California Health Providers' Attitudes Regarding a COVID-19 Vaccine Goodwin and Simon Strategic Research December 2020 California Health Providers' Attitudes Regarding a COVID-19 Vaccine December 2020 Author: Goodwin Simon Strategic Research In early December 2020, as two vaccines against COVID-19 were moving toward consideration by the US Food and Drug Administration, the California Health Care Foundation (CHCF) in conjunction with Goodwin Simon Strategic Research, conducted a statewide survey of California health care providers regarding attitudes and motivations around a COVID-19 vaccine. The survey was conducted December 2–9, 2020, among 1,203 health care providers. Key findings include: • Statewide, 83% of health care providers say they will get the vaccine. More than half (53%) will "definitely" get the vaccine if it is made available to them, and another 31% will "probably" get it. • As for timing, nearly half of providers (47%) would want to get the vaccine immediately after it is made available to them, and another 23% would want to get it one to two months after. • Sixty-five percent of all providers favor an employer mandate that clinicians receive the vaccine. While majorities across provider types favor an employer mandate, a potentially vocal minority (15%) of providers strongly oppose one. . Here is the breakdown of provider types who were interviewed. Respondent Type Specialty Quantity PCPs and other mixed specialty who treat patients/residents. MDs/DOs Can work in any of the settings in Q6, including skilled nursing, 501 assisted living, or long-term care facilities. NPs/PAs NPs/PAs who treat patients/residents 320 Nurses Nurses who treat patients/residents 318 Providers at Direct providers at skilled nursing (SN), assisted living (AL), or 300 SN/AL/LTC Facility long-term care (LTC) facilities QUESTIONNAIRE AND RESPONSES Following is the complete questionnaire with responses. Thank you for agreeing to take our confidential and anonymous survey. To participate, simply answer the question(s) on each page and click the "Continue" button to progress in the survey. Your responses will be submitted as you progress through the survey. Overall, we expect your participation to take approximately 10 minutes. 1 Click the "Continue" button below to begin. Now we have some questions that are strictly for statistical use. S1. Please indicate your state of residence. [INSERT STATE DROP DOWN] California = CONTINUE; ALL ELSE = TERMINATE 1. In what county do you practice primarily? [INSERT CA COUNTY DROP DOWN, + UNSURE] Bay Area: Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, 23% Solano, Sonoma Rural North: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, 3 Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Greater Sacramento: El Dorado, Placer, Sacramento, Yolo 5 Central Coast: Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura 6 Central Valley: Fresno, Kern, Kings, Madera, Mariposa, Merced, San Joaquin, Stanislaus, 7 Tulare Los Angeles County: Los Angeles 29 San Diego / Orange: Orange, San Diego 21 Inland Empire / Desert: Imperial, Inyo, Mono, Riverside, San Bernardino 7 * Indicates that less than one half of one percent of respondents gave this response. - Indicates that no respondents gave this response. Please note that due to rounding, totals may equal a few points more or less than one hundred. 2. Would you describe where you primarily practice as: A large city with about a half-million people or more 53% A smaller city 20 A suburb near a city 20 A small town or rural area 7 Unsure * 2 3. In the last six months, have you provided direct care to patients in any setting (private practice, hospital, urgent care center, etc.) and/or direct care to residents in a skilled nursing facility, nursing home, or residential care facility (assisted living or long-term care)? This could include in-person or telehealth. (Telehealth includes providing patient care virtually by telephone or video.) Yes, direct care to patients 78% Yes, direct care to residents in a skilled nursing facility, nursing home, 5 or residential care facility (assisted living or long-term care) Yes, both 16 No, neither - TERMINATE Unsure - TERMINATE 4. Which of the following licenses, credentials, or degrees do you currently hold? (Please select all that apply.) [ALLOW MULTIPLE RESPONSES] MD 38% DO 3 Nurse Practitioner (NP) 17 Physician Assistant (PA) 10 Respiratory Therapist * RN 29 Licensed Practical Nurse/Licensed Vocational Nurse 3 (LPN/LVN) Certified Nursing Assistant (CNA) * Certified Registered Nurse Anesthetist (CRNA) * Clinical Nurse Specialist (CNS) 1 Certified Nurse Midwife (CNM) 1 Dietitian 2 Occupational Therapist * Physical Therapist 3 Speech Therapist - Other TERMINATE Prefer not to say TERMINATE Unsure TERMINATE [ASK Q5 IF MD, DO, NP, OR PA] 5. What is your medical specialty? (n = 821) Primary care (general and family practitioner, general internist) 41% Specialist (medical specialist, surgeon, ob/gyn, radiology) 27 Pediatrics 11 Psychiatry 5 Emergency medicine 9 Other (Please specify) 8 Unsure - 3 [RESUME ASKING EVERYONE] 6. In which of the following settings have you primarily practiced or worked in the last six months? (Please select all that apply.) [ALLOW MULTIPLE RESPONSES] Emergency department 14% NET: HOSPITAL In-patient hospital 38 65% Outpatient clinic or service within a hospital such as cardiology, radiology, 31 or specialty clinics (excluding ED) Outpatient surgery center or infusion (chemotherapy) or dialysis clinic 6 NET: Urgent care center 10 NONHOSPITAL: Community health center or clinic, free or reduced-fee clinic, or public 14 43% health center Federally Qualified Health Center 5 Skilled nursing facility (SNF) or nursing home 11 Residential care facility (assisted living or long-term care) 6 Home health care 7 Other (specify) 12 Unsure * • [IF Q6 ≠ 8/9, USE "PATIENT" LANGUAGE BELOW] • [IF Q6 = 8/9 AND OTHER Q6 ITEMS, USE "PATIENT AND/OR RESIDENT" LANGUAGE BELOW] • [IF Q6 = 8/9 ONLY, USE "RESIDENT" LANGUAGE BELOW] 7. Do you currently belong to a professional association (e.g., California Medical Association) or to a labor union for health workers? Yes, to a professional association 47% Yes, to a labor union 9 Yes, to both 7 No, neither 35 Unsure 2 8. What percentage of your patient population [resident population / patient and resident populations] would you estimate are Medicaid/Medi-Cal or uninsured? Your best guess is fine. [CODE ANYONE WHO RESPONDS 30% OR MORE (3:5) AS "SAFETY-NET PROVIDER"] None 4% TOTAL NOT SAFETY-NET Less than 30% 30 PROVIDER: 34% 30% to 50% 26 TOTAL SAFETY-NET 51% to 75% 18 PROVIDER: 62% More than 75% 18 Unsure 4 4 9. In the last six months, approximately how many COVID-19 patients [patients and residents/residents] have you seen or treated? Your best guess is fine. Zero 9% 1 to 5 18 6 to 10 14 11 to 20 13 21 to 50 18 51 to 100 11 101 or more 12 Unsure 5 10. Thinking about where you work most frequently, do you have enough personal protective equipment (PPE) to prevent the spread of COVID-19? Yes 76% No 17 Unsure 7 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Yes 79% 76% 72% 75% No 15 18 20 18 Unsure 6 6 8 7 11. At your workplace, which of the following best describes COVID-19 testing for health care providers like yourself? I receive routine testing 14% Testing is available at my request 56 I do not have access to adequate testing 27 Unsure 4 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers I receive routine testing 8% 10% 20% 32% Testing is available at my request 68 56 42 44 I do not have access to adequate 22 30 32 20 testing Unsure 3 4 5 4 5 12. How concerned are you about contracting COVID-19 at work? Extremely concerned 19% TOTAL Very concerned 27 CONCERNED: Somewhat concerned 33 80% A little concerned 15 Not concerned at all 5 Unsure * 13. When a COVID-19 vaccine receives emergency use authorization from the FDA and becomes available for health care providers like yourself, would you definitely get the vaccine, probably get the vaccine, probably would not get the vaccine, or definitely would not get the vaccine? Definitely get the vaccine 53% TOTAL WOULD GET VACCINE: Probably get the vaccine 31 83% Probably not get the vaccine 9 TOTAL WOULD NOT GET VACCINE: Definitely not get the vaccine 4 13% Unsure 4 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Definitely get the vaccine 65% 48% 40% 46% Probably get the vaccine 28 31 33 35 Probably not get the vaccine 4 13 14 10 Definitely not get the vaccine 2 4 6 4 Unsure 2 3 7 5 SPLIT SAMPLE A (n 300 distributed across sample types at the top of page 1) 14. Regardless of whether or not you would get the vaccine, what are the one or two main reasons you would get a COVID-19 vaccine once it is available? [OPEN-ENDED] ______________________ SPLIT SAMPLE B (n 300 distributed across sample types at the top of page 1) 15. Regardless of whether or not you would get the vaccine, what are the one or two main reasons you would not get a COVID-19 vaccine once it is available? [OPEN-ENDED] ______________________ SPLIT SAMPLE C (n 300 distributed across sample types at the top of page 1) 16. When a COVID-19 vaccine becomes available, what, if anything, would increase your