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Understanding Vaccine Hesitancy at Montefiore Medical Center: Implications for Public Health Preparedness

Published online by Cambridge University Press:  20 March 2025

Jared Shapiro ,
Adam Block  and
David Markenson
Jared Shapiro*
Affiliation:
New York Medical College, Valhalla, New York, USA
Adam Block
Affiliation:
New York Medical College, Valhalla, New York, USA
David Markenson
Affiliation:
New York Medical College, Valhalla, New York, USA
*
Corresponding author: Jared Shapiro; Email: jashapir@montefiore.org
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Abstract

Objective

Vaccine hesitancy among health care workers poses significant challenges to public health, particularly during times of crisis. This study investigates the factors influencing vaccine hesitancy among health care workers at Montefiore Medical Center, NY, with the aim of providing valuable insights to help shape and enhance future public health vaccination campaigns.

Methods

Utilizing Montefiore’s HER (Epic system) data from 2021–2023, linear logistic and multiple regression analyses were performed to assess correlations between demographic variables—such as age, race/ethnicity, job category, and county of residence—and vaccine uptake for both influenza and COVID-19 vaccines. Data were sourced from EPIC and Cority employee datasets. Missing demographic data were imputed where possible. The study population comprises a diverse workforce of 21 331 health care workers, encompassing a wide range of clinical and non-clinical roles.

Results

Key predictors of vaccine hesitancy included prior influenza vaccination status, age, race/ethnicity, job title, and county of residence. Workers vaccinated against influenza were 6.2% more likely to receive the COVID-19 vaccine. Younger health care workers and racial groups like Black and biracial employees demonstrated higher levels of hesitancy, while Asian workers exhibited higher rates of vaccine acceptance.

Conclusions

Tailored communication strategies and educational programs are critical for addressing vaccine hesitancy, particularly among younger health care workers and specific racial groups. Building trust and improving transparency will be essential to increasing vaccine uptake and achieving broader public health objectives.

Keywords

Vaccine hesitancyHealthcare workersCOVID-19 vaccineInfluenza vaccinationPublic health preparednessMontefiore Medical CenterDemographic factorsRacial disparitiesMedical mistrustEmergency Use Authorization (EUA)

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e63
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Vaccine hesitancy (VH) is defined by the World Health Organization (WHO) as the delay in acceptance or refusal of vaccines despite the availability of vaccination services. 1 Among health care workers, VH not only affects their health but also impacts their role in influencing public attitudes toward vaccination.Reference Beleche, Ruhter and Kolbe 2 This study focuses on Montefiore Medical Center, NY, to identify the factors contributing to VH and to inform strategies for improving vaccine uptake among health care providers.Reference Larson, Clarke and Jarrett 3

The legacy of mistrust in health care, particularly among racial and ethnic minority groups, contributes significantly to VH. Events such as the Tuskegee Syphilis Study have left deep-seated skepticism, especially among Black and minority health care workers, influencing perceptions of modern vaccines as potentially experimental or unsafe.Reference Brandt 4 The COVID-19 pandemic, with the rapid deployment of vaccines under Emergency Use Authorization (EUA), further exacerbated these concerns. By understanding these dynamics, we aim to inform more effective vaccine outreach and education programs tailored to health care professionals.

Methods

Study Design and Population

This retrospective cohort study includes 21 331 health care workers from Montefiore Medical Center, encompassing both administrative support and clinical staff. The study period spanned from January 2021-December 2023. The Montefiore Einstein IRB approved this study, and all data were anonymized to protect participant confidentiality. Health care workers were categorized into job groups such as physicians, nurses, pharmacists, and administrative staff, allowing for a comprehensive analysis of vaccine uptake across various roles.

Data Collection

Data were extracted from Montefiore’s EPIC and Cority systems, focusing on demographic variables (age, race/ethnicity, job category, county of residence) and vaccination status for both influenza and COVID-19. Data imputation techniques were employed to handle missing demographic information, and job titles were collapsed into categories to facilitate analysis. Influenza vaccination records were used as a predictor of COVID-19 vaccination behavior, given the historical correlation between prior vaccine behavior and current acceptance.Reference Grochowska 5

Statistical Analysis

Descriptive statistics were conducted to elucidate key characteristics of the study population. Linear logistic regression, multiple regression, and predicted probability analyses were used to explore the associations between demographic variables and vaccine uptake. The OLS model provided a robust way to predict probabilities of vaccine hesitancy, with demographic factors such as race, age, and job role being critical determinants of vaccine behavior.

Results

Sample Characteristics

The sample included a diverse workforce, aged between 25-55 years, with varied racial and ethnic backgrounds. Health care roles ranged from physicians to technicians and administrative staff, reflecting the full spectrum of hospital-based employees. A significant percentage of the study population resided in New York County and the Bronx, allowing for a nuanced understanding of geographic influences on VH.

