ROCHESTER, Minn. — COVID-19 vaccine acceptance among health care personnel is highest for doctors and nurses, lower among employees who perform administrative duties, and bottoms out among workers responsible for basic patient care services such as bathing, feeding, exercising and home health care.

Those are a few of the findings of a new Kaiser Family Foundation/Washington Post survey measuring vaccination intentions among a nationally representative sample of 1,327 front-line health care workers.

The study looked at workers from hospitals, doctor's offices, outpatient clinics, nursing homes, assisted care centers and home health care providers.

Paired with other recent findings on the economic and political drivers of vaccine hesitancy, a clearer picture of the phenomenon among health care workers has begun to take shape, and it falls outside of the provision of accurate information in itself.

Vaccination varies according to where you work in health care, and part of that has to do with how workers are treated.

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In the latest Kaiser Family Foundation study, at 66%, hospital workers had the highest COVID-19 vaccination rate. They were followed with those employed in outpatient clinics (at 64%), employees of doctors' offices (53%), and employees of nursing homes and assisted care facilities (50%).

Coming in last, however: Home health care workers had just a 26% vaccination rate. The low vaccination rate among home health care workers is explained in part through the fact that only 34% had been offered vaccine from their employer, compared to 60% of those who were not self-employed.

These results mirror findings from an earlier study at Yale-New Haven Hospital which found that 90% of medical residents wanted vaccine at the earliest opportunity, compared to just 33% of the hospital's food service workers.

Fewer than 1 in 5 health care workers opposed to vaccine

There was good news in the recent survey in that those who identified as being resistant to vaccine were only 18%, or fewer than one in five.

Of the remaining portion surveyed, 52% had received vaccine, 18% planned to get vaccinated and another 12% remained undecided but not opposed.

That suggests the sector is on track to becoming 70% vaccinated at a minimum, possibly surpassing 80% immunity before the industry is forced to make any decisions about compulsory vaccination.

Regardless, having so many vaccine-resistant workers within health care remains a paradox for an industry built on trust in the provision of medical treatments and, in some senses, is a moment for reflection as well.

Over 80% of those studied listed side effects and concern over the speed of development behind their hesitancy, and these fears fell along divisions according to race, political orientation and economic opportunity.

Specifically, roughly half of all health care workers who were Black, those without a college degree, and those described as Republican-leaning said they did not trust that the COVID-19 vaccines had been tested thoroughly.

These concerns held in spite of the fact that the emergency use authorization for the vaccines received the same safety review as all other medicines. For each group of the concerned a different reason has been offered.

Observers have depicted vaccine hesitancy among the lowest-paid workers as a lack of trust in "a health care industry that seems to put profits over patients and staff."

The mistrust of vaccination programs among persons of color has been traced to a documented history of maltreatment of Blacks at the hands of medical research.

Political fault lines over vaccine have been traced to the presidency of Donald Trump. For a recent study in the journal PLOS One, Swiss researchers offered insight on elevated hesitancy among those who lean Republican.

"Donald Trump, before his profile was suspended," the authors reported, "was the main driver of vaccine misinformation on Twitter."

The authors made this charge after highlighting the former president's outsized influence on an integrated anti-vaccine community online, one prone to emotional words.

Their work determined that Trump held 14 times the influence on that community as the World Health Organization held on vaccine supporters.

Though Trump is often credited with marshalling the vaccine development program known as Operation Warp Speed, he also held an "indirect ability to influence the great majority of individuals associated with the anti-vaccination movement," according to the authors, influence he did not use.

It has recently emerged that Trump himself received the COVID-19 vaccine, although he chose not to publicize the fact.

He held sway during this same window over anti-vaccination communicators online, parties behind 13 times as many replies and seven times more sharing as vaccine supporters, and "acting as an echo chamber for a pool of content generated by a small fraction of users."

The 18% of the vaccine-opposed within health care may prove to be moot, however, should providers one day make vaccination a requirement for employment. Given the difficulty in retaining its lowest paid and most vaccine-resistant employees, those requirements could force the industry to either raise pay or continue to face shortages for the hard-to-fill positions.