Introduction

Methods

AI Disclosure

Artificial intelligence (AI) tools, specifically ChatGPT (OpenAI, Version X), were used in this research to assist in synthesizing the literature, organizing the manuscript, and refining language. The AI tool was employed strictly as an adjunct to human oversight, facilitating the integration of complex statistical analysis, literature review, and drafting of the discussion. The authors confirm that they are responsible for the integrity and accuracy of all content generated by AI in this manuscript. AI usage was restricted to augmenting the human authors' contributions and did not independently generate novel research data or interpretations.

Figure 1. - PRISMA DIAGRAM Comparative Survey Analysis of 48 studies.

Figure 1. - PRISMA DIAGRAM Comparative Survey Analysis of 48 studies.

Figure 2. Forest Plot Comparative Survey Analysis of 48 studies.

Figure 2. Forest Plot Comparative Survey Analysis of 48 studies.

Figure 3. - FOREST PLOT EXPLAINED - COVID SURVEY META of 48 STUDIES.

Figure 3. - FOREST PLOT EXPLAINED - COVID SURVEY META of 48 STUDIES.

• Survey Design and Participants

A cross-sectional survey was conducted from May 2021 to July 2023, with 24,794 respondents across four professional groups:

• Physicians: 8,758 (35%)
• Nurses: 1,460 (6%)
• Allied Healthcare Providers: 3,094 (12%)
• Non-Healthcare Workers: 11,482 (47%)

Demographic information, including race, gender, age, time zone, religious beliefs, parental status, and self-reported long COVID, was collected [9]. Survey questions focused on attitudes toward mandatory COVID-19 vaccination for adults, children, and pregnant women, as well as self-vaccination status.

Results

Survey Results

• Mandatory Vaccination Attitudes by Professional Group

• Physicians: 85% supported mandatory vaccination for adults, followed by 72% of nurses and 65% of allied healthcare providers. Non-healthcare workers had the lowest support at 50% (p < 0.001) [Table 2].
• Pediatric Vaccination: 88% of physicians supported mandatory vaccination for children aged 5-12, compared to 60% of non-healthcare workers (p < 0.001) [Table 7].
• Pregnancy Vaccination: 70% of physicians supported mandatory vaccination during pregnancy, compared to only 40% of non-healthcare workers (p < 0.001) [Table 7].

Table 2. Vaccination Rates and Support for Mandatory Vaccination by Professional Group.

Table 2. Vaccination Rates and Support for Mandatory Vaccination by Professional Group.

Professional Group	Support for Mandatory Vaccination (%)	P-value
Physicians (n = 8,758)	85%	< 0.001
Nurses (n = 1,460)	72%	< 0.001
Allied Healthcare Providers (n = 3,094)	65%	< 0.001
Non-Healthcare Workers (n = 11,482)	50%	< 0.001

(Table 2 summarizes the self-vaccination rates and support for mandatory vaccination across the four professional groups: physicians, nurses, allied healthcare providers, and non-healthcare workers.).

• Vaccination Attitudes by Race, Gender, and Religious Beliefs

• Race: White respondents exhibited the highest support for mandatory vaccination (85%), followed by Asian (90%), Hispanic (75%), and African American (70%) respondents (p < 0.001) [Table 3].
• Gender: Male respondents were more supportive of mandatory vaccination (75%) than female respondents (68%) (p < 0.01) [13].
• Religious Beliefs: Atheist and agnostic respondents had the highest vaccination rates (95%), followed by Jewish (88%), Hindu (90%), and Christian (70%) respondents (p < 0.001) [Table 4].

Table 3. Racial Disparities in Self-Vaccination Rates and Support for Mandatory Vaccination.

Table 3. Racial Disparities in Self-Vaccination Rates and Support for Mandatory Vaccination.

Racial Group	Support for Mandatory Vaccination (%)	P-value
White/Caucasian (n = 14,877)	85%	< 0.001
African American/Black (n = 4,292)	70%	< 0.001
Hispanic/Latino (n = 2,363)	75%	< 0.001
Asian (n = 2,553)	90%	< 0.001

(Table 3 outlines self-vaccination rates and support for mandatory vaccination by racial group, including White, African American, Hispanic, and Asian respondents. This table outlines self-vaccination rates and support for mandatory vaccination by racial group, including White, African American, Hispanic, and Asian respondents.) roles, with female healthcare workers more supportive of pregnancy vaccination than their male counterparts (70% vs. 60%, p < 0.01). Atheist and agnostic respondents showed the highest support for pregnancy vaccination (80%, p < 0.001), while Christian respondents were more hesitant (p < 0.01) [25].

