Healthcare workers attitude towards SARS-COVID-2 Vaccine, Ethiopia

The SARS-COVID-2 pandemic is still an alarmingly increasing. It has already claimed the lives of 1.76 million people in the world [1]. It has also detrimental effect in the world economy and societal interactions. An international poll conducted in April 2020 found that 61% of those surveyed identifi ed COVID-19 as the most concerning national issue, overtaking unemployment, health care, and poverty [2]. Despite Abstract

The SARS-COVID-2 effect is much expected to be much more deleterious in resource limited countries like Africa.
Vaccines are just beginning to become available in Africa. Even if available, dose may not be enough for the whole population and prioritizing target group such as front health workers will be the initial solution to halt the spread of the virus. But to our knowledge, no one currently knows the attitude of Africans towards the SARS-COVID 2 vaccines. There are no published studies or reports to date. Thus, we conducted this study to explore attitudes of Ethiopian healthcare workers aged 18 and above towards the COVID-19 vaccine and predictors of negative attitude.

Materials and methods
This study was conducted in Ethiopia by investigators.
A structured questionnaire was prepared in English by the investigators. The questionnaire included questions on demography, workplace information, COVID-19 vaccine acceptance when available to them, whether they will encourage their patients to get COVID-19 vaccinated when it is available to them, whether they will encourage their families to get The questionnaire was distributed among adult Ethiopian healthcare workers (physicians, health offi cers, nurses, laboratory technicians, Pharmacists, and other healthcare workers such as pharmacy tech, phlebotomists etc.…) practicing in Ethiopia aged 18 years and above. It was distributed via email, telegram, Facebook messenger, viber, and other social media. Hospital research coordinators, members of nursing association, and investigators used email and social media accounts to distribute the questionnaires. The participants were instructed to fi ll only one time to avoid duplications. Responses of the health workers were directly received by investigators and converted to excel for further analysis.

Sample size determination
We calculated a total sample size of 668 using a population proportion formula with assumption of 95 % level of confi dence, margin of error of 3.78, and estimated response rate of 60 percent based on Federal Ministry of health unpublished report there were 73514 health workers in 2014 [5]. Seven years have elapsed since the 2014 report, a projection was made with an estimated growth rate of 3 percent. The projected current healthcare worker number was estimated to be 90413. A total of 1110 health workers were invited. The study participants were selected randomly with the goal that they would be representative of the health workers of Ethiopia. To attract higher response rate, the questionnaire was designed to be respondent friendly. It was short survey questionnaire with clear questions, non-offensive, and easy to respond. Participants were eligible if they had access to the internet via computer, tablets, or smartphone. We believe that the major reason for not responding might have been access to internet.

Statistical methods
A total of 702 responses were obtained. Data cleaned after conversion to excel. Responses (34) from other countries such as Ghana, Sierra Leone, South Sudan, Eritrea, Uganda, and Lesotho are excluded in the analysis of the study. For data analysis, Covid-19 acceptance response rate was dichotomized into 0= No and 1= yes. A scoring system was generated for fears/concern response. Those who did not have any fears or concerns were given a score of 0, those who have one concern or fear is given 1, and two concern 2, and a maximum of score 5.
Descriptive statistics were calculated for each response using Epi Infor version 7 software. Associations of demographic factors with COVID-19 vaccine acceptance, willingness to encourage family or patients, risk/concern, and risk/concern score were calculated using CDC Epi Info version 7.

Results
A total of 668 health workers completed the survey. General characteristics of the study population are shown in Table 1 The majority were also Hospital workers 75.6% (505 Majority of the participant (77 %) had one or more fears or concerns about the COVID-19 vaccine. We classifi ed their fears or concerns on score of 0-5 where 0 represents no fear, 1 for one concern for example the vaccine is not effective, 2 for tow concerns or fears for example the vaccine is not effective and the vaccine will cause an adverse effect/side effect, 3 for three different fears or concerns etc. and the maximum score recorded was 5 which represents fi ve different concerns or fears  about the vaccine. Based on the scoring, 314 (47.01 %) surveyed healthcare workers had one concern, about 40 percent had 2 or more concerns, and 0.6 percent (4/668) had fi ve concerns (Tables 5,6).
Higher fear/concern score was noticed among those who said they would be vaccinated but not sure whether they would encourage their patients (1.5), health offi cers who were not sure to encourage their family to take COVID-19 vaccine (average score of 2), and health offi cers who were unsure to encourage their patients to take COVID-19 vaccine (1.8).
Among the fears or concerns most mentioned were I will have an adverse reaction/side effect to the vaccine 193/514 (37. Despite no fears or concerns, 16.7 % of those who had no fear would not accept the vaccine. In contrast, 74.5 % of the participants would accept the vaccine despite one or more concerns or fears on the vaccine but the likelihood of being vaccinated is high among those who do not have fears (OR 2.76, 95% CI 1.84-4.13, P < 0.0001) than those who have fears.

Discussion
Vaccine acceptability of 72.2 percent is comparable with studies done in US and other countries in the world [6,7].
But the fact that this survey was done among healthcare workers who are expected to have low vaccine hesitancy rate is genuinely concerning. Of course, Ethiopian population is mainly young which is also refl ected among health workers in our study (94 percent age group 18-44 years). This might have affected the vaccine acceptability rate since young population of a community may think that they will not have severe disease even if they acquire COIVD-19 infection as they are expected to have few comorbid diseases. We did not ask in our survey the participants' medical history which is one of the limitations of our study. But according to Lianna matt McLemon who wrote on Dec 17, 2020 CIDRAP newsletter "Data reveal deadliness of COVID-19, even in young adults" stated that 38% of all excess deaths occurred in adults aged 25 to 44 years March through July 2020 were COVID-19 related [8].

Acknowledgment
We sincerely thank Prof Rashida Khakoo and Prof Melanie Fisher of the Department of Medicine, West Virginia University, for their time in reviewing the manuscript. We would also like to thank study participants. The authors declare no confl ict of interest and no funding source. I do not have any concern 154(23.1) - Table 6: COVID-19 vaccine acceptability across Healthcare Workers Fear/concern score, 2021 Ethiopia.