willingness to get vaccinated? [OPEN-ENDED] ______________________ SPLIT SAMPLE D (n 300 distributed across sample types at the top of page 1) 17. When a COVID-19 vaccine becomes available, what, if anything, would decrease your willingness to get vaccinated? [OPEN-ENDED] ________________________ 6 [RESUME ASKING EVERYONE] 18. For each of the following, please indicate if it would make you more likely or less likely to get a COVID-19 vaccine, or if it would make no difference one way or the other. For this question, assume the vaccine has been approved by the FDA under emergency use authorization. Much more Somewhat Somewhat Much less No Not RANDOMIZE likely more likely less likely likely difference applicable Unsure SPLIT SAMPLE A (n = 600) a. The vaccine is shown to be 85% to 58% 26% 2% 1% 11% - 2% 94% effective at preventing sickness b. The vaccine trials included people demographically similar to you (e.g., 47 32 2 1 18 - 2 similar age, race, gender, etc.) c. The vaccine shows no serious side 76 15 2 1 5 * 1 effects d. The vaccine is recommended by 21 26 3 2 45 2 1 your employer e. All vaccine-related costs are covered by your employer and/or the state 45 23 1 1 29 1 1 of California SPLIT SAMPLE B (n = 603) f. The vaccine is shown to be 95% to 68 21 1 * 10 * * 99% effective at preventing sickness g. A large number of other health care providers have already received the 47 29 2 * 20 * 1 vaccine h. The vaccine trials included people with similar health conditions as you 42 30 2 * 17 8 * (e.g., heart disease, high blood pressure, diabetes, obesity, etc.) i. The vaccine is recommended by 25 33 2 1 37 1 1 your personal doctor j. The vaccine is required by your 45 23 4 2 22 2 2 employer IF UNION MEMBER IN Q7, ASK: (n = 185) k. The vaccine is recommended by 15 18 4 2 57 1 3 your union IF MEMBER OF PROFESSIONAL ASSOCIATION IN Q7, ASK: (n = 651) l. The vaccine is recommended by 30 32 4 1 32 * 1 your professional association 7 [RESUME ASKING EVERYONE] 19. After the FDA grants emergency use authorization and it becomes available to you, when would you want to get the COVID-19 vaccine? Immediately 47% After one to two months 23 After three to four months 11 Wait longer than that 12 Never 2 Unsure 5 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Immediately 56% 44% 38% 41% After one to two months 25 21 19 27 After three to four months 9 12 12 12 Wait longer than that 6 14 21 13 Never 1 2 2 2 Unsure 3 7 8 5 20. For you personally, how important is each of the following when it comes to getting a COVID-19 vaccine? RANDOMIZE Not Extremely Very Somewhat A little important important important important important at all Unsure a. To protect yourself 71% 16% 7% 2% 2% 1% b. To protect your family 86 9 3 1 1 1 c. To protect your friends 64 24 7 2 1 1 d. To protect your coworkers 63 26 7 1 1 1 e. To protect your patients [patients and residents / residents] 70 23 4 1 1 1 f. To protect people in the community where you live 57 31 8 2 2 1 21. Which of the following sources would you trust to provide you with accurate information about a COVID-19 vaccine? Please select all that apply. [RANDOMIZE] Peer-reviewed medical journals (e.g., Journal of the American Medical Association) 74% Research studies/literature 70 Centers for Disease Control and Prevention (CDC) 63 Dr. Anthony Fauci 57 Food and Drug Administration (FDA) 49 California Department of Public Health 41 8 Biden administration's COVID-19 Task Force 33 Leadership at your hospital or medical facility (e.g., medical director, chief medical officer, etc.) 31 Colleague(s) in your field 30 Your county's public health officer 26 [IF IN PROFESSIONAL ASSOCIATION ON Q7] Your professional association 24 President-elect Joe Biden 17 General health media (e.g., Kaiser Health News, California Healthline, VoxCare) 13 Governor Gavin Newsom 12 Western States Scientific Safety Review Workgroup 8 [IF IN UNION ON Q7] Your labor union 2 Other, please specify: 4 Unsure 1 22. When a vaccine to prevent COVID-19 is approved by the FDA for the general public, would you recommend the vaccine to your patients [patients and residents / residents] OR probably recommend it [patients and residents / residents], probably not recommend it, or definitely not recommend it to your patients [patients and residents / residents]? Definitely recommend the vaccine 57% TOTAL RECOMMEND Probably recommend the vaccine 33 VACCINE: 91% Probably not recommend the vaccine 2 TOTAL NOT RECOMMEND Definitely not recommend the vaccine 1 VACCINE: 3% Unsure 7 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Definitely recommend the vaccine 68% 