Original Article

Differences in Motivating Factors for SARS-CoV-2 Vaccination and Perceptions of Infection Risk among Healthcare and EMS Personnel in South Carolina

Authors: Mirinda Ann Gormley, PhD, Melissa S. Nolan, PhD, Moonseong Heo, PhD, Alain H. Litwin, MD, Arnold Alier, EdD, Virginie Daguise, PhD


Objectives: Although medical workers were prioritized to receive the coronavirus disease 2019 (COVID-19) vaccination, many have declined. Even though studies have investigated differences in COVID-19–related attitudes and vaccination for workers in hospitals and long-term care facilities, none have included emergency medical services (EMS) personnel. We investigated the association between type of medical worker (EMS vs healthcare worker [HCW]) and COVID-19 vaccination, vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions.

Methods: The data for self-identified HCWs came from surveys distributed to randomly selected residents of South Carolina and EMS personnel recruited at a targeted surveillance testing event during the South Carolina EMS Symposium. Pearson χ2 and Fisher exact tests analyzed differences in the distribution of demographic characteristics and self-reported COVID-19 vaccination attitudes by medical workers. Multivariable logistic regression assessed the association between COVID-19 vaccination and type of medical worker, adjusting for age, sex, race, and frontline status, and assessed the associations among vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions by type of medical worker, adjusting for age, sex, race, frontline status, and vaccination status.

Results: Of the 126 respondents 57.9% were EMS, 42.1% were HCWs, and 73.6% of the cohort were self-reported frontline medical workers. Approximately two-thirds of respondents received a vaccine for COVID-19, with no significant differences between EMS and HCWs; however, EMS workers were significantly less likely to receive the vaccination out of concern about exposures at work/school (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.08–0.57), concern about exposures within the community (aOR 0.18, 95% CI 0.07–0.48), or to do their part to control the pandemic (aOR 0.20, 95% CI 0.06–0.69). EMS workers also were significantly less likely to wear a mask all/most of the time when outside the home (aOR 0.04, 95% CI 0.0–0.21) and less concerned about the spread of COVID-19 in their community as compared with HCWs (aOR 0.19, 95% CI 0.06–0.56).

Conclusions: EMS personnel were significantly less concerned about the spread of COVID-19 in their community and significantly less likely to wear a mask all/most of the time while outside the home as compared with HCWs. Differences in the COVID-19-related attitudes and personal protection behaviors of EMS personnel should be used to develop targeted interventions to increase vaccine motivation and adherence to personal protection protocols.
Posted in: Infectious Disease84

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Table 1. Demographic characteristics and COVID-19 attitudes and behaviors of the SC STRONG dataset by type of medical worker, February 2021 (N = 126)

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Table 2. ORs for the association between type of medical worker (EMS vs HCW) and COVID-19 vaccination, vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions

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1. Centers for Disease Control and Prevention. COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#datatracker-home. Accessed April 5, 2022.
2. Nguyen LH, Drew DA, Graham MS, et al. Risk of COVID-19 among frontline health-care workers and the general community: a prospective cohort study. Lancet Public Health 2020;5:e475–e483.
3. Gholami M, Fawad I, Shadan S, et al. COVID-19 and healthcare workers: a systematic review and meta-analysis. Int J Infect Dis 2021;104:335–346.
4. Huang P. First COVID-19 vaccine doses to go to health workers say CDC advisors. https://www.npr.org/sections/health-shots/2020/11/05/931844298/first-covid-19-vaccine-doses-to-go-to-health-workers-say-cdc-advisers. Published November 5, 2020. Accessed April 5, 2022.
5. Meyer MN, Gjorgjieva T, Rosica D. Trends in health care worker intentions to receive a COVID-19 vaccine and reasons for hesitancy. JAMA Netw Open 2021;4:e215344.
6. Kuter BJ, Browne S, Momplaisir FM, et al. Perspectives on the receipt of a COVID-19 vaccine: a survey of employees in two large hospitals in Philadelphia. Vaccine 2021;19;39:1693–1700.
7. Biswas N, Mustapha T, Khubchandani J, et al. The nature and extent of COVID-19 vaccination hesitancy in healthcare workers. J Community Health 2021;46:1244–1251.
8. Shekhar R, Sheikh AB, Upadhyay S, et al. COVID-19 vaccine acceptance among health care workers in the United States. Vaccines 2021;9:119.
9. Bitely C, Miller B, Glauser J. EMS disease exposure, transmission, and prevention: a review article. Curr Emerg Hosp Med Rep 2019;7:135–140.
10. Newberry JA, Gautreau M, Staats K, et al. SARS-CoV-2 IgG seropositivity and acute asymptomatic infection rate among firefighter first responders in an early outbreak county in California. Prehospital Emerg Care 2021:1–10.
11. Caban-Martinez AJ, Silvera CA, Santiago KM, et al. COVID-19 vaccine acceptability among U.S. firefighters and emergency medical services workers. J Occup Environ Med 2021;63:369–373.
12. Stanley-Becker I. Many police officers spurn coronavirus vaccines as departments hold off on mandates. https://www.washingtonpost.com/health/2021/05/02/police-low-vaccination-rates-safety-concerns/. Published May 2, 2021. Accessed April 5, 2022.
13. Johnson A. These NC firefighters were able to get the COVID vaccine first. Most didn’t. https://www.newsobserver.com/news/local/counties/wake-county/article248505640.html. published January 15, 2021. Accessed May 5, 2021.
14. Nolan M, Daguise V, Davis M, et al. SARS-CoV-2 viral incidence, antibody point prevalence, associated population characteristics and vaccine attitudes— South Carolina, February 2021. Public Health Rep 2022;333549221081128.
15. Gadoth A, Halbrook M, Rimoin AW. Cross-sectional assessment of COVID19 vaccine acceptance among health care workers in Los Angeles. Ann Intern Med 2021;174:882–885.
16. Caban-Martinez AJ, Schaefer-Solle N, Santiago K, et al. Epidemiology of SARS-CoV-2 antibodies among firefighters/paramedics of a US fire department: a cross-sectional study. Occup Environ Med 2020;77:857–861.
17. Tarabichi Y, Watts B, Collins T, et al. SARS-CoV-2 infection among serially tested emergency medical services workers. Prehospital Emerg Care 2020;25:39–45.
18. Gibson C, Ventura C, Donald G. Emergency medical services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey. Heliyon 2020;6:e03900.
19. Hatt K. Survey identifies where public safety is divided on face mask policy. https://www.ems1.com/ems-products/personal-protective-equipment-ppe/articles/survey-identifies-where-public-safety-is-divided-on-face-mask-policy-iZkFZiuGtSk7bJeY/. Published July 31, 2020. Accessed April 5, 2022.
20. Centers for Disease Control and Prevention. First Responders. Interim recommendations for emergency medical services (EMS) systems and 911 public safety answering points/emergency communication centers (PSAP/ ECCs) in the United States during the coronavirus disease (COVID-19) pandemic. https://public4.pagefreezer.com/browse/CDC%20Covid%20Pages/11-05-2022T12:30/https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html. Updated July 15, 2020. Accessed May 5, 2021.
21. Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control-after-vaccination.html. Updated February 2, 2022. Accessed May 21, 2021.