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Background Major efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. Ethiopia began on March 13, 2021, to vaccinate healthcare workers (HCWs) for COVID-19 with the AstraZeneca vaccine. However, willingness to be vaccinated depends to a large extent on factors beyond the availability of vaccines. This study aimed to determine the rate of intention to refuse COVID-19 vaccination   and associated factors among HCWs in northeastern Ethiopia. northeastern, Ethiopia. Method An institution-based cross-sectional study  was employed among 404 HCWs in Dessie City, northeastern Ethiopia in May, 2021. Data were collected, checked, coded, entered into EpiData Version 4.6 and exported to Statistical Package of Social Sciences (SPSS) Version 25.0 for cleaning and analysis. The dependent variable was refuse to receive COVID-19 vaccination and the independent variables included socio-demographic factors, knowledge, attitudes and perceptions. A Binary logistic regression model was used to determine the association between vaccine refusal and the independent variables. From bivariate analysis, variables with  p -values &lt; 0.25 were retained for multivariable analysis. From multivariable analysis, variables with adjusted odds ratio (AOR),  p -values &lt;0.05 at 95% confidence interval (CI) were declared as factors significantly associated with refusal to be vaccinated among HCWs in Dessie City, northeastern Ethiopia. Results The proportion of HCWs with overall good knowledge, good perception, and positive attitudes about COVID-19 vaccination were 62.5%, 60.5%, and 52.3%, respectively; 64.0% of the HCWs wanted to be vaccinated while 36.0% said that they would refuse to do so. Multivariable analysis identified negative attitudes (AOR: 3.057; 95%CI [1.860 - 5.026]) and poor perceptions (AOR: 4.73; 95%CI [2.911 - 7.684]) about COVID-19 vaccines were significantly associated with refusal to be vaccinated for COVID-19. Nearly half (46.9%) of the HCWs stated that vaccines could worsen any pre-existing medical conditions and 39.5% of them thought that vaccines could cause COVID-19 infections. Conclusion The willingness of HCWs to get vaccinated against COVID-19 was relatively high among HCWs. Negative attitudes and poor perceptions towards the anticipated COVID-19 vaccination were significant factors to refuse to be vaccinated. Our findings may provide information for the management authorities and stakeholders to promote and improve attitudes, knowledge and perceptions towards COVID-19 vaccination uptake among HCWs.

Knowledge, attitudes, and perceptions of COVID-19 vaccine and refusal to receive COVID-19 vaccine among healthcare workers in northeastern Ethiopia