In the battle against the COVID-19 pandemic, vaccines have emerged as a critical tool for controlling the spread of the virus and modifying its impact on public health [1]. However, despite the widespread availability and proven efficacy of COVID-19 vaccines, vaccine hesitancy remains a significant challenge, even among medical staff [2].

Medical staff, including doctors, nurses, and other healthcare workers, play an essential role in the healthcare system, acting as frontline responders to public health. They possess a unique perspective on vaccination, having first-hand knowledge of the disease, its consequences, and the potential benefits of immunization. However, despite their professional expertise and exposure to scientific evidence, a portion of healthcare providers exhibit hesitancy towards receiving COVID-19 vaccines [3].

Understanding the reasons behind vaccine hesitancy among medical staff is crucial for several reasons. Firstly, their vaccination decisions can influence public perceptions and attitudes towards COVID-19 vaccines, impacting vaccine uptake rates among the general population [4]. Secondly, healthcare professionals who are hesitant may be less inclined to actively promote vaccination to their patients, potentially leading to missed opportunities for vaccine education and advocacy [3]. Lastly, addressing the concerns and barriers faced by medical staff can help improve vaccine acceptance rates within this critical group, bolstering the overall effectiveness of vaccination campaigns and ensuring the well-being of both healthcare workers and the patients they serve [5].

According to certain studies, the level of COVID-19 vaccination hesitancy among healthcare workers (HCWs) is believed to be comparable to that of the general population. To illustrate, a survey conducted by the Kaiser Family Foundation in December 2020 revealed that 29% of HCWs expressed reluctance towards receiving COVID-19 vaccines, while the same sentiment was shared by 27% of individuals in the general population [18]. Although there is data about the hesitancy toward the COVID-19 vaccine among medical students in Kabul [9], there is no data about hesitancy among healthcare providers in this part of the world.

This research aims to explore hesitancy and the underlying factors contributing to vaccine hesitancy among healthcare professionals, seeking to shed light on their concerns, motivations, and attitudes towards COVID-19 vaccination.

A cross-sectional study was conducted among the healthcare workers of ten randomly selected referral hospitals in Kabul between May 10, 2023, and June 2, 2023. Currently working in a hospital as medical staff and being able to understand the questionnaire were the inclusion criteria of the study. The administration staff were excluded from the research. A brief explanation of the study was provided to the health workers who entered the survey, and informed consent was signed by participants. A total of 400 participants received the printed questionnaire, and 349 completed it voluntarily and anonymously, and they did not receive any compensation. The validated questionnaires with close-ended questions were adapted from former studies by Azimi et al. [9]. Then the related questions were selected and modified to suit the study participants. The data were transferred to Microsoft Excel for coding, and the data were analyzed by the Statistical Package for Social Sciences program (SPSS) Version 23. The results were presented with tables and graphs as appropriate.

The questionnaires were given out to 400 health care workers, and 349 of them completed the survey, resulting in a response rate of 87.25%. The majority of the participants were male, accounting for 51.3%. Doctors comprised 47.3% of the respondents, nurses made up 25%, and the remaining participants included midwives, pharmacists, and anesthesiologists. The highest hesitancy toward the COVID-19 vaccine was seen among anesthesiologists, while pharmacists had a lower frequency of vaccine hesitancy (Table 1).

Table 1: Participant’s according to their profession and hesitancy in each profession.

It should be noted that in Afghanistan, many anesthesiologists have completed a four-year study period to become anesthesiologists, even without holding an MD degree. The majority of the participants had 1–5 years’ experience in the medical field (Table 2).

Table 2: Experience.

All respondents were aware of the location of the COVID-19 vaccination center, but the availability of the vaccine in their own hospitals was reported by 63% of participants. The hesitancy toward vaccines was 23.7%, and most of the hesitant staff were female (54.3%). Johnson & Johnson was at the top of the list of vaccines received (Table 3).

Table 3: Name of Received Vaccines.

Protecting myself from COVID-19 and protecting others from the virus were the main reasons for accepting the vaccine (Table 4).

Table 4: Reasons for Accepting the Vaccine.

