Objectives: This study aimed to identify COVID-19 vaccine perception, acceptance, confidence, hesitancy, and barriers among healthcare workers (HCW).

Methods: An online national cross-sectional pilot-validated questionnaire was self-administered by HCW in Saudi Arabia, a nation with MERS-CoV experience. The main outcome variable was HCW’s acceptance of COVID-19 vaccine candidates. The associated factors of vaccination acceptance were identified through a logistic regression analysis and the level of anxiety using a validated instrument to measure general anxiety levels.

Results: Out of 1512 HCWs who completed the study questionnaire—62.4% women, 70% were willing to receive COVID-19 vaccines. Logistic regression analysis revealed that male HCWs (ORa=1.551, 95% CI: 1.122–2.144), HCWs who believe in vaccine safety (ORa=2.151; 95% CI:1.708–2.708), HCWs who believe that COVID vaccines are the most likely way to stop the pandemic (ORa=1.539; 95% CI: 1.259–1.881), and HCWs who rely on Centers for Disease Control and Prevention website for COVID 19 updates (ORa=1.505, 95% CI: 1.125–2.013) were significantly associated with reporting willingness to be vaccinated. However, HCWs who believed vaccines were rushed without evidence-informed testing were found to be 60% less inclined to accept COVID-19 vaccines (ORa=0.394, 95% CI: 0.298–0.522).

Conclusion: Most HCWs are willing to receive COVID-19 vaccines once available; yet satisfactoriness of COVID-19 vaccination among HCWs is crucial because health professionals’ knowledge and confidence toward vaccines are important determining factors for their own vaccine acceptance and recommendation to their patients.

Study Design and Study Population

This was a national cross-sectional survey among HCWs in KSA during the COVID-19 pandemic [30]. The survey was aimed at different categories of HCWs from various specialties working in public and private healthcare settings across KSA.  Participants were recruited from several social media platforms and email lists using a convenience sampling technique.

Data Collection

Data were collected from November 4 to November 14, 2020.  The survey employed a pilot-validated, self-administered questionnaire that was sent to HCW online through SurveyMonkey©, a platform that allows researchers to deploy and analyze surveys via the web [34]. The questionnaire was adapted from our previously published study [26] with modifications and additions related to COVID-19 vaccine candidates.

The questions addressed the demographic characteristics of respondents (job category, age, gender, years of clinical experience, and work area), previous exposure to MERS-CoV or COVID-19 infected patients, and whether HCWs themselves were ever infected with COVID-19.

We assessed HCW readiness to receive the COVID-19 vaccine as the main outcome. We also evaluated the timing of HCW acceptance to receive the vaccine, HCWs’ beliefs about COVID-19 vaccination, and the barriers and reasons for refusal of new vaccines for those who completely rejected receiving it.

Additionally, we assessed the HCWs’ perceived worry about the COVID19 pandemic using a series of Likert-like scales (Scale 1–5) and their generalized anxiety level using the general anxiety disorder-7 (GAD-7). This validated instrument is a seven-item tool that is used to assess the severity of generalized anxiety disorder, with each item asking the individual to rate the severity of his or her symptoms over the past two weeks [35]. GAD-7 was previously used to assess HCWs’ anxiety due to COVID-19 [36, 37]. In short,  the participants were asked to rate their worries on  a scale of 1 to 5, with 1 indicating “Not worried at all” and 5 indicating “Extremely worried”.  The questions were: “Rate how much worry you experienced over the past two weeks: About contracting COVID-19 infection yourself? About transmitting COVID19 Infection to your family members?”, “Over the last 2 weeks, how often have you been bothered by the following problems? GAD-7.

Before participation, the purpose of the study was explained in English at the beginning of the online survey. The respondent was given the opportunity to ask questions via a dedicated email address for the study. The Institutional Review Board at the College of Medicine and King Saud University Medical City approved the study (approval # 20/0065/IRB). A waiver for signed consent was obtained since the survey presented no more than a minimal risk to subjects and involved no procedures for which written consent is usually required outside the study context. To maximize confidentiality, personal identifiers were not required.

Statistical analysis

Descriptive statistics approaches with mean and standard deviation were applied to continuous variables, while percentages were used for dichotomous variables. The two-sample t test was used to evaluate continuous scores, and the chi-squared test (χ²) of independence was used to compare proportions.

A multivariate binary logistic regression model was used to explore the associations between the outcome variable of HCWs’ willingness to receive the COVID-19 vaccine and demographic characteristics of HCWs, HCW beliefs toward COVID-19 vaccines and anxiety from COVID-19 and levels of anxiety using the GAD-7. The associations between predictors and the outcome were expressed as adjusted odds ratio and 95% confidence interval. The SPSS IBM Version 21 [38] was used for data analysis, the Excel program was used for creating figures and depictions, and the p-value ≤ 0.050 was considered statistically significant.