Health and social care workers who felt under greater pressure from their employers to receive Covid-19 vaccination were more likely to decline it, research has revealed.
The study, not yet peer-reviewed, was led by the London School of Hygiene and Tropical Medicine (LSHTM) in collaboration with the NHS Race and Health Observatory, Public Health England and the Royal College of Nursing.
In the survey of nearly 2,000 people, participants were asked for their level of agreement with the statement ‘I feel/felt under pressure from my employer to get a Covid-19 vaccine’.
This was asked on a four-point scale from (one) strongly disagree to (four) strongly agree. For each additional point of agreement on the scale, participants were 75% more likely to have declined Covid-19 vaccination.
Among unvaccinated participants, worrying concerns were raised about how their vaccination decision might impact their job security.
For social care workers, the pressure was exacerbated by hearing of care sector employers making Covid-19 vaccination mandatory for staff, and the vulnerability of social care worker positions (e.g. employment on zero-hours contracts).
Feeling pressurised had damaging effects, eroding trust and negatively affecting relationships at work, and often exacerbated Covid-19 vaccination concerns and hardened stances on declining vaccination.
The study also identified structural barriers to vaccination uptake: Black African and Mixed Black African workers were not offered vaccination at the same rates as White British and White Irish participants (8.9% not offered as compared to 5.5%).
When additional demographic and situational factors were controlled for, Black African and Mixed Black African participants were around twice as likely not to be offered the vaccine as White British and White Irish participants, and social care workers were around 50% more likely to not be offered Covid-19 vaccination than health care workers.
The latter, likely linked to the organisational structure and nature of roles within social care.
Dr Sadie Bell, research fellow at LSHTM and lead author said: ‘Our findings emphasise the importance of Covid-19 vaccination remaining voluntary. Organisational factors and workplace culture play an important role in the likelihood of both being offered and getting vaccinated.
‘Health and social care providers need to offer a space for their staff to have ‘conversations’ where they feel safe to ask about Covid-19 vaccination, and not feel judged and stigmatised for having questions and/or concerns.’
Black African and Mixed Black African staff were almost twice as likely to decline a Covid-19 vaccine as White British and White Irish participants (9.5% and 5.1% respectively), citing reasons including concerns about a lack of research on Covid-19 vaccines and distrust in the vaccines, healthcare providers, and policymakers.
The survey revealed common reasons for declining the vaccine were concerns about side-effects and a lack of research on the vaccine. It revealed the main motivation for vaccine acceptance was protecting family members and friends, and self-protection from Covid-19.
Participants suggested tailoring vaccination communication to promote uptake amongst health and social care workers from ethnic minority backgrounds, and engaging faith leaders and trusted figures who understand community member concerns.
Sandra Mounier-Jack, an associate professor in health policy at LSHTM and study author, said: ‘Our work shows a move towards mandating Covid-19 vaccination is likely to harden stances and negatively affect trust in the vaccination, provider, and policymakers.
‘Health and social care employers are in a pivotal position to facilitate COVID-19 vaccination access, ensuring staff are aware of how to get vaccinated and promoting a workplace environment in which vaccination decisions are informed and voluntary.’
UNISON general secretary Christina McAnea said employment will get better results through encouragement and reassurance.
‘This study makes plain any talk of compulsory vaccination could damage take-up severely.
‘Care workers need clear, accurate information from their employers about when and how they to get their jabs.
‘If achieving maximum coverage is the goal, employers and policymakers will get better results through encouragement, reassurance and removal of any practical barriers for staff.
‘Forced injections simply aren’t the answer.’
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