furthermore, data analysis was carried out using SPSS 21. The results of the quantitative analysis were described by mapping the location of the readiness of health workers related to the COVID-19 vaccine using a geographic information system using the open-source Quantum GIS application.
Before the implementation of questionnaire data collection, respondents and informants were explained in advance about the purpose of conducting the research and guidelines for filling out informed consent. If the respondent agrees to participate in the study, the respondent will be asked to sign an informed consent as proof of their willingness to be involved in the study.
Results
The results of the quantitative study are described in the distribution of 112 respondent characteristics, as shown in Table 1.
Respondent Characteristics of MRA.
Based on Table 1, it can be illustrated that the majority of respondents have an age range of 26–35 years as a productive age range and an age range of 36–54 years where the respondent is still very active in carrying out his work in health facilities. Demographic data also show that the majority of respondents are women, up to 77.7% and 91.1% are Muslims. This, of course, can be one of the factors that influence the respondents’ beliefs. Based on marital status, the majority of research respondents are married, and 47.3% have an educational background of Strata 1. The latest education is diploma and profession, considering that the respondents are health practitioners and specialist doctors. Most of the respondents are from medical personnel, nursing personnel and midwifery personnel, who, in general, are the most responsible person in the COVID-19 vaccination section at the health service facility where they work, followed by public health personnel resources and other health workers. The largest respondents in this study came from the community health centre by 85.7% and the hospital by 14.3%. The average expenditure of the respondents is considered moderate to above, where respondents use their finances ranging from a nominal value of more than 1 million 400 thousand to more than 4 million Rp. 800 thousand.
Bivariate analysis was carried out using the chi-square test to analyse the relationship between the dependent variable, namely perception and belief, with the independent variable, namely the demographic characteristics of the respondents. The results of the bivariate analysis on the perception variable can be seen in Table 2.
The Relationship between Independent Variables and Perceptions of Readiness of Health Workers related to the COVID-19 Vaccine.
Based on Table 2, the results of the analysis of the relationship between age and the perception of health workers related to the COVID-19 vaccine respondents obtained that the results of the chi-square test obtained a value of p = .079, it can be concluded that there is no relationship between the age variable and perceptions related to the COVID-19 vaccine in respondents. The unrelated statistical test also showed in gender variable that the value of p = 1.000.
The results of the chi-square test for the marital status variable obtained that a p value = .937, so it can be concluded that the marital status variable is not related to the perception of health workers regarding the COVID-19 vaccine. So did it with the educational background variable that known the p value = 1.000 is more than .05. The results of the bivariate profession variable found that the p value is .353; thus, it can be said that there was no significant relationship between professional variables and the perception of health workers regarding the COVID-19 vaccine. So did it with the monthly expenditure variable; the results of the chi-square test found that the p value is .878. The last variable is workplace service facilities; based on the results of bivariate analysis, it showed that the p value = .481, so it can be concluded that the variable of workplace service facilities is not related to the perception of health workers regarding the COVID-19 vaccine.
Bivariate analysis was carried out using the chi-square test to analyse the relationship between the bivariate analysis on the belief variable can be seen in Table 3.
The Relationship between Independent Variables and Belief of Health Workers’ Readiness regarding the COVID-19 Vaccine.
Based on Table 3, the results of the analysis of the relationship between age and the belief of health workers related to the COVID-19 vaccine of respondents, it was found that the p value is .021, so it can be concluded that there is a significant relationship between age and beliefs of health workers regarding the COVID-19 vaccine. From the results of the analysis, the OR value is 2.692 (95% CI: 1.229–5.896), meaning that respondents aged more than 35 years have the opportunity or possibility to have good faith in the COVID-19 vaccine 2.692 times compared to respondents aged less than 35 years.
In the gender variable on the beliefs of health workers related to the COVID-19 vaccine, the results of statistical tests showed that the value of p = 1,000, thus it can be concluded that there is no relationship between the gender variable and the beliefs of health workers regarding the COVID-19 vaccine in respondents. It also showed in the marital status variable on the belief of health workers regarding the COVID-19 vaccine obtained that a value of p = 1,000.
The next variable is educational background; based on statistical tests, it is known that the p value = .145 is more than .05, so it can be concluded that there is no relationship between education and beliefs of health workers regarding the COVID-19 vaccine. The last variable is workplace service facilities; based on the results of bivariate analysis, it showed that the p value = .040, so it can be concluded that the variable of workplace service facilities is related to the beliefs of health workers regarding the COVID-19 vaccine.
Mapping of HCWs readiness related to COVID-19 vaccine perception analysis with geographic information system mapping is shown in Figure 1.
Levels of Health Workers Regarding the COVID-19 Vaccine
Figure 1 is the result of mapping from the distribution of community health centres in Semarang City based on the HCWs’ perception regarding the readiness to procure COVID-19 vaccines. From the map, it can be shown that the procurement of the COVID-19 vaccine affects the perception of health workers who are considered lacking in Tugu, Gunungpati, Gajahmungkur, Candisari, Central Semarang and Pedurungan sub-districts. Next is a picture of the perception of health workers regarding the COVID-19 vaccine, which is considered quite good in Mijen, Banyumanik, South Semarang, Gayamsari, North Semarang and Genuk Districts. The results of data collection found that the perception that was considered good for health workers related to the COVID-19 vaccine was in the workplace of health workers in the districts of Ngaliyan, Tembalang, West Semarang and East Semarang.
