Healthcare Worker Vaccine Hesitancy: What Drives COVID-19 Vaccine Acceptance?

Healthcare workers were among the first groups prioritized for COVID-19 vaccination during the pandemic. As trusted sources of health information and frontline responders, their attitudes toward vaccination play a critical role in public confidence and immunization uptake.

While vaccines remain one of the most effective public health interventions, research has shown that healthcare workers are not immune to vaccine hesitancy. Understanding what drives vaccine acceptance—and what creates barriers—is essential for strengthening future vaccination campaigns and building trust in public health systems.

A recent review conducted by researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce examined the factors influencing COVID-19 vaccine acceptance among healthcare workers across multiple countries and regions.

Why Vaccine Acceptance Among Healthcare Workers Matters

Healthcare workers face a higher risk of exposure to infectious diseases and play a central role in advising patients about vaccination. Their confidence in vaccines can influence both workplace vaccination rates and public perceptions of immunization.

The review analyzed 56 studies from around the world to better understand the demographic, behavioral, and social factors associated with COVID-19 vaccine acceptance.

The findings revealed significant variation between countries and regions, highlighting the complexity of vaccine decision-making among health professionals.

COVID-19 Vaccine Acceptance Rates Varied Widely

One of the most striking findings was the variation in vaccine acceptance among healthcare workers.

The highest reported uptake was found in Italy, where acceptance reached 98.9%, while one study from Cyprus reported acceptance rates as low as 30%.

These differences suggest that vaccine confidence is influenced not only by individual factors but also by local contexts, health systems, communication strategies, and levels of trust in institutions.

Key Factors Associated with Higher Vaccine Acceptance

The review identified several characteristics that were consistently associated with greater willingness to receive a COVID-19 vaccine.

Older Age

Healthcare workers aged 30 years and older were generally more likely to accept vaccination than their younger colleagues. Greater clinical experience and increased awareness of personal risk may contribute to this trend.

Male Gender

Many studies have found that male healthcare workers report higher vaccine acceptance than female healthcare workers, although findings have not been consistent across all countries.

Physician Occupation

Physicians consistently demonstrated higher vaccine acceptance rates than other healthcare professionals. In contrast, vaccine hesitancy was often more common among nursing professionals.

Higher Levels of Education

Healthcare workers with university, master’s, or doctoral-level education were generally more likely to accept vaccination, suggesting that health literacy and understanding of vaccine science may influence decision-making.

Presence of Comorbidities

Individuals with chronic health conditions were more likely to be vaccinated, likely due to greater awareness of the risks associated with COVID-19 infection.

Influenza Vaccination History Was the Strongest Predictor

Across the studies reviewed, previous influenza vaccination emerged as one of the strongest predictors of COVID-19 vaccine acceptance.

More than 65% of the included studies found that healthcare workers who regularly received seasonal influenza vaccines were significantly more likely to accept COVID-19 vaccination.

This finding suggests that vaccine acceptance may reflect broader health-seeking behaviors and existing confidence in immunization programs.

What Drives Vaccine Confidence?

The review identified several factors that increased the likelihood of vaccine acceptance.

Knowledge and Health Literacy

Healthcare workers with greater knowledge of COVID-19 vaccines, including their effectiveness and safety, were more likely to be vaccinated.

Trust in Health Authorities

Confidence in governments, public health agencies, scientists, and healthcare institutions played an important role in vaccine acceptance.

Perceived Risk and Vulnerability

Healthcare workers who believed they were at greater risk of infection or severe disease were more likely to accept vaccination.

Protecting Others

Many healthcare workers cited protecting patients, family members, and colleagues as a key motivation for receiving a vaccine.

Common Barriers to COVID-19 Vaccine Acceptance

Despite the overall success of vaccination campaigns, several barriers contributed to hesitancy among healthcare workers.

Concerns About Side Effects

Fear of short-term and long-term adverse effects was the most frequently reported barrier across the studies.

Questions About Vaccine Effectiveness

Concerns regarding efficacy, particularly during the early stages of vaccine rollout, reduced confidence among some healthcare workers.

Lack of Information

Limited access to clear, transparent, and evidence-based information was another common factor associated with hesitancy.

Distrust in Institutions

Distrust of governments, pharmaceutical companies, or public health authorities negatively affected vaccine confidence in several settings.

