New study helps inform actions to increase COVID-19 vaccine uptake among Albania’s health workers – World Health Organization

Enxhi Durmishaj is 29 years old and works in an administrative role at Mother Teresa Hospital, a large public hospital in Tirana, Albania’s capital. Rudina Çopa is 33 and oversees the sanitation team’s work and waste management at the Durres Regional Hospital in western Albania. Both women are vaccinated against COVID-19, having received 2 primary vaccine doses and a booster dose. 

Why did they get vaccinated? Durmishaj explains, “I believe that vaccination is the most effective form of protection against COVID-19. I believe in vaccination and its effectiveness. In Albania, one of the things we are most proud of is the immunization programme. The programme is one of the most consolidated public health interventions.”

“I got vaccinated because COVID-19 became frightening and people my age started to get very sick and die,” says Çopa. “Also, I believe the scientists did a great job to make it possible for us to have a vaccine.” 

These young female health workers’ experiences of and attitudes towards COVID-19 vaccination, especially towards getting a booster dose, are not, however, typical among their peers. 

According to a recent study from Albania, as of June 2022, while nearly 90% of health workers had received a primary COVID-19 vaccine series, less than a fifth (about 19%) had received a booster dose. Booster dose uptake was even lower among younger (under 35) health workers, female health workers, and nurses, midwives, support staff and administrative staff.

This is in spite of the evidence that boosters can prevent infection and especially severe disease from COVID-19, and the fact that non-physician health workers participating in the study were more likely than physicians to have been infected with COVID-19 in the first 18 months of the pandemic.

“Many of my colleagues have been hesitant about getting the COVID-19 booster,” admits Durmishaj, who participated in the study together with Çopa. “I have encouraged them to get the booster, as prevention is better than cure.”

The study also found that uptake of a COVID-19 primary vaccine series was lower among younger health workers and female health workers. These findings reveal that many health workers of reproductive age are missing out on the benefits of vaccination. 

This is of concern, as pregnant women infected with COVID-19 are more likely to develop severe illness compared with non-pregnant women. COVID-19 vaccines have been shown to be safe and effective for pregnant women, and vaccination of pregnant women appears to protect their newborn babies from falling sick as well. 

The study, conducted by Albania’s Institute of Public Health with support from WHO/Europe, the Task Force for Global Health, and the United States Centers for Disease Control and Prevention (CDC), was just published in The Lancet Regional Health – Europe.

A study like no other 

Every week, between February 2021 and June 2022, some 1500 health workers – over 40% of the staff of 3 large public hospitals – provided detailed information to the study team as part of a broader study to evaluate COVID-19 vaccine effectiveness. Data from the study were analysed to better understand the uptake of COVID-19 vaccines among Albanian health workers.

“The strength of the study lies in this: having a considerable number of health workers participating in the study for a considerable period, feeding the study team with information about their health and COVID-19 vaccination status on a regular basis. I don’t think there are many studies like this in this part of the world,” says Silvia Bino, the study’s senior author and Head of the Control of Infectious Diseases Department of Albania’s Institute of Public Health. 

“The study helps us to understand what categories of health workers have remained unvaccinated or partially vaccinated since January 2021, when COVID-19 vaccination began in Albania. The findings can help inform health policies and interventions so we can increase vaccine uptake in this high-priority group,” explains Bino.

Pernille Jorgensen, the study’s coordinator and Technical Officer at WHO/Europe, points out, “The study also found that health workers who had previously received the seasonal influenza vaccine, a vaccine that has been recommended for all health workers in Albania since 2014, were more likely to have received 1 or more doses of COVID-19 vaccines.” 

Jorgensen adds, “We found the same connection between influenza vaccination and COVID-19 vaccine uptake in other WHO studies in several European countries. These findings suggest that increasing influenza vaccine uptake may, in addition to preventing influenza, potentially lead to an increased uptake of pandemic vaccines in the future.”

Elga Spaho, a 52-year-old psychiatrist who participated in the Albanian study, agrees. “Having been vaccinated against influenza did influence my decision to get the COVID-19 vaccine because I have known over time the benefits of being vaccinated. I was already vaccinated when I tested positive for COVID-19, and this prepared my immune system to get over the disease easily. I got my entire family vaccinated and have also tried to convince everyone I know to get vaccinated against COVID-19.” 

Vaccines remain the best protection against COVID-19

It has been over 3 years since COVID-19 first emerged in the WHO European Region, which covers 53 countries across Europe and central Asia. The virus remains a threat to millions of people in the Region who are still unvaccinated, including health workers. 

Health workers are highly susceptible to COVID-19 due to their profession. They risk both getting ill and spreading the disease to vulnerable patients. For these reasons, health workers were among the first groups to receive a COVID-19 vaccine. 

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.

While COVID-19 vaccine uptake has generally been high among health workers in many high-income countries, uptake has varied in low- and middle-income countries. In the European Region, at the end of June 2022 more than 80% of health workers in high-income countries had received a complete primary COVID-19 vaccine series and 51% an additional dose (a booster), compared with 33% and 8%, respectively, of health workers in upper-middle-income countries. 

Richard Pebody, Head of the High-threat Pathogen Team at WHO/Europe, explains, “While most health workers in the Albanian study completed the primary COVID-19 vaccine series, many had not taken up the offer of a booster dose. Efforts should be made to understand the reasons for the low booster dose uptake, particularly among young health workers, female health workers and non-physician health workers. Identifying these reasons will help health authorities to tailor their vaccine programme to protect health workers and preserve essential health services during future waves of SARS-CoV-2.” 

He adds, “Also, more needs to be done to raise awareness about the safety and benefits of COVID-19 vaccination for health workers of reproductive age and pregnant women in general.” 

To conclude, Pebody emphasizes, “Vaccines remain the best protection we have against severe disease and death from COVID-19. Boosters reinforce protection against severe disease. Even in communities that have experienced high COVID-19 infection rates, vaccination and boosters provide an additional layer of protection against reinfection and especially severe disease. We really need to get this message out all the more, over and over again.”