Attitude of Primary Healthcare Workers with Influenza Vaccination Hesitancy towards the Strategies to Increase Vaccine Uptake Rate

Talk Code: 
Man Chi Dao
Fu SN, Ho ISF, Ng MS, Tam JCY, Chan CW, Luk W, Yiu YK
Author institutions: 
Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong


The uptake rate of seasonal influenza vaccination among local healthcare workers (HCWs) in Hong Kong remained much lower than the World Health Organization (WHO) target vaccination rate. Statistics showed the vaccination rate of HCWs in primary care clinics in Hong Kong was only 37%. Vaccination hesitancy (VH), coined by WHO, refers to a delay in acceptance or refusal of vaccination despite availability of vaccination services. Previous local study in 2014 showed two major reasons of VH were fear of systemic side effects and distrust of vaccine due to perceived low efficacy and safety. Various strategies were implemented to tackle the misconceptions by HCWs. In order to evaluate the current and potential strategies, we have to explore the views and attitude of the HCWs who refused vaccination, and to find out if there are any change of reasons accounting for seasonal influenza VH.


This was a cross-sectional questionnaire study involving all staffs working in 18 government-funded primary care clinics in Hong Kong. Self-administered anonymous questionnaire in Chinese was developed based on the National Flu Survey Questionnaire by the Centers for Disease Control and Prevention in the US. Pilot study was done to ensure the validity and reliability of questionnaire items. There were three main components of the questionnaire:(1) Attitude towards seven strategies were graded at 4 point Likert-scale of “encouragement to have vaccination”. Positive attitude was defined as reported high or moderate encouragement,(2) Views on vaccine effectiveness and safety,(3) The major reasons of seasonal influenza VH.


There were total 567 staffs and 474 (83.6%) responded. The overall reported vaccination rate was 45.9%. Doctors were the highest (82.6%) while dispensary staff were the lowest (21.4%). Among the respondents who refused vaccination (N=253), the promotion strategies received most positive attitude were providing more information (37.9%), appointing a clinic vaccine ambassador to handle queries (37.5%) and offering intranasal flu vaccine (35.8%) which is not available in Hong Kong. Some disagreed that vaccine is very effective (52.8%) and very safe (37%). The top two major reasons of refusal were the fear of systemic side effects (36.9%) and perceived low vaccine efficacy (25.4%). Logistic regression showed that having flu vaccine last year is strongly associated with having flu vaccine this year (p<0.0005, OR 27.9 [95% CI 13.8-56.3]), which indicated habitual vaccination acceptance or refusal.


The seasonal influenza vaccination rate among primary HCWs remained low. It is crucial to increase HCW vaccination rate to ensure patient and staff safety. Following the results from this study, offering more resources and educational materials would be beneficial.

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Man Chi Dao
Funding acknowledgement: 
This project was supported in part by the Princess Margaret Hospital Clinical Research Center Mini Research Grant.