Medical students’ vaccine hesitancy, knowledge and attitudes: A cross-sectional study

BACKGROUND: Despite physicians being in a unique position to address concerns about vaccine hesitancy (VH), there are hesitant and concerned physicians about vaccination safety and utility. This study aimed to investigate medical students’ knowledge, VH and their association: besides students’ attitudes towards vaccines. METHODS: VH, knowledge, and attitudes towards vaccines were collected using an anonymous self-administered questionnaire. Cronbach's alpha of questionnaire domains was 0.70, 0.80 and 0.78 for VH, knowledge and attitudes, respectively. The opinion answers were added to calculate vaccine Hesitancy Index (HI < 18=low, 19-22=medium, >23=high). RESULTS: Although the frequency of hesitant students decreased from the first to the fifth year, unfortunately a percentage of future doctors with a non-negligible HI level persisted (medium HI level: 31.3%, high HI level 14.9%). We found a negative association between the percentage of students aware of recommended vaccines for healthcare professionals (chickenpox 74.5%vs 57.5%, p = 0.00; measles, mumps, and rubella 92.8%vs83.5%, p = 0.03; meningococcus 79.7%vs 67.7%, p = 0.00) and HI (low vs high). Furthermore, we found a positive association between the frequency of students who had not been vaccinated (varicella 2.3%vs3.9%, p = 0.00) or who did not know if they were (varicella 8.2%vs22.8%, p = 0.00; Hepatitis B 11.4%vs20.5%, p = 0.02; Tdap 4.6%vs15.0%, p = 0.00) and HI (low vs high). Overall, the reason for not getting vaccinated given by most students was ‘I didn't have time’ (flu: 60.8%vs66.9%) showing a positive association with HI. Conversely, a negative association was found with the reason ‘The vaccine is not free’ (flu 71.4%vs0.0%) that is higher HI corresponded to less vaccine knowledge. CONCLUSIONS: Actions are needed in the future on the education of medical students as well as on the role they perceive themselves to have in responding to patient hesitation, and on their level of confidence in doing so. KEY MESSAGES: • Physicians are in the best position to understand hesitance patients, to respond to their worries and concern, and to find ways of explaining to them the benefit of vaccination. • Widespread and interdisciplinary training on vaccine hesitancy, risk communication, infodemiology and community engagement are needed.