Introduction

COVID-19 is a novel coronavirus disease that was declared a pandemic by the World Health Organization (WHO) in January 2020 [1]. Since then, the disease has had a significant impact on lives and economies worldwide [2–4]. The outbreak originated as pneumonia in Wuhan, Hubei Province of China [5]. Ghana recorded its first two cases of COVID-19 on March 12, 2020, and as at June 23, 2024, there had been a total of 775 million cases and 7 million deaths worldwide, with 172,045 cases and 1,462 deaths in Ghana [3,6]. Initial national responses included case identification, contact tracing, quarantine and isolation of infected persons, social distancing, and the widespread use of face masks and hand sanitizers [7].

Vaccination is one of the most effective interventions for combating the spread of infectious diseases in the general population [8,9]. According to the WHO, at least 70% vaccination coverage is needed to prevent transmission of SARS-CoV-2, the causative organism for COVID-19 [10], although higher thresholds have been proposed to address more transmissible variants such as Delta and Omicron [10–12].

Despite this evidence, vaccination campaigns worldwide have been constrained by vaccine hesitancy [13–15]. Vaccine hesitancy is defined by the WHO Strategic Advisory Group of Experts (SAGE) as the delay in accepting or refusing vaccination despite the availability of vaccination services [16]. It is acknowledged to be complex, context-specific, and dynamic, shaped by factors of complacency, convenience, and confidence [17,18].

Within Ghana, studies exploring COVID-19 vaccine hesitancy among healthcare workers have reported divergent findings. For example, Agyekum et al. (2021) documented a hesitancy prevalence of 60.7% among healthcare workers in Accra, a strikingly high figure at the time of early vaccine rollout [19]. Similar rates of such hesitancy have been observed among this group in Ghana and other sub-Saharan African (SSA) countries [20–24]. These further highlight the role of vaccine efficacy and safety, availability and accessibility, vaccination history, occupational status, societal and peer influence and conspiracy theories in shaping vaccine attitudes among health professionals in Ghana [19,23–27]. These discrepancies reflect differences in study timing, geographical location, cadre of health workers sampled, and the evolving information environment.

Several studies have been conducted globally to assess COVID-19 vaccine hesitancy among the general population in most countries [28–32]. Given that healthcare workers are at increased occupational risk and serve as trusted sources of health information for the wider population, understanding the factors underlying their vaccination decisions remains a critical public health priority. However, while several studies have assessed vaccine hesitancy among the general population in Ghana, relatively fewer have focused specifically on healthcare workers and particularly those in teaching hospitals [19,22–24,27,33]. The present study therefore seeks to assess the prevalence and determinants of COVID-19 vaccine hesitancy among frontline clinical staff at Ho Teaching Hospital in the Volta Region of Ghana, thereby contributing to the limited but growing body of Ghanaian evidence on this subject.

Materials and methods

Results

Sociodemographic and clinical characteristics of participants

A total of 216 healthcare workers responded to the survey giving a 78.55% response rate. Majority were females (n = 135, 62.50%) and aged between 20–39 years (n = 204, 94.44%), were Christians (n = 212, 98.15%) and had never been married (n = 147, 68.06%). (Table 1).

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Table 1. Descriptive analysis of sociodemographic and clinical characteristics of the health care workers (n = 216).

https://doi.org/10.1371/journal.pone.0333412.t001

Nurses and midwives (n = 140, 64.81%) were the most common occupation, followed by medical doctors (n = 43, 19.91%), and undergraduate/diploma qualification n = 184, 85.19%) was commonest highest educational level. Majority of them had been practicing for less than 10 years (n = 199, 92.13%).

Majority had been previously vaccinated (n = 199, 92.13%). Most of them had no chronic diseases (n = 206, 95.37%) and had not been diagnosed with COVID-19 since the inception of the pandemic (n = 173, 80.09%). The majority of the respondents did not have a family member who had been diagnosed with COVID-19 (n = 184, 85.58%). Most of the healthcare workers had come into contact with a patient diagnosed with COVID-19 (n = 152, 70.37%). Most of them had received training on COVID-19 via a lecture mode (n = 132, 61.11%) (Table 1).

