Healthcare Workers' Attitudes towards Mandatory COVID-19 Vaccination: A Systematic Review and Meta-Analysis

Abstract

Background: COVID-19 vaccine mandates are considered a controversial public health policy both in public debate and among healthcare workers (HCWs). Thus, the objective of this systematic review is to give a deep insight into HCWs' views and attitudes towards COVID-19 vaccination mandates amid the ongoing COVID-19 pandemic.

Methods: A systematic literature search of five databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) was conducted between July 2022 and November 2022. Original quantitative studies that addressed the attitudes of HCWs regarding COVID-19 vaccine mandates were considered eligible for this systematic review. All the included studies (n = 57) were critically appraised and assessed for risk of systematic bias. Meta-analyses were performed, providing a pooled estimate of HCWs' acceptance towards COVID-19 vaccine mandates for: 1. HCWs and 2. the general population.

Results: In total, 64% (95% CI: 55%, 72%) of HCWs favored COVID-19 vaccine mandates for HCWs, while 50% (95% CI: 38%, 61%) supported mandating COVID-19 vaccines for the general population.

Conclusions: Our findings indicate that mandatory vaccination against COVID-19 is a highly controversial issue among HCWs. The present study provides stakeholders and policy makers with useful evidence related to the compulsory or non-compulsory nature of COVID-19 vaccinations for HCWs and the general population. Other: The protocol used in this review is registered on PROSPERO with the ID number: CRD42022350275.

Keywords: global health policy; healthcare workers; mandatory COVID-19 vaccination; publication bias.

Figure 1

Conceptual framework: HCWs and COVID-19 vaccine mandates.

Figure 2

Flowchart of our systematic literature search (July 2022–November 2022).

Figure 3

Results of the meta-analysis. The pooled proportion (orange rhombus) of HCWs’ acceptance of mandatory COVID-19 vaccines for the general population was 50% (95% CI: 38%, 61%) [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49].

Figure 4

DOI plot with LFK index = 0.04, along with the funnel plot and Egger’s test (p-value = 0.864).

Figure 5

Results of the meta-analysis. The pooled proportion (orange rhombus) of HCWs’ acceptance of mandatory COVID-19 vaccines for HCWs was 64% (95% CI: 55%, 72%) [32,36,37,40,43,44,45,46,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69].

Figure 6

DOI plot with LFK index = 2.42, along with the funnel plot and Egger’s test (p-value = 0.063).

Figure 7

Relationship between physicians and other HCWs regarding the acceptance of COVID-19 vaccine mandates for HCWs [52,56,57,65].