Determinants of Vaccine Hesitancy Among Healthcare Professionals

Key Takeaways

• Across literature, hesitancy was linked to knowledge gaps, fears and doubts about vaccines, communication difficulties, and barriers within healthcare organizations.
• Reported hesitancy varied across professional groups, care environments, and vaccines, reflecting study heterogeneity rather than a single overall pattern.
• The authors identified evidence-based information, continuing education, effective communication, and organizational support as recurring themes across the included studies.

A systematic review in Expert Review of Vaccines synthesized 221 articles and characterized vaccine hesitancy among healthcare professionals as a multidomain issue rather than a simple knowledge deficit. The investigators grouped the literature into knowledge, attitudinal, communicative, and organizational factors. Findings varied across professional roles, practice settings, and vaccine types. Overall, hesitancy extended from personal beliefs and counseling dynamics to workplace conditions.

The investigators searched PubMed and Scopus in February 2024 and assembled a PRISMA-based review of studies published from 1974 through 2023. They used thematic synthesis to organize findings and excluded COVID-19-focused reports. Methodological quality was assessed with a cross-sectional study evaluation tool, and GRADE was used to assess confidence in the review findings; publication bias was not assessed.

Knowledge-related barriers included limited understanding of vaccine benefits, efficacy, safety, infectious disease risk, official recommendations, and gaps in medical education. Attitudinal barriers were distinct and included fear of adverse events, doubts about vaccine utility, low perceived disease risk, and concern about giving several vaccines together. Communication issues appeared in 37 studies and included limited counseling confidence, weak communication skills, and fragmented or inconsistent messages. Organizational barriers included access and availability problems, insufficient time, unclear guidelines, cost, and liability concerns, underscoring how personal and workplace factors both shaped hesitancy.

Included populations ranged across physicians, nurses, midwives, pharmacists, medical residents, and other healthcare workers in multiple care settings and regions. Europe contributed 82 studies and North America 53, while physicians appeared in 98 studies, nurses in 28, and midwives in 7. Influenza was the most frequently studied vaccine at 69 studies, followed by HPV at 28 and childhood vaccination at 16. These distributions help explain why hesitancy was not uniform across healthcare worker populations.

The review linked healthcare worker hesitancy with downstream effects on patient counseling and vaccine recommendation practices, noting that hesitant providers may pass uncertainty to patients. The authors emphasized evidence-based information, continuing education, effective communication, and organizational support as central themes for improving vaccination-related knowledge, attitudes, and practices. In the GRADE assessment, risk of bias and indirectness were rated low, inconsistency and imprecision were rated moderate, and publication bias was not assessed. Overall, educational, communicative, and organizational approaches were the main responses emerging from the literature.