Barriers to COVID-19 vaccinations and moral struggle among nurses in a Chinese community : a critical medical anthropology analysis

Abstract

Background: Past studies have shown that people are less inclined to get vaccinated when healthcare providers are hesitant about the immunisation. Nurses have been documented as the most hesitant healthcare group towards COVID-19 vaccination in both Western and Chinese communities. This study investigates the perceptions of COVID-19 vaccines among nurses in a Chinese society and the reasons contributing to their high hesitancy. Methods: A qualitative descriptive approach was used, involving in-depth semi-structured interviews from September to December 2022 with 35 nurses in Hong Kong who did not receive COVID-19 vaccinations. A thematic analysis of the data was implemented in accordance with the critical medical anthropology framework. Results: Two themes were identified: barriers to receiving COVID-19 vaccinations and the moral struggles of participants in not getting vaccinated. Participants demonstrated a lack of confidence and individual safety concerns, related to the negative information shared among their healthcare colleagues and non-healthcare workers through social media platforms. Participants revealed resistance towards the vaccination policies of the government and their workplaces, and they distrusted the commercial and profit-oriented nature of the vaccines against COVID-19. Conclusion: At the individual level, participants' lack of confidence and worries about vaccine safety emerged from the intertwined relationship of the negative information shared among their healthcare colleagues and non-healthcare workers through social media platforms at both the individual and micro-social levels. In addition, resistance was seen at the intermediate-social level, involving distrust of the profit-oriented nature of the capitalist operation, as well as cultural confidence in the efficacy of traditional Chinese medicine against COVID-19 infection at the macro-social level. This study suggests that addressing the agents that can affect nurses' socialisation process at different social levels according to the critical medical anthropology framework is crucial for motivating nurses' vaccine acceptance.