52% 47% 53% Probably recommend the vaccine 28 38 37 34 Probably not recommend the vaccine 1 2 3 2 Definitely not recommend the vaccine * 1 2 1 Unsure 3 6 11 10 23. Would you favor or oppose the state of California mandating that all health care providers get a COVID-19 vaccine? Strongly favor 37% NET TOTAL Somewhat favor 28 FAVOR: 65% Somewhat oppose 15 NET TOTAL Strongly oppose 15 OPPOSE: 30% Unsure 6 9 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Strongly favor 44% 31% 32% 36% Somewhat favor 30 31 22 25 Somewhat oppose 12 17 19 16 Strongly oppose 9 16 22 18 Unsure 6 4 5 4 MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers NET TOTAL FAVOR: 73% 62% 54% 61% NET TOTAL OPPOSE: 21 33 41 35 24. Would you favor or oppose employers at health care facilities like yours mandating that all health care providers at their facility get a COVID-19 vaccine? Strongly favor 37% NET TOTAL Somewhat favor 28 FAVOR: 65% Somewhat oppose 15 NET TOTAL Strongly oppose 15 OPPOSE: 30% Unsure 5 Responses by subgroup MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers Strongly favor 45% 32% 31% 35% Somewhat favor 27 32 25 27 Somewhat oppose 13 17 17 16 Strongly oppose 10 16 23 19 Unsure 5 3 4 4 MDs/DOs NPs/PAs Nurses SN/AL/LTC Providers NET TOTAL FAVOR: 72% 64% 56% 62% NET TOTAL OPPOSE: 23 33 40 35 10 [ON-SCREEN] These last questions are strictly for statistical purposes only. 25. Are you employed by any of the following? (Please select all that apply.) [ALLOW MULTIPLE RESPONSES] A private practice or physician-owned practice 27% A private medical system or hospital (including a private 18 university-owned system or hospital) Medical group–owned practice 14 A hospital-owned or hospital-system-owned practice 21 Self-employed / own practice 8 A city 1 A county (including a county-owned hospital) 7 A health care district 1 The University of California 5 The state of California, other than the University of California 3 The federal government 3 FQHC 5 Other (please specify) 6 Unsure 2 26. Approximately how many health care providers are there at the facility where you work most frequently? 1–5 18% 6–10 10 11–25 11 26–50 10 51–100 9 101–250 10 More than 250 31 Unsure 2 27. How frequently do you get a flu shot, if ever? Every year 90% Most years 4 Just some years 3 Rarely 2 Never 2 Unsure * 11 28. What percentage of your patient [patient or resident / resident] population would you estimate is patients of color (e.g., Black / African American, Hispanic/Latino/a, Asian / Pacific Islander, or Native American)? 10% or less 7% NET 25% OR LESS: 11%–25% 16 24% 26%–50% 38 51%–75% 25 NET 51% OR MORE: More than 75% 12 37% Unsure 1 29. What is your gender? Are you . . . Male 33% Female 66 I identify differently * 30. What is your age? [CODE AS A NUMERIC VALUE] 18–24 * 25–29 4% 30–34 12 35–39 15 40–44 15 45–49 13 50–54 11 55–59 10 60–64 9 65+ 10 Unsure * 12 31. And just to make sure we have a representative sample, what is your race or ethnicity? You may select all that apply. [ALLOW MULTIPLE RESPONSES] White/Caucasian 56% African American / Black 3 Hispanic/Latino/Latina 9 East Asian (Chinese, Japanese, Vietnamese, Korean, Taiwanese, etc.) 19 South Asian (Indian, Bangladeshi, Pakistani, Nepalese, Sri Lankan, etc.) 6 Filipino 6 Other Asian (Thai, Cambodian, Laotian, etc.) 1 Pacific Islander 1 Middle Eastern 2 Native American (Apache, Cherokee, Lakota, Navajo, etc.) 1 Other: specify ________________ 1 Unsure 1 32. Have you ever gotten tested for COVID-19? If you prefer not to say, please indicate that. Yes 66% No 31 Prefer not to say 3 Unsure * [IF Q32 = YES, ASK Q33] (n = 790) 33. And have you ever tested positive for COVID-19? If you prefer not to say, please indicate that. Yes 7% No 92 Prefer not to say 1 Unsure * [RESUME ASKING EVERYONE] 34. Thank you for your participation. If you had any technical or other issues with the survey, or if there is anything else you would like to add about the topics of the survey, please share with us in the box below. [OPEN-END, INSERT TEXT BOX]  Nothing to share Thank you for your participation. 13 About the Authors Goodwin Simon Strategic Research (GSSR) is an independent opinion research firm with decades of experience in polling, policy analysis, and communications strategy for clients in the public and private sectors. GSSR's Partner Amy Simon, Senior Research Director John Whaley, and research analyst Andrea Hackl all contributed their thought leadership to this survey research in collaboration with the California Health Care Foundation. About the Foundation The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford. 14