Abstract
Among healthcare workers (HCWs), SARS-CoV-2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed with a self-completed questionnaire that included a tool (Q-No) for the identification of nocebo-prone individuals. A total of 1309 HCWs (67.2% women; 43.4% physicians; 28.4% nurses; 11.5% administrative staff; 16.6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q-No scores were ≥15 in 325 participants (24.8%) suggesting nocebo-prone behavior. In a multivariate logistic regression model with Q-No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p < 0.001) in participants with Q-No score ≥ 15 vs. Q-No score < 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p < 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu-like symptoms. In a multivariate logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated ORs of AE reporting were 2.0 in females vs. males (p < 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q-No score, which were not significantly associated with OR of AE. These findings suggest that nocebo-prone behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.
Highlights
COVID-19 continues to spread worldwide, and acceptance of anti- SARS-CoV-2 vaccines is crucial for achieving sufficient immunization to impede the pandemic [1]
Our findings provide evidence that nocebo prone behavior and by extension, the nocebo effect, is linked to vaccine hesitancy, a crucial challenge amid the COVID-19 pandemic: In two French cross-sectional studies investigating the intention for vaccination, hesitancy towards theSARS-CoV-2 vaccine reached 25–27% among healthcare workers (HCWs) [4,24]
In a cross-sectional survey conducted in five hospitals in Athens, in the spring of 2021, two out of eleven HCWs refused vaccination for SARS-CoV-2
Summary
COVID-19 continues to spread worldwide, and acceptance of anti- SARS-CoV-2 vaccines is crucial for achieving sufficient immunization to impede the pandemic [1]. Healthcare workers (HCWs) represent a priority group for vaccination because of their elevated risk of SARS-CoV-2 infection and potential contribution to nosocomial transmission. The nocebo effect, and its opposite, the placebo effect, refer to health changes attributed to negative and positive patients’ expectations, respectively, rather than pharmacological or physical implications of the treatment [11]. Both nocebo and placebo effects are very powerful and pervasive in clinical practice, they are underestimated and underappreciated [12]
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