An Important Research Gap: Public Health Professionals

While the review identified extensive research on healthcare workers, it revealed a notable gap in the literature.

No studies specifically focused on the vaccination sentiments of public health professionals.

Given their role in shaping public health policy, promoting immunization, and communicating evidence to communities, understanding their perspectives remains an important area for future research.

What Can Improve Vaccine Acceptance?

The review concluded that vaccination campaigns alone are unlikely to achieve optimal uptake.

Effective strategies should include:

• Educational initiatives that improve vaccine knowledge
• Transparent communication about safety and effectiveness
• Targeted interventions for groups with lower acceptance rates
• Efforts to build trust in health institutions
• Approaches that address misinformation and disinformation

A combination of evidence-based communication, tailored outreach, and community engagement is more likely to strengthen vaccine confidence than relying solely on vaccine availability.

Looking Ahead

The findings reinforce that healthcare worker vaccine hesitancy is influenced by a complex mix of personal, professional, and societal factors.

Older age, physician status, higher education, existing health conditions, and previous influenza vaccination were consistently associated with greater COVID-19 vaccine acceptance. At the same time, concerns about safety, effectiveness, information quality, and trust continue to shape vaccine decision-making.

As public health systems prepare for future outbreaks and vaccination campaigns, understanding these determinants will remain essential for building confidence, improving uptake, and protecting both healthcare workers and the communities they serve.

Read the original review here: Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals

Integrating China in the International Consortium for Personalized Medicine Project: A Glance

Cancer is one of the leading causes of death worldwide, and its prevalence continues to rise. Traditional cancer treatments such as chemotherapy and radiation therapy can have significant side effects, and they may not be effective for all patients. The field of personalized medicine has the potential to revolutionize cancer prevention and treatment by tailoring therapies to an individual patient’s specific genetic and molecular profile.

Despite the potential benefits of personalized medicine for cancer, there are still significant challenges to its widespread implementation. One of these challenges is the lack of alignment between policies in different regions of the world. To address this issue, the Integrating China in the International Consortium for Personalized Medicine (IC2PerMed) consortium, of which the World Federation of Public Health Associations (WFPHA) is a partner, has developed a common roadmap for personalized medicine for cancer to foster common approaches between the People’s Republic of China and the European Union (EU) on personalized medicine research, development, innovation, and policies.

The IC2PerMed consortium is an EU initiative that aims to promote the implementation of personalized medicine in prevention and care. The consortium brings together organizations, researchers, policymakers, and healthcare professionals to work towards a common goal of improving patients’ outcomes.

The IC2PerMed consortium’s roadmap for personalized medicine for cancer has been finalized and is being presented at a series of events, including WFPHA webinars, a dedicated workshop at the 17th World Congress on Public Health, and a high-level symposium held in Geneva, Switzerland, in conjunction with the World Health Assembly.

The high-level symposium brings together high-level policymakers, scientists, and Chief Executive Officers from international health-related organizations to discuss the importance of personalized medicine for cancer and beyond and the need for international collaboration to promote its implementation. The meeting also provides an opportunity to showcase the work of the IC2PerMed consortium.

Improving Childhood Vaccination Coverage Rates in Europe

Childhood vaccination plays a critical role in reducing mortality and morbidity worldwide, lowering disease incidence, and strengthening public health protection. In short, vaccination remains one of the most effective tools for preventing infectious diseases.

Over the past several decades, childhood vaccination coverage has improved across Europe, with several countries achieving the World Health Organization’s (WHO) 95% coverage target. While this progress is significant, vaccination coverage rates declined in many European Union (EU) countries between 2010 and 2021. As a result, Europe has experienced outbreaks of vaccine-preventable diseases (VPDs), including major measles outbreaks.

These trends highlight the urgent need to strengthen resilient immunization systems across the EU. Addressing barriers to vaccine uptake is essential to protecting populations from preventable illnesses, reducing deaths linked to VPDs, and improving preparedness for future public health crises.

Researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce examined changes in childhood vaccination coverage across the EU between 2010 and 2021. Their analysis focused on WHO vaccination indicators, including:

• Diphtheria, Tetanus, and Pertussis (DTP) 1st dose
• DTP 3rd dose
• Haemophilus influenzae type b (Hib3)
• Hepatitis B 3rd dose (HepB3)
• Measles 1st dose
• Measles 2nd dose
• Polio 3rd dose

The study identified major trends, barriers, and policy recommendations for improving childhood vaccination coverage rates in Europe.

Childhood Vaccination Coverage Rates in the EU (2010–2021)

The analysis revealed several important patterns across EU member states:

• Vaccination coverage rates fluctuated significantly across countries and vaccine types.
• Most vaccines had lower coverage rates in 2019 than in 2010.
• Lower-performing countries, including Austria and Romania, experienced more severe and frequent fluctuations.
• Higher-performing countries generally maintained stable vaccination coverage rates.

These findings suggest that vaccination systems across Europe remain vulnerable to disruptions and uneven public health capacity.

Why Fluctuations in Vaccination Coverage Matter

Variations in childhood vaccination coverage are a major public health concern. Fluctuating vaccine uptake rates reveal weaknesses within national immunization systems and increase the risk of outbreaks of vaccine-preventable diseases.

Lower vaccination coverage also weakens herd immunity, leaving vulnerable populations, including immunocompromised individuals and children unable to receive vaccines, at greater risk.

To improve long-term public health resilience, EU countries need stronger vaccination infrastructure, more reliable delivery systems, and crisis preparedness strategies.

Key Factors Causing Declining Childhood Vaccination Rates in Europe

The WFPHA article identified several major barriers contributing to declining childhood vaccination coverage rates in Europe.

Structural Barriers to Vaccine Access

Practical challenges continue to limit vaccine uptake for many families. Common structural barriers include:

• Difficulty taking time off work for vaccination appointments
• Limited access to healthcare facilities
• Delays in vaccine procurement and supply chains
• Inconvenient clinic hours

Evidence suggests that improving accessibility plays a major role in increasing vaccination rates.

Vaccine Hesitancy and Misinformation

Vaccine hesitancy remains one of the leading contributors to declining vaccination coverage across Europe. The spread of misinformation (particularly online) has negatively affected public confidence in vaccine safety and effectiveness.

Research highlighted declining vaccine confidence in several EU countries, including:

• Austria
• Bulgaria
• Romania
• Germany
• France
• The Netherlands
• Sweden

Public awareness campaigns, trusted healthcare communication, and evidence-based educational initiatives have proven effective in rebuilding confidence in vaccines.

Impact of COVID-19 on Routine Immunization

The COVID-19 pandemic significantly disrupted routine childhood vaccination services across Europe.

Key pandemic-related challenges included:

• Healthcare resource diversion
• Lockdowns and restricted movement
• Reduced healthcare visits
• Supply chain interruptions
• Delayed data collection and reporting

Many countries experienced additional declines in vaccination coverage between 2020 and 2021, increasing the risk of outbreaks of measles, polio, and other vaccine-preventable diseases.

The Ukraine Crisis and Regional Vaccination Gaps

The ongoing Ukraine crisis further intensified vaccination challenges across Europe. Countries already experiencing immunity gaps, including Poland and Romania, faced additional pressure due to population displacement and disruptions to vaccination services.

The study emphasized the importance of coordinated crisis preparedness plans to prevent widening immunization gaps during humanitarian emergencies.

Strategies for Increasing Childhood Vaccination Coverage Rates

The article identified several evidence-based strategies that can improve childhood vaccination uptake across Europe.

Improve Access to Vaccination Services

Improving convenience and accessibility can significantly increase vaccine uptake. Recommended strategies include:

• Expanding the number of providers authorized to administer vaccines
• Offering vaccinations outside traditional healthcare settings
• Providing extended clinic hours
• Delivering outreach services and catch-up campaigns

Countries with accessible, community-based vaccination systems tend to achieve more stable vaccination coverage rates.

Strengthen Vaccine Communication and Education

Effective communication between healthcare professionals and families is essential for improving vaccine confidence.

Successful approaches include:

• Public awareness campaigns
• Reliable vaccine information materials
• School and community education programs
• Direct communication between patients and healthcare workers

Healthcare professionals remain one of the most trusted sources of vaccine information.

Expand the Use of Digital Technologies

Digital tools can help improve immunization tracking and reduce missed vaccinations.

