Hesitancy on the frontline

Lessons learned in preparing for and responding to health worker hesitancy

Common Thread
3 min readAug 31, 2021


Healthcare workers are critical for COVID-19 vaccine rollout. They are the backbone of routine immunisation services and highly influence whether a person will vaccinate or not. But the voices that carry the most weight are not automatically the biggest advocates.

The COVID-19 vaccine rollout has shone a spotlight on mistrust in vaccines among healthcare workers at a global scale. Healthcare workers, like the rest of us, worry about vaccine safety, fall prey to misinformation, and have varied levels of trust in the government.

Healthcare worker hesitancy to vaccinate is not a new challenge, but the COVID-19 pandemic has introduced new complexity: an aggressive vaccine roll-out, high-risk of exposure and more pressure for healthcare workers to have all the answers for an increasingly skeptical public.

A literature review conducted in April of 2021 found that among 76,471 healthcare workers across the globe, 22.51% reported that they were hesitant to receive the COVID-19 vaccine. A survey of 6,043 Arabic-speaking healthcare workers living in and outside of Arab countries found that only 26.7% accepted the vaccine, with the leading barrier to acceptance being fear of side-effects. Another survey found concerns over vaccine risks and mistrust among healthcare workers in Romania, Croatia, Greece, and France — all the countries in the study.

These statistics are dangerous given the high level of public trust in healthcare workers.

Woman wearing PPE handling vaccine.
Photo by Mufid Majnun on Unsplash

How can immunisation programme managers better understand healthcare worker hesitancy in their contexts?

COVID-19 vaccine roll-out and preparing for the next pandemic starts with building demand for vaccination and increasing trust within our healthcare workforce. But measuring demand and hesitancy in the healthcare workforce and the wider population is complex. So how do you spot it?

By diving into the data. Social and behavioural data on healthcare workers offer clues as to what groups are more likely to be hesitant to the COVID-19 vaccine. Early data collection on 12,000 healthcare workers in the UK suggests that pregnancy, belief in COVID-19 conspiracies, lack of vaccination against the flu, a prior infection with COVID-19, lower health literacy, and higher economic security are all factors that can potentially make someone less likely to accept the vaccine to protect against COVID-19. These factors ring true for hesitancy in the general population as well. Data like this can help you identify potentially hesitant groups so that you can co-develop interventions tailored to their needs and concerns.

Understanding healthcare worker hesitancy in your own context starts with determining what you already know. Exploring previous research on general healthcare worker vaccine demand can provide a wealth of insight into what behaviours breed hesitancy in your context. Gathering lessons and indicators from previous health crises can also help you construct a better picture of what hesitancy looks like in your context.

Build on this existing knowledge by conducting your own research. You can explore different methodologies to fit within your budget — including rapid qualitative insights — or simply having regular conversations with healthcare workers. Whatever method you decide best suits your situation, ensure that you are collecting data regularly to stay on top of shifts in attitude.

Want to learn more about specific actions you can take to build trust of health workers and reduce healthcare worker hesitancy in your context? Read the full article on LNCT.