The main reason for hesitancy was found to be visiting patients who experienced many moderate side effects due to the COVID-19 vaccine (Table 5).

Table 5: Reasons of Vaccine Hesitancy.

It is interesting that 27 participants reported being hospitalized before getting the vaccine due to the COVID-19 infection, while 34 of them reported a severe infection after vaccination. The majority of the participants (88.8%) would encourage their family and relatives to receive the COVID-19 vaccine.

The main source of negative news about the COVID-19 vaccine was the media (Figure 1).

Figure 1: Source of Negative News about Covid-19 Vaccine.

The results of hesitancy toward the COVID-19 vaccine among medical staff raise important points for debate. Vaccine hesitancy within the healthcare workforce is a noteworthy concern, as these individuals play a critical role in promoting public health and are directly involved in patient care. Understanding and addressing the reasons behind this hesitancy is crucial for effective vaccination campaigns and ensuring the overall success of public health initiatives.

The findings of this research indicate 23.7% hesitancy toward vaccines among medical staff, with a higher percentage of hesitancy among females. The availability of the vaccine was reported by 63% of participants. Protecting myself from COVID-19 and others from the virus were the main reasons for accepting, while visiting patients with critical conditions due to the COVID-19 vaccine was the main reason for hesitancy.

A recent scoping review that examined 35 studies published subsequent to vaccine authorizations revealed that among a total of 76,471 healthcare workers (HCWs), the rate of vaccine hesitancy was found to be 22.5%.6 The Lebanese and Canadian healthcare staff had a higher acceptance rate (86.8% and 80.9%, respectively) [7,8] compared to this study. By the way, this study found that hesitancy was much lower among medical staff than among medical students in Kabul, which was 42.3% [9]. The lower vaccine hesitancy among medical staff compared to medical students in Kabul may be attributed to their direct exposure to the impact of diseases, comprehensive education on vaccines, and access to accurate information, as well as their professional responsibility to protect patients' health. These factors contribute to their greater understanding and confidence in vaccination.

One notable finding is that a significant proportion of hesitant staff were female, while in Lebanon, this was quite the opposite {7}. According to the findings of this research, the hesitancy toward the COVID-19 vaccine seems to be more prevalent among Iranian, Arabic, French, and Canadian female healthcare staff [10-13].

Like many other studies [14,15,17], one of the main reasons for not accepting the vaccine was found to be concerns about the safety and side effects, but the most common cause of reluctance in this study was visiting patients who experienced many moderate side effects due to the COVID-19 vaccine. Although most of the side effects of COVID-19 vaccines were mild to moderate and self-limiting, there were some reports of hospitalization of individuals after receiving the COVID-19 vaccine [16].

Limitation and Strength

This study's key strength lies in its novelty, as we could not find any previously published research about the hesitancy of healthcare providers towards the COVID-19 vaccine in Afghanistan to the present day. This study only included some hospitals in Kabul, which is a limitation of this study.

Recommendation

It is suggested that we conduct a more comprehensive survey to find out the causes of hesitancy. According to the findings of this study, it is also suggested to promote open dialogue, address concerns about the safety of vaccines, address specific concerns of medical staff through targeted communication campaigns, and explore the factors and tailor interventions that specifically address the concerns and needs of female health care workers.

In conclusion, this study revealed that a significant proportion of healthcare workers (23.7%) exhibited vaccine hesitancy, with a higher prevalence among female participants. Concerns about moderate side effects experienced by patients who received the vaccine were identified as a key reason for hesitancy. However, despite this hesitancy, a majority of participants expressed willingness to encourage their family and relatives to receive the COVID-19 vaccine, indicating a potential for addressing vaccine hesitancy through education and targeted interventions among healthcare workers.

Declaration

Ethical consideration

The proposal for research was approved by the research committee of Kabul University of Medical Sciences. Participants signed informed consent, and the principles outlined in the Helsinki Declaration were upheld.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Consent for Publication

Hereby, we confirm that all researchers involved in this study have provided their informed consent for their research to be published in accordance with the guidelines and policies of the BMC Journal.

Competing interest

The researchers involved in this study have no conflicts of interest.

Funding

No funding was provided for this research.

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