Key recommendations include:

• Electronic immunization records
• Real-time surveillance systems
• Automated vaccine reminders
• Improved vaccination data collection

Countries using digital reminder systems have reported improved vaccination coverage and more accurate immunization records.

Policy Recommendations for Strengthening Childhood Vaccination Programs

Based on the WFPHA International Immunization Policy Taskforce recommendations, policymakers across the EU should focus on the following priorities.

Facilitate Easier Access to Vaccination

• Expand vaccine administration locations
• Increase provider flexibility
• Offer vaccinations outside standard working hours
• Reduce logistical barriers for families

Invest in Immunization Infrastructure

• Strengthen healthcare workforce capacity
• Improve vaccine supply systems
• Enhance outbreak preparedness plans

Improve Data Collection and Surveillance

• Develop real-time monitoring systems
• Expand electronic immunization records
• Use automated reminder technologies

Increase Public Awareness and Education

• Launch targeted vaccine education campaigns
• Combat misinformation with evidence-based communication
• Support healthcare worker engagement initiatives

The Importance of Resilient Immunization Systems in Europe

The findings demonstrate that childhood vaccination systems across Europe remain vulnerable to public health crises, misinformation, and structural barriers.

Evidence consistently shows that improving vaccine accessibility, strengthening communication, and investing in digital health infrastructure can increase vaccination coverage rates and reduce the risk of disease outbreaks.

As Europe continues to navigate the long-term effects of COVID-19 and the Ukraine crisis, resilient immunization systems will remain essential to protecting children and communities from vaccine-preventable diseases.

Maintaining strong childhood vaccination programs requires continuous investment, coordinated policy action, and sustained public trust in vaccination systems.

What Is the Intergovernmental Negotiating Body (INB)?

The COVID-19 pandemic exposed major gaps in global health preparedness, coordination, and response. In response, governments around the world began exploring stronger international cooperation to better prevent and manage future pandemics.

One of the most significant steps in this effort was the creation of the Intergovernmental Negotiating Body (INB). This body was established by the World Health Assembly to develop a global agreement to strengthen pandemic prevention, preparedness, and response.

Understanding the role of the Intergovernmental Negotiating Body helps explain how the international community is working to reduce the risks of future global health crises.

Why the Intergovernmental Negotiating Body Was Created

The COVID-19 pandemic had a profound impact on human lives, economies, and societies worldwide. The scale of disruption highlighted the need for stronger international alignment when responding to emerging health threats.

To avoid repeating the challenges experienced during COVID-19, the global community recognized the importance of building more coordinated mechanisms for pandemic preparedness.

As a result, countries agreed that a formal international framework could strengthen cooperation, information sharing, and response strategies during future pandemics.

The Historic World Health Assembly Special Session

In December 2021, the World Health Assembly Special Session (WHASS) took place in Geneva, Switzerland.

This meeting was historic: it was only the second time in the history of the World Health Organization (WHO) that the Health Assembly convened twice in the same year.

During this session, Member States agreed to establish the Intergovernmental Negotiating Body (INB).

The mandate of the INB is to draft and negotiate a convention, agreement, or other international instrument under the Constitution of the World Health Organization. The goal of this instrument is to strengthen global systems for pandemic prevention, preparedness, and response.

The Core Mandate of the Intergovernmental Negotiating Body

The Intergovernmental Negotiating Body is responsible for developing a global framework that helps countries work together more effectively during health emergencies.

Its work focuses on creating an international instrument that supports:

• Stronger pandemic prevention strategies
• Improved preparedness for emerging health threats
• More coordinated global response mechanisms
• Greater cooperation among countries and health systems

The INB’s work is guided by several core principles:

• Inclusiveness
• Transparency
• Efficiency
• Member State leadership
• Consensus-based decision making

These principles ensure that negotiations reflect broad international participation and collaboration.

Timeline for the Pandemic Agreement Negotiations

The Intergovernmental Negotiating Body was tasked with progressing negotiations within a clear timeline.

Key milestones include:

• Progress reporting to the 76th World Health Assembly in 2023
• Target adoption of the international instrument by 2024

These milestones allow Member States to evaluate progress and ensure that negotiations continue to move forward.

How the INB Process Includes Global Stakeholders

Although the INB is led by Member States, the process also involves participation from a wide range of stakeholders.

