The development of the vaccine against COVID-19 can be regarded as an illustration of international collaboration, as well as the challenges nations and the planet face in such a critical situation. The immunization of the population has been implemented at a different pace across the globe, and the World Health Organization (WHO), in collaboration with national governments, diverse institutions, and entities, contributed considerably to this process (Carr, 2021; Papagiannis et al., 2020). For instance, the created vaccines have been distributed among countries, and Moldova was the first European country to receive a COVID-19 vaccine (Kluge and McKee, 2021). Nevertheless, the vaccination process is not as efficient as expected or desired due to a set of issues. This paper includes a review of current literature on vaccination coverage among healthcare professionals in Moldova and the reasons behind vaccine deferral or acceptance in this European country.
This review is based on the analysis of scholarly articles published between 2019 and 2021 in English. The chosen period is determined by the outbreak of the pandemic that started in 2019, and the vaccination was commenced at the end of 2020 and the beginning of 2021. The following databases were utilized to locate the most relevant articles on the topic: PubMed, Google Scholar, and Science Direct. Such keywords as COVID-19, Moldova, vaccination, vaccination acceptance, vaccination refusal in different combinations have been utilized.
Vaccination in Moldova
The pace of vaccination implementation in the Republic of Moldova has been rather low. For instance, the vaccination rate of the general population in Moldova in April 2021 was lower than 5% (Pastorino et al., 2021). In August 2021, the rate of fully vaccinated people reached almost 16%, which is quite a low figure compared to other countries (Chatarajupalli et al., 2021). It is necessary to add that vaccines are available for the population of the country. The republic received substantial financial aid from the World Bank (World Bank, 2021). The Moldova COVID-19 Emergency Response Project, for instance, aims at covering half of the population of Moldova (World Bank, 2021). Therefore, the availability of vaccines is not the primary reason for the low rate of vaccination in this country. The attitudes of the general population and medical staff, in particular, can be seen as the central factors affecting the process and pace of vaccination.
Reasons Behind Vaccination Acceptance
Healthcare professionals have historically been advocates for vaccination, so it is quite expected that many of them display vaccination acceptance. For instance, a study implemented by Paudel, Palaian, Shankar, and Subedi (2021) suggests that such factors as the views regarding the pandemic and personal experiences are central to the positive attitude towards vaccination. This study involved 266 healthcare professionals employed at a Nepalese medical college. It has been reported that those who take the pandemic seriously, as well as those who have been diagnosed with COVID, see vaccination as an effective measure and exhibit readiness to be vaccinated. Although the sample is comparatively small and the study is confined to a single facility, the findings are consistent with other studies.
Similar findings are provided by Israeli researchers who examined healthcare practitioners’ acceptance of vaccination against COVID. Dror et al. (2020) have analyzed the questionnaires of 1941 participants and reported that people who have been diagnosed with COVID-19 or cared for people infected with this virus were likely to accept vaccination. The sample size of this study is sufficient to make conclusions concerning some trends related to people’s perspectives regarding vaccination. It is clear that exposure to the illness predicts a more positive attitude towards vaccines and willingness to be vaccinated. At the same time, a study by Patelarou et al. (2021) displays a different result regarding medical students’ attitudes as those who have not had the clinical experience have been more likely to be vaccinated. In that case, the exposure to the clinical environment negatively correlated with people’s acceptance of the vaccine.
The fear of being infected or develop serious complications associated with COVID can be seen as an influential factor. Patelarou et al. (2021) have found that medical students who had certain concerns regarding their health or fears linked to COVID-19 were more likely to accept vaccination. Gagneux-Brunon et al. (2021) have drawn similar conclusions based on the survey implemented during the first wave of COVID-19 in France. The research involved 1.554 medical workers who provided answers regarding hypothetical vaccination. Almost 77% of respondents would accept vaccines if they were offered to undergo this procedure (Gagneux-Brunon et al., 2021). The primary reason behind this kind of readiness was people’s fear of being infected or hospitalized due to the infection.