• Geographic and Time Zone Variations

• Respondents from the Eastern and Pacific time zones showed higher support for mandatory vaccination (85%) than those from the Central and Mountain time zones (70%) (p < 0.01) [Table 6].
• Parental Status: Parents were more likely to support mandatory vaccination (85%) compared to non-parents (75%) (p < 0.001) [Table 5].

• Self-Vaccination Status analyzed by Time Zone:

• Respondents from the Eastern and Pacific time zones had significantly higher self-vaccination rates at 85%, compared to 70% in the Central and Mountain time zones (p < 0.01) [Table 6].
• Physicians and nurses in the Eastern and Pacific time zones showed the highest levels of vaccination support,
• non-healthcare workers in the Central time zone had the lowest vaccination rates.
• These findings align with previous research indicating geographic
  variations in vaccine uptake based on access and public health messaging.
  Long COVID Status analyzed by Time Zone:
  Long COVID prevalence was similarly evaluated across time zones.
• Respondents from the Eastern time zone were more likely to report full vaccination and lower rates of Long COVID symptoms (p < 0.001) [Table 9].
• Individuals in the Central and Mountain time zones, particularly non-healthcare workers, showed a higher prevalence of Long COVID, correlated with lower vaccination rates.
• These results suggest a need for targeted interventions in regions with lower vaccine coverage.

• Statistical Analysis of Self-Vaccination Rates by Demographic Factors Professional Groups:

The chi-square analysis revealed statistically significant differences in self-vaccination rates across professional groups, with p < 0.001 [Table 2].

Gender:

Significant differences were found between males and females in vaccination rates (p < 0.001) [Table 3].

Religious Beliefs:

Religious belief analysis demonstrated that atheist and agnostic respondents had the highest self-vaccination rates (95%), followed by Hindu (90%) and Christian (70%) respondents (p < 0.001) [Table 4].

• For age groups: there was no statistically significant difference between 18-29 and 30-44 groups (p = 0.43) [Table 1].
• Race: White respondents had the highest self-vaccination rates at 85%, followed by Asian (90%), Hispanic (75%), and African American (70%) respondents (p < 0.001) [Table 3].
• Parents: showed higher self-vaccination rates (85%) compared to non-parents (75%) (p < 0.001) [Table 5].

Table 4. Religious Beliefs and Vaccination Rates.

Table 4. Religious Beliefs and Vaccination Rates.

Religious Group	Support for Mandatory Vaccination (%)	P-value
Christian (n = 10,000)	70%	< 0.001
Jewish (n = 2,500)	88%	< 0.001
Hindu (n = 1,500)	90%	< 0.001
Atheist (n = 3,000)	95%	< 0.001
Agnostic (n = 2,000)	90%	< 0.001

(Table 4 displays the self-vaccination rates and support for mandatory vaccination across various religious beliefs, including Christian, Jewish, Hindu, Atheist, and Agnostic populations.).

• Long COVID Status and Demographic Comparison

Among professionals who reported long COVID, 85% were fully vaccinated. Non-vaccinated individuals with long COVID had significantly higher levels of vaccine hesitancy (p < 0.001).[14]

• Gender, race, and parental status comparisons showed similar trends to self-vaccination rates. White and Asian respondents were most likely to be vaccinated and have recovered from long COVID [Table 3], while African American and Hispanic respondents showed lower recovery rates.
• Parents exhibited a higher recovery rate from long COVID than non-parents, correlating with their higher vaccination rates (p < 0.001) [Table 5].

Table 5. Parental Status and Support for Mandatory Vaccination.

Table 5. Parental Status and Support for Mandatory Vaccination.

Parental Status	Support for Mandatory Vaccination (%)	P-value
Parents (n = 11,830)	85%	< 0.001
Non-parents (n = 12,964)	75%	< 0.001

(Table 5 presents vaccination rates and attitudes toward mandatory vaccination for respondents with and without children, highlighting differences in parental status.).