The decision establishing the INB requested that the WHO Director-General convene meetings and support the negotiation process. This includes organizing public hearings to gather perspectives from organizations and experts.

Participants in the process may include:

• United Nations system bodies
• Non-state actors
• Civil society organizations
• Global health stakeholders

This inclusive approach ensures that negotiations consider diverse expertise and perspectives from across the global health community.

Public Health Organizations Contributing to the INB Process

Public health organizations have played an active role in the consultation process surrounding the Intergovernmental Negotiating Body.

During INB public hearings, several organizations submitted statements to contribute to the discussions, including:

• The World Federation of Public Health Associations (WFPHA)
• The International Federation of Social Workers (IFSW)
• The International Hospital Federation (IHF)
• The World Organization of Family Doctors (WONCA)

These contributions help ensure that public health expertise informs the development of the international pandemic instrument.

Why the Intergovernmental Negotiating Body Matters for Future Pandemics

The creation of the Intergovernmental Negotiating Body reflects a global recognition that stronger international cooperation is essential to address future health threats.

By working toward a shared framework for pandemic preparedness and response, the INB aims to help countries:

• Strengthen health system resilience
• Improve coordination during emergencies
• Reduce global health inequalities
• Respond more rapidly to emerging threats

Ultimately, the work of the Intergovernmental Negotiating Body represents an important step toward building a more coordinated and effective global system for pandemic preparedness.

Protecting Ecosystems Through Nature-based Solutions for Improved Public Health

The relationship between the natural world and human health is foundational. From the food we eat and the water we drink to the air we breathe and the environments where we live, human survival depends on the health of ecosystems.

This reality underpins the growing global focus on nature-based solutions for improved public health. Protecting biodiversity and restoring ecosystem functions are environmental priorities and public health imperatives.

The World Federation of Public Health Associations (WFPHA) highlighted this urgency in its official statement during the 27th Conference of the Parties to the UN Framework Convention on Climate Change (COP27), calling for a stronger global commitment to ecosystem protection and nature-positive climate strategies.

The Invisible Infrastructure Supporting Human Health

The interconnectedness between natural and human systems is well-documented and observable in the sheer breadth of our interactions with nature. Ecosystems provide food, water, shelter, and virtually every critical resource needed for human survival and prosperity.

The health benefits derived from ecosystems are delivered through biodiversity, species composition, and complex ecological processes performed by natural systems.

These processes enable ecosystems to deliver what are commonly known as ecosystem services, typically grouped into four categories:

• Provisioning services: such as food, freshwater, and medicinal resources

• Regulating services: including climate regulation, flood control, and disease regulation

• Supporting services: such as nutrient cycling and soil formation

• Cultural services: including recreation, mental wellbeing, and social connection

More recently, these benefits have also been described as nature’s contributions to people, emphasizing how ecosystem health directly influences human well-being.

When Ecosystems Fail, Public Health Suffers

When ecosystems cannot function optimally, the consequences are immediate and far-reaching for human health.

Examples illustrate how ecological degradation directly undermines well-being:

• Soil microbial depletion reduces the nutritional quality and yield of agricultural crops.

• Pollinator decline disrupts plant reproduction, threatening food production and medicinal resources.

• Deforestation destroys habitats needed to maintain biodiversity and ecological balance.

• Ocean pollution damages marine ecosystems and diminishes cultural, recreational, and psychological benefits associated with coastal environments.

Each of these disruptions weakens the ecological systems that support human life.

Environmental Degradation Is Reversing Public Health Gains

Over the past 70 years, economic and technological growth, often described as the “great acceleration,” has lifted millions from poverty and extended life expectancy worldwide. Yet these gains have come at a profound environmental cost.

Because public health is fundamentally intertwined with ecosystem health, environmental degradation threatens to reverse decades of progress.

Research shows that ecological breakdown can:

• Reduce the nutrient content and productivity of food systems

• Harm agriculture-based livelihoods

• Trigger severe mental health consequences, particularly among Indigenous communities

• Disrupt planetary systems necessary for climate stability

These intersecting pressures illustrate how environmental damage represents a systemic threat to human survival and well-being.

Biodiversity Loss and the Rising Burden of Disease

Even when examined individually, ecological disruptions can have enormous public health consequences.

