COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March–June 2021. Coverage was 67%; 18% reported no intent to get vaccinated. Primary concerns were potential side effects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confidence in this population.

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March-June 2021.Coverage was 67%; 18% reported no intent to get vaccinated.Primary concerns were potential side eff ects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confi dence in this population.tests for differences in percentages to compare reachable versus reluctant groups among each of the worker categories.This activity was reviewed by the Centers for Disease Control and Prevention and was conducted consistent with applicable federal law and Centers for Disease Control and Prevention policy (Appendix).
Among all unvaccinated essential workers, reasons for not getting vaccinated included concern for possible side effects (58.0%), vaccine safety (42.9%), and distrust of the vaccine (41.9%) (Table 1).Higher percentages of the reachable group than the reluctant group planned to wait to see if the vaccine is safe (54.4% vs. 35.2%)and believed that other persons need the vaccine more (28.7% vs. 12.2%).A higher percentage of the reluctant group reported a lack of trust in CO-VID-19 vaccines compared with the reachable group (56.2% vs. 22.3%).More respondents in the reluctant group also did not believe a vaccine is needed (36.6% vs. 10.5% of reachable group), did not think COVID-19 is much of a threat (25.9% vs. 8.6%), and did not know whether a vaccine will work (27.8% vs. 19.9%).
Concern about COVID-19 disease was lower (38.5%)than concern about side effects from the vaccine (46.4%) among all essential workers (Appendix Table 2).Among reachable groups, 42.5% reported concern about getting COVID-19 compared with 21.8% of those in reluctant groups.Among HCP, 85.5% of reachable respondents were concerned about vaccine side effects compared with 68.8% of those in reluctant groups.Among all essential workers, the main motivators for getting vaccinated were protection from spreading COVID-19 to family and friends (51.4%), receiving more information on effectiveness of COVID-19 vaccines (44.4%), and reducing spread of COVID-19 in the community (41.9%) (Table 2).Motivators that were higher among the reachable than the reluctant groups were increased information on vaccine safety (39.8% vs. 20.8%)and effica- The first limitation of our study is that although the panel recruitment survey methodology and data weighting were designed to produce nationally representative results, respondents might not be fully representative of the general US adult population.Vaccination coverage among respondents was self-reported and could be subject to recall or social desirability bias.Data were combined across multiple survey waves, which might overaverage any recent changes in vaccination coverage and intent.Finally, state-specific vaccine prioritization varied during the data collection period, which might have affected vaccination coverage responses to items related to attitudes, behaviors, and perceptions.
Among essential workers in this sample, predominant motivators for getting vaccinated were protecting family and friends, gaining more information about the safety and effectiveness of vaccinates, and preventing community spread.These data suggest that clear, consistent messages from healthcare providers, public health officials, and immunization partners about the safety and effectiveness of the vaccine could increase vaccination coverage and vaccine confidence more broadly (12).In addition, framing messages in terms of benefits such as protecting family and friends; being able to travel; and resuming work, school, and social activities might further boost immunization coverage and confidence (12).
Among unvaccinated essential workers, nearly 60% were worried about vaccine side effects.Connecting employers and employees to credible resources on vaccine safety and expected side effects might improve vaccination coverage among essential workers.Implementing interventions to mitigate barriers to vaccination, such as flexible scheduling, paid time off for vaccination and illness resulting from side effects, on-site vaccination, and walk-in clinics, also could improve vaccination coverage.
In conclusion, our findings suggest public health officials and other leaders should differentiate between continued challenges in accessing vaccines for all populations from behavioral factors associated with vaccination.To reach vaccination goals for essential workers and everyone in the community, healthcare providers, public health officials, and immunization partners should consider KABs when tailoring messages and strategies to increase vaccination uptake and confidence, especially at local community levels.

About the Author
Dr. Nguyen is an epidemiologist in the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.She is working with the CDC COVID-19 Vaccine Task Force.Her research interests include investigating gaps in COVID-19 vaccination coverage and developing strategies to increase vaccination uptake and confidence.

Figure 2 .
Figure 2. Average prevalence of COVID-19 vaccination status and intent by essential and nonessential worker groups, United States, March 5-June 2, 2021.Asterisk (*) indicates statistically significant (p<0.05)differences between vaccination coverage and intent among each essential worker group versus vaccination coverage and vaccination intent among nonessential workers.COVID-19, coronavirus disease.

Table 1 .
Reasons for not getting a COVID-19 vaccine, by essential worker group and vaccination intent, United States, March-

17.1 (12.3- 22.9)
Bold text indicates statistical significance (p<0.05) between reachable and reluctant groups; reluctant group is the referent.R respondents were defined as adults who probably would or were unsure about getting a COVID-19 vaccine.RL respondents were defined as adults who probably or definitely would not get a COVID-19 vaccine.COVID-19, coronavirus disease; R, reachable; RL, reluctant.

Table 2 .
Motivators for getting a COVID-19 vaccine, by essential worker group and vaccination intent, United States, March-June 2021*