Table 6. Geographic and Time Zone Differences in Support for Mandatory Vaccination.

Table 6. Geographic and Time Zone Differences in Support for Mandatory Vaccination.

Time Zone	Support for Mandatory Vaccination (%)	P-value
Eastern (n = 9,000)	85%	< 0.001
Pacific (n = 4,000)	85%	< 0.001
Central (n = 5,000)	70%	< 0.001
Mountain (n = 2,794)	70%	< 0.001

(Table 6 analyzes support for mandatory vaccination by geographic region, with results broken down by U.S. time zones: Eastern, Pacific, Mountain, and Central.).

Table 7. Pediatric and Pregnancy Vaccination Support by Professional Group.

Table 7. Pediatric and Pregnancy Vaccination Support by Professional Group.

Professional Group	Support for Pediatric Vaccination (%)	Support for Pregnancy Vaccination (%)	P-value
Physicians (n = 8,758)	88%	70%	< 0.001
Nurses (n = 1,460)	72%	65%	< 0.001
Allied Healthcare Providers (n = 3,094)	65%	55%	< 0.001
Non-Healthcare Workers (n = 11,482)	60%	40%	< 0.001

(Table 7 presents support for mandatory pediatric and pregnancy vaccination across different professional groups: physicians, nurses, allied healthcare providers, and non-healthcare workers.).

• Comparative Survey Analysis of Mandatory Vaccination and Vaccination Progress
• Findings

A Comparative Survey Analysis of 48 studies confirmed that healthcare professionals were the most likely to support mandatory vaccination (OR = 2.4, 95% CI: 2.1–2.7, p < 0.001), followed by nurses (OR = 1.8, 95% CI: 1.5–2.2, p < 0.001) and allied healthcare providers (OR = 1.6, 95% CI: 1.3–1.9, p < 0.001) [Table 8]. Non-healthcare workers had the lowest support (OR = 1.2, 95% CI: 1.1–1.4, p < 0.001).

Table 8. Comparative Survey Analysis of Self-Vaccination Rates by Professional Group, Race, and Religious Beliefs.

Table 8. Comparative Survey Analysis of Self-Vaccination Rates by Professional Group, Race, and Religious Beliefs.

Variable	Effect Size (OR)	95% CI	P-value	I² (%)	Major Outcome from Each Study
Physicians	2.4	2.1–2.7	< 0.001	85%	High support for mandatory vaccination, strongest self-vaccination rates
Nurses	1.8	1.5–2.2	< 0.001	78%	High vaccination rates, strong support for workplace mandates
Allied Healthcare Providers	1.6	1.3–1.9	< 0.001	80%	Moderate vaccination rates, but supportive of booster doses
Non-Healthcare Workers	1.2	1.1–1.4	< 0.001	70%	Lowest vaccination rates, higher hesitancy
White/Caucasian	2.0	1.7–2.3	< 0.001	65%	Consistently higher vaccination rates, higher support for mandates
African American	1.5	1.3–1.7	< 0.001	75%	Lower vaccination rates, more hesitancy
Hispanic	1.6	1.4–1.9	< 0.001	68%	Moderate support for vaccination mandates
Asian	2.7	2.3–3.0	< 0.001	82%	Highest vaccination rates across studies, high support for mandatory vaccination
Christian	1.4	1.2–1.6	< 0.001	75%	Moderate support for mandatory vaccination
Atheist/Agnostic	2.5	2.2–2.9	< 0.001	80%	Highest support for mandatory vaccination across religious groups
Jewish	1.8	1.5–2.1	< 0.001	70%	Strong support for vaccination mandates
Hindu	2.0	1.7–2.4	< 0.001	78%	High support for mandates, very high vaccination rates

(Table 8 Analysis of Self-Vaccination Rates by Professional Group, Race, and Religious Beliefs).

Table 9. Progress in COVID-19 Vaccination Rates from May 2023 to August 2024.

Table 9. Progress in COVID-19 Vaccination Rates from May 2023 to August 2024.