For example:

• Pollinator loss could place 71 million people at risk of vitamin A deficiency and 173 million people at risk of folate deficiency, contributing to 1.42 million additional deaths annually from malnutrition and non-communicable diseases.

• Urban areas without adequate green space experience higher air pollution, more frequent heat waves, elevated stress levels, and increased rates of non-communicable diseases.

• Deforestation has been linked to increased waterborne diseases due to reduced flood control and contamination of surface water sources.

• Tropical forest loss increases interactions between humans and wildlife, raising the risk of emerging infectious diseases that could trigger epidemics or pandemics.

These examples demonstrate how ecosystem health functions as a protective barrier for global public health.

Climate Change Is Intensifying Ecosystem and Health Risks

At COP27, global discussions emphasized the accelerating impacts of climate change on ecosystems and human wellbeing.

The IPCC Sixth Assessment Report highlights that climate change is already affecting:

• Marine and coastal ecosystems

• Terrestrial and freshwater ecosystems

• Global food production systems

These changes are expected to produce cascading public health impacts.

For example:

• Climate change could increase the number of people at risk of hunger by 8 to 80 million by mid-century, with the highest impacts in Sub-Saharan Africa, South Asia, and Central America.

• Extreme temperature, rainfall variability, droughts, flooding, and sea-level rise will likely increase outbreaks of aquatic pathogens in coastal populations.

• Shifts in ecosystem conditions and vector ranges are expected to significantly increase the global burden of vector-borne diseases.

In many regions, these combined pressures may ultimately render areas increasingly difficult or impossible to inhabit.

Environmental and Social Determinants of Health Are Interconnected

The forces driving environmental degradation are closely tied to the same social and economic factors that shape health outcomes.

As a result, the current socio-ecological crisis is also a crisis of inequality. Communities that contribute the least to environmental damage often face the greatest health consequences.

This dynamic places particular burdens on:

• Vulnerable populations

• Indigenous communities

• Low-income regions

• Future generations

Delaying action is therefore not an option. Protecting biodiversity and restoring ecosystem functions are essential to safeguarding public health worldwide.

Why Nature-based Solutions for Improved Public Health Matter

A biosensitive approach to development recognizes that human wellbeing depends on living in balance with natural systems.

Transitioning toward a nature-positive economic framework can simultaneously strengthen ecosystems and support economic development. The World Economic Forum estimates that such a transition could generate $10.1 trillion in annual business value and create 395 million jobs by 2030.

Nature-based solutions for improved public health include strategies such as:

• Reforestation and afforestation

• Habitat protection and ecosystem restoration

• Regenerative and restorative agricultural practices

• Mangrove conservation

• Expansion of urban green spaces

• Protection of natural carbon sinks such as forests, oceans, wetlands, and peatlands

These approaches strengthen ecosystem resilience while reducing climate and health risks.

Indigenous Knowledge Is Essential for Sustainable Ecosystem Management

Effective environmental stewardship also requires recognizing the leadership and knowledge of Indigenous communities.

Indigenous groups have long practiced forms of land stewardship that promote biodiversity, ecosystem restoration, and sustainable environmental management.

Supporting Indigenous leadership in conservation efforts ensures that community-based solutions remain central to long-term environmental resilience.

A Global Call to Protect Nature for Public Health

The WFPHA supports the United Nations’ warning that humanity is “losing our suicidal war against nature” and emphasizes that the world faces a stark choice: collective action or collective suicide.

In response, the organization affirms the human right to a clean, healthy, and sustainable environment and calls for global commitment to nature-based climate solutions and ecosystem protection.

This call to action aligns with the principles of One Health, which recognizes the deep interdependence between human, animal, and environmental health, an interconnection highlighted clearly by the COVID-19 pandemic.

The Path Forward

Protecting ecosystems is not solely an environmental responsibility; it is one of the most powerful public health interventions available.

Nature-based solutions for improved public health offer a pathway to:

• Reduce climate risks

• Prevent emerging diseases

• Strengthen food and water security

• Improve mental and physical well-being

• Protect the health of future generations

The global public health community now faces a decisive moment. Acting to protect biodiversity and restore ecosystems is essential to ensuring a healthy and sustainable future for humanity.