COVID-19 vaccine hesitancy

Of the 216 participants, few of them had refused accepting the COVID-19 vaccine (i.e., hesitant) (n = 43, 19.91%). Most commonly cited reasons for vaccine hesitancy were apathy towards taking the vaccine (n = 8/43, 18.60%), followed by belief of not being at risk of infection with the virus (n = 7/43, 16.28%).

63 out of the 173 participants who delayed in taking the vaccine cited reasons of uncertainty about the long-term adverse effect of vaccine (n = 28/63, 44.44%), and poor accessibility to vaccine (n = 6/63, 9.52%). The most (n = 72/173, 41.62%) commonly cited reason for taking the COVID-19 vaccine was the perceived risk of infection from COVID-19 (41.62%) followed by workplace requirement (n = 34/173, 19.65). The commonest brand of vaccine received by most participants was ChAdOx-1s (n = 92/173, 19.08%), followed by Ad26.COV2-S (n = 33/173, 19.08%). The majority of the participants (149/173, 86.13%) who accepted vaccination received the full dose of the vaccine, and most of them (n = 111/173, 64.16%) did not receive booster doses. (Table 2)

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Table 2. A descriptive analysis of vaccine and vaccine hesitancy.

https://doi.org/10.1371/journal.pone.0333412.t002

Most (n = 130/216, 60.19%) responded that COVID-19 vaccines should be voluntary for healthcare workers. Furthermore, most (n = 160/216, 74.07%) of them responded that vaccination is an effective way to prevent and control COVID-19 and that they (n = 185/216, 85.65%) would advise their friends and family to take the COVID-19 vaccine. Most of them responded that their views on the COVID-19 vaccine had not changed over time (n = 139/216, 64.35%). (Table 2)

Factors associated with COVID-19 vaccine hesitancy

Vaccine hesitancy was associated with gender status (p = 0.031), being a member of the COVID care team (p = 0.019), having received any other vaccination apart from childhood vaccines (p < 0.001), having attended COVID-19 lecture (p = 0.011), view of the vaccine requirement for health workers (p < 0.001), knowledge of the vaccine being an effective way to prevent and control COVID-19 (p < 0.001) and whether the person would recommend the COVID-19 vaccine to friends and family (p < 0.001) (Table 3).

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Table 3. Bivariate analysis between COVID-19 vaccine hesitancy and various socio-demographic and clinical characteristics of the health care workers (n = 216).

https://doi.org/10.1371/journal.pone.0333412.t003

Predictors of COVID-19 vaccine hesitancy

Vaccine hesitancy was predicted by participant’s knowledge of the vaccine being an effective means of preventing and controlling the disease (aOR= 0.01; CI 95%: 0.01–0.00; p < 0.001), COVID-19 training via lecture method (aOR= 0.34; CI 95%: 0.13–0.85; p = 0.022), their view on vaccine requirement for health workers (aOR= 3.28; CI 95%: 1.08–10.01; p = 0.037). past vaccination history (aOR= 0.18, CI 95%: 0.07–0.45; p < 0.001). (Table 4)

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Table 4. Logistic regression between independent variables that showed statistically significant association and COVID-19 vaccine hesitancy (n = 216).

https://doi.org/10.1371/journal.pone.0333412.t004

Discussion

This study found a COVID-19 vaccine hesitancy prevalence of 19.91% among frontline clinical healthcare workers at Ho Teaching Hospital. When situated within the broader Ghanaian literature, this prevalence is relatively low. For instance, Agyekum et al. (2021) reported a much higher hesitancy rate of 60.7% among healthcare workers in Accra at the onset of the vaccine rollout [19]. Similarly, Lamptey et al. (2022) and Botwe et al. (2022) documented high levels of uncertainty and refusal in other Ghanaian cohorts [22,27]. In contrast, our findings align more closely with those of Alhassan et al. (2021) in Northern Ghana, who reported that a majority of healthcare workers were willing to accept vaccination, particularly when vaccines were accessible and clear communication was provided [23]. The lower hesitancy we observed may reflect the timing of our study, which was conducted when vaccines were more widely available, when healthcare workers had greater exposure to training and public campaigns, and when local experiences with COVID-19 outcomes may have reinforced the perceived importance of vaccination.