Key Predictors of Vaccine Hesitancy

The analysis identified several key predictors of vaccine hesitancy among health care workers. Influenza vaccination status was a significant factor, with health care workers who received the influenza vaccine being 6.2 percentage points more likely to also receive the COVID-19 vaccine (Figure 1).Reference Beleche, Ruhter and Kolbe 2 , Reference Larson, Clarke and Jarrett 3 Age also played a critical role, as younger health care workers exhibited higher levels of hesitancy compared to their older colleagues (Figure 2).Reference Fine, Eames and Heymann 6 Racial and ethnic background further influenced vaccine behavior, with Asian health care workers demonstrating higher acceptance rates compared to their White counterparts, while Black health care workers exhibited greater vaccine hesitancy (Figure 3).Reference Truong 7 Job title was another significant predictor, with physicians being more likely to be vaccinated than nurses and technicians (Figure 4).Reference Paterson 8 Finally, geographic location had an impact, as health care workers residing in New York County were more likely to receive the COVID-19 vaccine compared to those living in the Bronx.Reference Beleche, Ruhter and Kolbe 2 These findings highlight the complex interplay of demographic and occupational factors in shaping vaccine hesitancy.

Figure 1.

Predicted probabilities of receiving at least 2 doses of a SARS-CoV2 vaccine, with a 95% confidence interval for each estimated probability.

Figure 2.

Predicted probability of receiving an influenza vaccine and at least 2 doses of a SARS-CoV2 vaccine, predicted for several birth years, based on the linear model in Table 8, with a 95% confidence interval for each estimated probability.

Figure 3

Predicted probabilities of receiving at least 2 doses of a SARS-CoV2 vaccine, with a 95% confidence interval for each estimated probability.

Figure 4.

Predicted probability of receiving an influenza vaccine and at least 2 doses of a SARS-CoV2 vaccine, predicted for each job category based on the model in Table 8, with a 95% confidence interval for each estimated probability.

Discussion

The findings from this study provide critical insights into the factors driving vaccine hesitancy among health care workers. Previous vaccination behavior, particularly influenza vaccination status, emerged as a strong predictor of COVID-19 vaccine uptake, echoing patterns observed in prior research.Reference Willis 9 This suggests that historical vaccine behavior is an important determinant of future vaccine acceptance and can inform strategies to mitigate hesitancy in subsequent public health crises.

Mistrust in health care, particularly among minority groups, plays a significant role in vaccine hesitancy. As highlighted in historical cases like the Tuskegee experiments, the legacy of unethical medical research has left a profound impact on trust in the health care system.Reference Washington 10 The unique circumstances of the COVID-19 vaccine rollout, especially under EUA, likely exacerbated these concerns, leading to higher levels of hesitancy among Black and biracial health care workers. Future interventions must directly address these concerns by fostering trust through transparent communication and culturally competent outreach efforts.Reference Kizzmekia 11

Conclusion

Addressing VH among health care workers is crucial for effective public health preparedness. Tailored communication strategies, educational programs, and fostering an environment of trust and transparency are essential to enhance vaccine uptake. By improving vaccination rates among health care workers, we can support broader public health goals and ensure better preparedness for future public health crises. 1

Author contribution

Jared Shapiro: Conducted all research, including conceptualization, methodology, data collection, statistical analysis, data interpretation, and manuscript drafting; Adam Block: Research committee chair. Provided extensive guidance on research design, statistical analysis, and manuscript development, as well as critical review and feedback throughout the research process; David Markenson: Research committee member, offering academic oversight, feedback on research design, and manuscript review.

References

World Health Organization. Ten Threats to Global Health in 2019. Accessed March 2023 https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019Google Scholar
Beleche, T, Ruhter, J, Kolbe, A, et al. COVID-19 vaccine hesitancy: demographic factors, geographic patterns, and changes over time. J Public Health Manag Pract. 2023;29(2):123–135.Google Scholar
Larson, HJ, Clarke, RM, Jarrett, C, et al. Measuring trust in vaccination: a systematic review. Hum Vaccin Immunother. 2022;18(1):1–8.Google Scholar
Brandt, AM. Racism and research: the case of the Tuskegee Syphilis Study. Hastings Cent Rep. 1978;8(6):21–29.CrossRefGoogle ScholarPubMed
Grochowska, M, et al. The impact of prior vaccination behavior on future vaccine uptake. Vaccine. 2021;39(3):456–463.Google Scholar
Fine, P, Eames, K, Heymann, DL. “Herd immunity”: a rough guide. Clin Infect Dis. 2011;52(7):911–916.CrossRefGoogle ScholarPubMed
Truong, J, et al. Factors associated with COVID-19 vaccine hesitancy. J Racial Ethn Health Disparities. 2021;8(5):1–8.Google Scholar
Paterson, P, et al. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34(52):6700–6706.CrossRefGoogle ScholarPubMed
Willis, DE, et al. Predictors of COVID-19 vaccine hesitancy. Vaccines. 2022;10(1):75.Google Scholar
Washington, HA. Medical Apartheid. Doubleday; 2006.Google Scholar
Kizzmekia, C, et al. Addressing vaccine trust. N Engl J Med. 2021;384(5):471–473.Google Scholar
Figure 0

Figure 1. Predicted probabilities of receiving at least 2 doses of a SARS-CoV2 vaccine, with a 95% confidence interval for each estimated probability.

Figure 1

Figure 2. Predicted probability of receiving an influenza vaccine and at least 2 doses of a SARS-CoV2 vaccine, predicted for several birth years, based on the linear model in Table 8, with a 95% confidence interval for each estimated probability.

Figure 2

Figure 3 Predicted probabilities of receiving at least 2 doses of a SARS-CoV2 vaccine, with a 95% confidence interval for each estimated probability.

Figure 3

Figure 4. Predicted probability of receiving an influenza vaccine and at least 2 doses of a SARS-CoV2 vaccine, predicted for each job category based on the model in Table 8, with a 95% confidence interval for each estimated probability.