On a global scale, the population of Asian countries displays a higher degree of readiness to participate in vaccination. Chew et al. (2021) have recruited 1720 medical practitioners from six Asian countries, including Bhutan, China, India, Indonesia, Singapore, and Vietnam. Over 95% of the respondents accepted vaccination and were more likely to see the infection as hazardous and the pandemic a serious threat to public health (Chew et al., 2021). Thus, the participants wanted to ensure their own safety and reduce the risk of infecting others. The researchers note that Asian countries tend to display a higher acceptance compared to the western states, which can be accounted for certain cultural peculiarities.
The substantial bulk of cross-sectional studies enables researchers to conduct meta-analysis studies and identify the most apparent trends regarding vaccination against COVID-19. Thus, Luo et al. (2021) has implemented a systematic review and meta-analysis that involved the records of 24,952 healthcare professionals. The researchers have examined the data obtained in different parts of the globe and have found that those with a history of COVID-19 infection have been more likely to get vaccinated or see vaccines positively. Luo et al. (2021) have stressed that the provision of information to medical staff, especially females under 30, could contribute to the development of a positive attitude towards vaccination.
Causes of Vaccination Refusal and Deferral
One of the major reasons behind people’s reluctance to receive a vaccine is associated with their attitudes and beliefs regarding safety and effectiveness. In Moldova, only 49% of people agreed that the available vaccines were safe, which is one of the lowest rates among European countries (Obregon, Mosquera, Tomsa and Chitnis, 2020). The disbelief in vaccines and the data provided by governments and pharmaceutical corporations have been questioned in many countries (Choi, 2021). People, including healthcare practitioners, are still unsure that the vaccines produced within such short periods of time can be as effective as noted (Dror et al., 2020). Choi (2021) has conducted a review of diverse sources on COVID vaccination in the middle- and low-income countries. The safety and effectiveness of vaccines are a common concern among African healthcare professionals as well (Paudel, Palaian, Shankar and Subedi, 2021). The researchers have found that the primary reason for Nepalese medical staff’s refusal to be vaccinated is the doubts linked to the safety of the provided vaccines.
Egypt is another African country with a low rate of vaccination. Mohamed Hussein et al. (2021) have implemented a study that involved 496 healthcare professionals aged between q8 and 65 years old from all over the country. The researchers have stressed the rate of vaccination acceptance is only slightly over 13%, while the refusal rate is as high as almost 41%. It is reported that 41% of the healthcare professionals in the country are strongly against vaccination, but only 13% strongly agree that it is needed (Mohamed Hussein et al., 2021). The major cause of healthcare workers’ reluctance to be vaccinated is their doubts related to the safety and efficacy of vaccines. The respondents emphasized that more time and research are needed to ensure that vaccines could be safe.
The analysis of medical staff’s refusal and deferral of vaccination has been a topic of extensive investigation. Berry et al. (2021) have explored the perspectives of nurses working for skilled nursing facilities in the USA. The study involved fifty facilities and 193 staff members who shared their views concerning vaccination. It turns out that nurses have doubts related to the efficacy of vaccines due to the short period of their development and a comparatively short period of the associated testing. Side effects, including infertility, have been common topics raised by the participants. The researchers have concluded that misinformation about vaccines can be seen as a central reason for mistrust and vaccination refusal. Shaw et al. (2021) have examined the attitudes of healthcare professionals in the health education sphere. The study involved 5.287 participants with a mean age of 42.5 years old. The fears related to the safety of vaccines that have been created within a short period of time prevailed and were the major reason for refusal to be vaccinated.
The reasons for refusal can be associated with the lack of knowledge regarding the nature of vaccination and vaccine production. Doctors tend to have more substantial knowledge in this respect as compared to nurses, who often have quite limited information due to the limitations in their curriculum (Gagneux-Brunon et al., 2021). Gagneux-Brunon et al. (2021) have found that medical workers had different views depending on their profession. Physicians were more likely to accept vaccination, while nurses were more reluctant to be vaccinated. Shaw et al. (2021) have also come to similar conclusions and stated that nurses were more reluctant to be vaccinated due to their doubts about the safety of vaccines, as well as their effectiveness.