Vaccine hesitancy among healthcare workers is particularly concerning given its benefits in protecting this vulnerable population due to increased exposure and their critical role in influencing public perception and vaccine uptake [14,15,18]. The finding that hesitancy among healthcare workers was not substantially lower than in the general population in this study and others in Ghana highlights a missed opportunity to leverage healthcare workers as vaccination advocates [30,36,37]. Apathy and a self-perceived low risk of infection emerged as the most frequently cited reasons for hesitancy, agreeing with findings from studies in Saudi Arabia and France [30–32]. This persistent misperception of risk among healthcare workers is concerning, as it may undermine compliance with future vaccination campaigns and weaken broader public health interventions if left unaddressed.

This study identified several factors significantly associated with vaccine hesitancy. Female gender, not having received prior adult vaccinations, lack of COVID-19 training, belief that vaccination should be voluntary, and doubts about the vaccine’s effectiveness were all predictive of hesitancy. Gender has been identified as a predictor of vaccine hesitancy among healthcare workers [38–40]. The finding of the influence of gender on vaccine hesitancy is consistent with a previous study indicating that female healthcare workers are more likely to exhibit vaccine hesitancy, often due to fears surrounding infertility or rare side effects, such as thromboembolic events associated with the AstraZeneca vaccine [40,41]. This is particularly relevant in Ghana, where AstraZeneca (ChAdOx1-S) was the most widely administered vaccine during the initial phases of the vaccination campaign [42].

A negative past vaccination history emerged as a strong predictor of hesitancy (aOR = 0.01, p < 0.001), reaffirming findings from other settings that vaccine confidence is often built on positive historical experiences with immunization [43,44]. Similarly, healthcare workers who had undergone COVID-19 training via lecture mode demonstrated reduced hesitancy (aOR = 0.34, p = 0.022), reinforcing the value of structured educational interventions in promoting vaccine acceptance [16–18]. Another crucial determinant was the belief in the vaccine’s effectiveness to prevent and control COVID-19, which significantly lowered the likelihood of hesitancy (aOR = 0.08, p < 0.001), as was proposed by the SAGE Working Group on Vaccine Hesitancy [16]. Notably, healthcare workers who believed that vaccines should be mandatory for healthcare professionals and those who were willing to recommend vaccination to others also showed lower hesitancy, aligning with similar findings in global and African studies [20,43,44].

Despite its valuable contributions, this study has limitations. First, the use of convenience sampling may introduce selection bias and limit the generalizability of findings. Second, the cross-sectional design restricts causal inference, and the use of a single tertiary hospital as the study site may not capture broader national or regional trends. However, the study remains significant as it adds to the limited empirical evidence on COVID-19 vaccine hesitancy among healthcare workers in Ghana and highlights the need for context-specific strategies to address misinformation, build vaccine confidence, and support institutional trust.

Conclusion

Vaccine hesitancy among healthcare workers in Ghana, while relatively low, remains a public health concern. The study found that vaccine hesitancy among the study population is primarily driven by apathy, a perceived low risk of infection, and concerns about vaccine safety. Significant predictors of hesitancy included female gender, a lack of prior adult vaccination, absence of formal COVID-19 training, and low confidence in the vaccine’s effectiveness.

Conversely, prior vaccination, training via lectures, belief in the vaccine’s protective value, and willingness to recommend it to others were associated with lower hesitancy. The predictors of vaccine hesitancy were participants’ knowledge of the vaccine effectiveness, COVID-19 training via lecture method, health workers’ view on whether the vaccine should be voluntary, and the knowledge of the effectiveness of the vaccine in preventing and controlling COVID-19.

Taken together, these findings contribute to a better understanding of COVID-19 vaccine hesitancy among healthcare workers in Ghana. They confirm that hesitancy is not static but responsive to evolving conditions such as vaccine availability and training opportunities. They also illustrate that interventions must be context-specific, as strategies that are effective in a tertiary teaching hospital may differ from those needed in rural or primary care settings.

Recommendations

From a policy perspective, the relatively low hesitancy observed in this study suggests that structured training programs and institutional support can play a critical role in building vaccine confidence among healthcare workers. Targeted education, particularly addressing gender-specific concerns, should be prioritized. Additionally, leveraging positive vaccination histories and ensuring that healthcare workers themselves are well-informed and supported could enhance their role as advocates for vaccination in the general population. By documenting these determinants, this study not only complements earlier Ghanaian reports but also highlights pathways through which vaccine hesitancy can be effectively reduced among health professionals in similar contexts.

Supporting information