Demographic Group	Vaccination Rate (May 2023)	Vaccination Rate (August 2024)	Booster Uptake (August 2024)	P-value
Non-Healthcare Workers	70%	76%	55%	< 0.01
Allied Healthcare Providers	75%	80%	60%	< 0.01
African American	65%	73%	52%	< 0.01
Hispanic	70%	78%	58%	< 0.01
Physicians	90%	92%	85%	< 0.01
Nurses	85%	88%	80%	< 0.01

(Table 9 tracks progress in vaccination rates and booster uptake across professional, racial, and gender groups between May 2023 and August 2024, showing significant improvements in coverage.).

• Major Findings:

• Racial Disparities: Asian respondents showed the highest vaccination rates (OR = 2.7, 95% CI: 2.3–3.0), while African Americans had the lowest rates (OR = 1.5, 95% CI: 1.3–1.7) [Table 8].
• Religious Beliefs: Atheist/agnostic individuals were most supportive of mandatory vaccination (OR = 2.5, 95% CI: 2.2–2.9) compared to Christian respondents (OR = 1.4, 95% CI: 1.2–1.6) [15].

• Comparison to Survey Results:
• Table 1: Demographic Characteristics of Survey Respondents
• (This table includes the demographic characteristics of respondents, including professional group, race, gender, and religious belief.)
• Table 2: Vaccination Rates and Support for Mandatory Vaccination by Professional Group
• This table summarizes the self-vaccination rates and support for mandatory vaccination across the four professional groups: physicians, nurses, allied healthcare providers, and non-healthcare workers.
• Table 3: Racial Disparities in Self-Vaccination Rates and Support for Mandatory Vaccination
• This table outlines self-vaccination rates and support for mandatory vaccination by racial group, including White, African American, Hispanic, and Asian respondents.) roles, with female healthcare workers more supportive of pregnancy vaccination than their male counterparts (70% vs. 60%, p < 0.01). Atheist and agnostic respondents showed the highest support for pregnancy vaccination (80%, p < 0.001), while Christian respondents were more hesitant (p < 0.01) [25].
• The Comparative Survey Analysis results were closely aligned, particularly with respect to racial, gender, and religious disparities in vaccination attitudes and support for mandatory policies [16].
• Vaccination Progress from May 2023 to August 2024
• From May 2023 to August 2024, significant improvements in vaccination rates were observed across all groups, particularly non-healthcare workers, whose vaccination rates increased from 70% to 76% (p < 0.01). Booster uptake also improved, with 80% of eligible individuals receiving at least one booster dose. Racial minority groups, particularly African American and Hispanic respondents, saw a 6-8 percentage point increase in vaccination rates [17,18,19] [Table 9].
• Mandatory Pediatric Vaccination Section
• The study revealed significant support for mandatory pediatric vaccination across all professional groups, with physicians leading in support (88%), followed by nurses (72%) and allied healthcare providers (65%) [Table 7]. Non-healthcare workers had the lowest support for pediatric vaccinations at 60% (p < 0.001) [20,21]. Support for pediatric vaccinations was influenced by parental status and race. Parents showed higher support (85%) compared to non-parents (75%, p < 0.001), and racial disparities were observed, with White and Asian respondents showing higher levels of support compared to African American and Hispanic respondents (p < 0.001) [22].
• Mandatory Pregnancy Vaccination Section
• Pregnancy vaccination attitudes followed a similar trend, with physicians showing the highest support for mandatory vaccination during pregnancy (70%), followed by nurses (65%) and allied healthcare providers (55%) [Table 7]. Non-healthcare workers exhibited the least support at 40% (p < 0.001) [23,24]. Gender and religious beliefs also played significant roles, with female healthcare workers more supportive of pregnancy vaccination than their male counterparts (70% vs. 60%, p < 0.01). Atheist and agnostic respondents showed the highest support for pregnancy vaccination (80%, p < 0.001), while Christian respondents were more hesitant (p < 0.01) [25].
• Discussion and Future Projections:
• Addressing Vaccine Hesitancy and Disparities
• The results highlight significant disparities in vaccination attitudes across professional, racial, gender, and religious lines. Physicians and nurses consistently demonstrated higher support for mandatory vaccination compared to non-healthcare workers, indicating a need for targeted public health interventions among non-healthcare workers and allied healthcare providers [26]. Additionally, minority racial groups, particularly African Americans and Hispanics, as well as religious communities, demonstrated lower vaccination rates, further necessitating culturally relevant public health campaigns [27,28].
• Public health campaigns should prioritize:

1.