Discussion
HCWs’ perception and attitude towards the COVID-19 vaccine play an important role in the implementation and formation of general public behaviour regarding the COVID-19 vaccine through verbal and social media consultations. The results of this study were in line with studies that have been conducted in Egypt, wherein in terms of age, it was not significantly associated with the decision to vaccinate. Viewed from the age group, this study is not following the research conducted by Grech et al., where the coverage of the COVID-19 vaccine was in the oldest age group than the younger age group because they are a more susceptible group and are more likely to receive the vaccine (Fares et al., 2012).
A good perception regarding the COVID-19 vaccine was also found in Saudi Arabia, where most of the KSA health workers (64.9%) were willing to receive the COVID-19 vaccine. Meanwhile, 35.1% of KSA health workers who looked for the COVID-19 vaccine had the main reason for refusing the vaccine, which was reported to be fear of potential side effects. Another thing that strongly supports the KSA community to be willingly vaccinated is that health workers and health service providers as sources of information on COVID-19 are very reliable. Across KSA organisations, health workers reportedly have high trust in the KSA Ministry of Health, the KSA Government and health care providers. The journey of administering the COVID-19 vaccine in KSA was found to make the authorities in health services, especially regarding the information needed to develop a COVID-19 messaging campaign. This campaign is also used to address the issue of the COVID-19 vaccine in the best possible way, especially as the country prepares to vaccinate its citizens (Elharake et al., 2021).
The kind of sex/gender showed that although the risk of disease is weight and the incidence of death is higher in men than women, but the proportion of this risk can change if there is disease accompaniment and or other factors. Also, need to consider how to administer the vaccine to pregnant and lactating women. Must keep in mind that health workers and other frontline workers, the ones who will be the priority to get the vaccine, may be a mother who are pregnant and/or breastfeeding; therefore, deep analysis is needed. Another consideration is how we handle the paediatric population concerning the COVID-19 vaccine recently. The difficulty is that concrete evidence of the effectiveness and safety of COVID-19 vaccines in children is not yet fully available (Balitbangkes, 2020).
A study in Saudi Arabia found demographic differences in the acceptance of the COVID-19 vaccine. Message boundaries to encourage belief in a COVID-19 vaccine should also be given to specific groups of the entire health care population. Female health workers were less likely to receive the COVID-19 vaccine compared to males, which is in line with this study (Elharake et al., 2021). Similar results were also found in Egypt where, when viewed by gender, the results were in line with other studies that the odds of receiving vaccination among men was significantly higher than that of women (Detoc et al., 2020; Fares et al., 2012).
The negative attitude towards the acceptance of the COVID-19 vaccine and the strong perception of the vaccine being tested too quickly are predictors of the emergence of a bad attitude towards acceptance. Education and political ideology were tested as covariates and did not show significant results on attitudes towards COVID-19 vaccine acceptance (Ciardi et al., 2021). The people who are committed to community health and have a greater understanding of the impact of protective measures are also more likely to be vaccinated. These people may be more community-focused than oriented on how their own lives will change. Compliance with social distancing and PPE use is conformant with a perception of a high-level threat due to COVID-19 among the population and is noted in an area where the impact of COVID-19 has been greater (Hogan et al., 2020).
Among medical personnel and health personnel, they also had the differences. It is related to the study that occurred in France. A recent study discussing the COVID-19 vaccine availability to be accepted by doctors and nurses in France, Belgium and Quebec revealed that 48.6% of participants reported high acceptance, while 23% reported moderate acceptance, and 28.4% reported hesitation or reluctance (Verger et al., 2021). The most important factors independently related to the emergence of doubts, reluctance and concerns about the safety of the COVID-19 vaccine were gender, age, the medical profession and contact with COVID-19 cases suspected or confirmed (Dzieciolowska et al., 2021). An often erroneous belief is that the attitude of health workers should always be positive towards vaccines because they have scientific and medical training. Even though we know that the background of health workers does not come from a homogeneous group, and most of them are not experts in the field of vaccination. Immunisation is moreover not an important part of their initial training, and professionals attracted by further education in this field tend to be those already ‘convinced’ about the benefits of vaccines (Verger et al., 2021).
The study has several limitations. First, only about 10% of all the HCWs in the surveyed institution participated. The suboptimal response rate may introduce significant selection bias into the results; however, the distribution of the survey was circulated uniformly to all employees both in print and electronically. Consequently, the generalisability of the study may also be limited as this was a single-centre study with a moderate sample size.
Conclusion
The perception of HCWs regarding the COVID-19 vaccine was considered good but in contrast to the beliefs. There was a significant relationship between age (p value = .021; OR: 2.692; 95% CI: 1.229–5.896) and also HCWs’ workplace (p value = .040; OR: 0.231; 95% CI: 0.0620–0.862) towards the belief of HCWs regarding the COVID-19 vaccine. Perception and belief in the COVID-19 vaccine are an essential determinants of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. Developing strategies to decrease HCWs and public hesitation and increase trust is vital for implementing vaccination programmes.
Footnotes
Acknowledgements
The authors thank colleagues from the Faculty of Health Science for suggestions and advice on this manuscript.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no support for the research, authorship, and/or publication of this article.