“Does it hurt?” asks Lela Beradze kindly as she administers an influenza vaccine to a health worker at the Botchorishvili Clinic, a large hospital in Tbilisi, Georgia. Lela is Chief Nurse at the Clinic’s emergency unit, and has been a nurse for 35 years. Her knowledge of vaccines is extensive.
She explains that the influenza vaccine is effective in protecting against the virus, adding that administering the vaccine in October or November will have the biggest impact. “Influenza is widespread among older people. The risk of an influenza outbreak [as the cold season approaches] is high. An important part of the solution to this is the influenza vaccine.”
As for the COVID-19 pandemic, Lela stresses that vaccination plays an important role. “I saw with my own eyes that people who were vaccinated had milder forms of COVID-19 and got well sooner. The unvaccinated suffered from severe forms of COVID-19 or died.”
Although they are very different viruses, COVID-19 and influenza share some similarities. They are both respiratory diseases and can both cause serious illness or be life-threatening, especially for those who are older, pregnant, living with an underlying health condition such as heart disease, or employed as a health worker.
Health workers like Lela are highly susceptible to COVID-19 and influenza infections due to their profession. They risk both getting ill themselves and spreading these diseases to vulnerable patients. Moreover, as health workers are a primary and trusted source of information, if they are positive about vaccination, their patients might be more likely to get vaccinated too.
Yet COVID-19 vaccine uptake has varied among health workers across the WHO European Region, which covers 53 countries in Europe and central Asia. Rates of vaccine coverage have been particularly low in some middle-income countries in the eastern part of the Region, including Georgia.
While a lack of COVID-19 vaccine availability and other factors have contributed to this low uptake, vaccine hesitancy among some health workers continues to be a challenge.
According to the latest data collected by Georgia’s NCDC, the uptake of a primary series (2 doses) of COVID-19 vaccine among the country’s health workers is 60–80%. However, coverage with an additional booster dose is only 18% among this risk group, according to WHO/Europe. Influenza vaccine uptake reached 55%, according to the latest data from the 2020/2021 season.
So, among Georgia’s health workers, which have been more likely to be vaccinated against COVID-19? What factors have influenced their decisions to get or not get vaccinated against COVID-19? And has it made a difference if they were previously vaccinated against influenza?
These are some of the questions a study conducted by WHO/Europe and Georgia’s NCDC, published this year, tried to answer.
COVID-19 vaccine uptake among health workers
Conducted between March and July 2021, the study assessed the factors associated with early COVID-19 vaccine uptake among over 1500 health workers, including Lela and many of her colleagues, in 6 major hospitals in Tbilisi and Batumi.
It found that, at the time, 17% of the study participants had received 1 dose of the COVID-19 vaccine. Those more likely to get the vaccine included older health workers, particularly those aged 50–59; health workers who considered the vaccines to be “somewhat effective” or “very effective” rather than “not effective”; and health workers who had been vaccinated against influenza in the past.
In fact, health workers vaccinated against influenza in the past were 3 times more likely to get vaccinated against COVID-19.
The study also revealed that, compared to physicians, other categories of the health-care workforce – including nurses and midwives, administrative staff, and ancillary staff – were less likely to have received the COVID-19 vaccine.
“This study can play a crucial role in shaping stronger vaccination campaigns. Understanding the reasons for low vaccine uptake among health workers is crucial if we want to increase COVID-19 vaccine uptake in this important population group,” points out Silviu Domente, WHO Representative and Head of the WHO Country Office in Georgia.
“Tailoring COVID-19 vaccine communications campaigns to younger and non-physician health workers, and continuing to emphasize the benefits of the COVID-19 vaccine, could help further increase vaccine coverage among Georgia’s health workers,” he adds.
Richard Pebody, Head of the High-threat Pathogen Team at WHO/Europe and coordinator of the study, explains, “Our findings suggest that a strong health-care worker vaccination programme for annual seasonal influenza may help boost uptake of the COVID-19 vaccine and also strengthen preparedness for the next pandemic – ensuring health workers get vaccinated even in the case of a future pandemic not caused by influenza or COVID-19.”
Considering that just over half of Georgian health workers were vaccinated against influenza, and that the COVID-19 vaccination rate among this group is relatively low, more work is needed to understand health workers’ decisions about vaccination and to better convey the effectiveness and safety of the vaccines.
As of October 2022, only 30% of Georgia’s population had completed the COVID-19 vaccine series, and 32% had received at least 1 dose of COVID-19 vaccine.
Vaccination against COVID-19 and influenza – key this autumn and winter
Back at the clinic, Lela is doing the rounds of her unit. She is checking that everything is running smoothly and making sure that her patients receive all the care and attention they need. She projects quiet authority and professionalism.
Today the unit is relatively quiet – a welcome change from last year when COVID-19 hospital admissions in Georgia reached 21% among those who were not vaccinated. But with COVID-19 cases on the rise again in several countries in the Region, coupled with an early spike in influenza, vaccination against both diseases among vulnerable groups remains key this autumn and winter.
“The pandemic showed us the important role vaccination plays for our health. Getting vaccinated does not only mean protecting yourself – it also means protecting those around you,” says Lela.
A colleague of Lela’s, 41-year-old nurse Eliso Matcharashvili, just got vaccinated against influenza. “Every autumn I look forward to the arrival of influenza vaccines so that I can get vaccinated and protect myself and my patients,” she says. “The vaccine provides a high level of protection for all health workers, and especially for health workers working in large hospitals, like myself.”
WHO/Europe’s advice is clear: There is an urgent need to protect people’s health, especially the most vulnerable, using all available tools, including vaccination. It is also important that people keep up with personal protective measures such as cleaning hands regularly, staying away from other people when unwell with a respiratory illness, and wearing well fitting masks, particularly when in crowded, closed settings with inadequate ventilation.