Another influential factor deterring people from receiving vaccines is related to side-effects. Mahapatra et al. (2021) examined the incidence of side effects among vaccinated medical staff and healthcare professionals’ views on vaccination or vaccines. The researchers have stated that the short-term side effects related to vaccination with COVISHIELD were mild and were more common among females. The number of participants reached 476 people aged between 20 and 70 years old. The qualitative component of the study involved 25 participants who were interviewed. The reason behind healthcare workers’ hesitancy to be vaccinated was their mistrust. The participants mainly expressed their concerns about the safety of the vaccine and potential effect on people’s health in the long run. They believe that the development of vaccines requires significantly more time (years instead of months) to ensure their safety and effectiveness. Although the qualitative data is based on the analysis of the perspectives of a small group of people, these results are consistent with the majority of other studies on people’s hesitancy to be vaccinated.
Other reasons for refusing to be vaccinated are related to people’s perception of health. Patelarou et al. (2021) have investigated the views of 2249 medical students enrolled in the universities of such European countries as Albania, the Czech Republic, Cyprus, Greece, Italy, Kosovo, and Spain. The researchers have found that medical students were reluctant to be vaccinated as they were deemed to be young and healthy, which, in their opinion, made them less receptive to the infection. The participants expressed doubts that they could be infected due to their age and strong health. They were also unsure about the effectiveness and safety of vaccines.
Similar to the study by Patelarou et al. (2021), Marquez et al. (2021) have concluded that age can be seen as an important factor affecting medical staff’s attitudes towards vaccination against COVID-19. Marquez et al. (2021) have concentrated on the perspectives of dental health specialists regarding their children’s vaccination. Only approximately 40% of the participants noted that they would vaccinate their children if necessary, and about a third stated that they would allow their children to receive vaccines if advised by their physician. One of the major reasons behind this view was medical professionals’ belief that their children were unlikely to be infected or hospitalized in case of infection (Marquez et al., 2021). It is noteworthy that the sample of this study is quite small as only 99 people took part in the research.
Feifer, Bethea, and White (2021) have explored an important aspect linked to medical staff’s views on vaccines focusing on the cultural aspect. The authors have claimed that the healthcare workers of U. S. nursing homes had different attitudes towards vaccination based on their cultural backgrounds, with black and Hispanic employees reluctant to be vaccinated. The researchers utilized demographic and vaccination data, and the overall sample size reached 27,000 employees. At that, almost half of the participants were whites, 21% were black employees, and 7% were Hispanic, up to 5% were representatives of other ethnic groups (Feifer, Bethea and White, 2021). This ethnic distribution makes the findings’ validity rather limited as the rate of people of color that participated in the study was rather low. Nevertheless, the trend is still apparent, and the researchers stress that minorities tend to be more hesitant and distrustful.
Based on numerous secondary sources, researchers have also conducted different reviews and identified the most recurrent trends and themes. Alhumaid et al. (2021) have implemented a meta-analysis of medical staff’s compliance with treatment and prevention measures globally. It is found that the lack of knowledge is one of the factors leading to healthcare professionals’ noncompliance with the existing guidelines. The study provides insights into the overall attitudes towards COVID as a health hazard, which can have an impact on people’s beliefs concerning vaccination. It is noteworthy no data from Moldova or Eastern Europe was included in the meta-analysis by Alhumaid et al. (2021).
Although quite recent data on COVID vaccination rates are available and numerous studies have been implemented on this matter, certain gaps and concerns are apparent. It is clear that healthcare professionals’ perspectives and compliance with vaccination policies have been investigated in detail. The provided information is related to different parts of the world, but almost no data from Moldova can be found. The analysis of the findings of recent studies unveils certain trends existing in all countries, such as disbelief in the safety and effectiveness of vaccines due to the short period of testing and a comparatively limited number of trials. At that, peculiarities regarding the matter are apparent in different settings. Healthcare workers have to address quite different challenges due to the socio-economic, political, and cultural specifics of their countries. Therefore, it is important to implement a study on the attitudes of healthcare professionals in the Republic of Moldova. This information can be utilized as a basis for the development and implementation of interventions and policies aimed at ensuring a proper rate of vaccination.
More data can be necessary as to the link between the cultural background and people’s attitude towards vaccination. This factor is under study in such multicultural countries as the United States, but such exploration should be conducted in other countries, including Moldova as well. It is necessary to ensure the recruitment of as many healthcare workers as possible. It can also be important to explore the differences in attitudes among physicians and nurses. Finally, more quantitative and qualitative data on the attitudes of healthcare professionals in Moldova is needed.
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