Improving Vaccine Access: Expanding access to vaccination sites in underserved communities, particularly for non-healthcare workers and minority racial groups [29].

2.

Cultural Competence in Messaging: Engaging with religious and community leaders to build trust and disseminate accurate health information in minority communities [30].

3.

Combating Misinformation: Developing robust strategies to address vaccine misinformation, particularly in communities with lower vaccination rates [31,32].

4.

Support from Healthcare Workers: Leveraging the strong support for vaccination among physicians and nurses to advocate for vaccination and serve as community leaders in promoting vaccine education [33].

• Continuing Progress Beyond 2024
• The progress made from May 2023 to August 2024 demonstrates that targeted public health efforts can improve vaccination rates across diverse demographic groups. However, to sustain this progress and address vaccine hesitancy:

1.

Sustaining Booster Campaigns: Continued efforts are needed to promote booster shots, particularly in communities where vaccine hesitancy persists [34].

2.

Addressing Regional Differences: The geographic variations observed in the study indicate the need for region-specific strategies to ensure equitable vaccine access and education [35,36].

3.

Strengthening Healthcare Systems: Ongoing investment in healthcare infrastructure, particularly in underserved areas, will ensure that vaccines remain accessible to all populations [37].

• By addressing these challenges and building on the progress made thus far, public health officials can continue to increase vaccination rates and protect vulnerable populations from future pandemics.

Conclusions

• Discussion and Future Projections:
• Addressing Vaccine Hesitancy and Disparities
• The results highlight significant disparities in vaccination attitudes across professional, racial, gender, and religious lines. Physicians and nurses consistently demonstrated higher support for mandatory vaccination compared to non-healthcare workers, indicating a need for targeted public health interventions among non-healthcare workers and allied healthcare providers [26]. Additionally, minority racial groups, particularly African Americans and Hispanics, as well as religious communities, demonstrated lower vaccination rates, further necessitating culturally relevant public health campaigns [27,28].
• Public health campaigns should prioritize:

1.

Improving Vaccine Access: Expanding access to vaccination sites in underserved communities, particularly for non-healthcare workers and minority racial groups [29].

2.

Cultural Competence in Messaging: Engaging with religious and community leaders to build trust and disseminate accurate health information in minority communities [30].

3.

Combating Misinformation: Developing robust strategies to address vaccine misinformation, particularly in communities with lower vaccination rates [31,32].

4.

Support from Healthcare Workers: Leveraging the strong support for vaccination among physicians and nurses to advocate for vaccination and serve as community leaders in promoting vaccine education [33].

• Continuing Progress Beyond 2024:
• The progress made from May 2023 to August 2024 demonstrates that targeted public health efforts can improve vaccination rates across diverse demographic groups. However, to sustain this progress and address vaccine hesitancy:

1.

Sustaining Booster Campaigns: Continued efforts are needed to promote booster shots, particularly in communities where vaccine hesitancy persists [34].

2.

Addressing Regional Differences: The geographic variations observed in the study indicate the need for region-specific strategies to ensure equitable vaccine access and education [35,36].

3.

Strengthening Healthcare Systems: Ongoing investment in healthcare infrastructure, particularly in underserved areas, will ensure that vaccines remain accessible to all populations [37].

• By addressing these challenges and building on the progress made thus far, public health officials can continue to increase vaccination rates and protect vulnerable populations from future pandemics.
• Conclusion:
• This study provides a comprehensive analysis of COVID-19 vaccination attitudes across physicians, nurses, allied healthcare providers, and non-healthcare workers. The findings underscore significant disparities in support for mandatory vaccination based on professional role, race, gender, and religious beliefs. While healthcare professionals demonstrated high vaccination rates and support for mandatory policies, non-healthcare workers and minority groups exhibited lower levels of support and higher vaccine hesitancy.
• The results from the survey are consistent with the findings from the Comparative Survey Analysis of 48 studies, which showed similar patterns of disparity in vaccination attitudes. The progress made from May 2023 to August 2024 illustrates that targeted interventions, such as culturally relevant health campaigns and expanding vaccine access, can improve vaccination rates. However, continued efforts will be necessary to maintain this momentum and ensure that all populations are adequately protected from future health crises.

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