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<title>Abstract</title> <bold>Background:</bold> This study aimed to assess COVID-19 vaccine confidence among healthcare personnel in the safety net sector of the United States and Puerto Rico. The study aimed to examine the extent to which increased knowledge and positive attitudes about COVID-19 vaccine safety and efficacy were associated with healthcare workers' COVID-19 vaccination status and their recommendation of the vaccine to all patients. <bold>Methods:</bold> The study collected online survey data from healthcare workers working in Free and Charitable Clinics across the United States and Federally Qualified Health Centers in Puerto Rico. The survey consisted of 62 questions covering various demographic measures and constructs related to healthcare workers' vaccination status, beliefs, and their recommendation of COVID-19 vaccination to all patients. Statistical analyses, including multivariate analysis, were conducted to identify the factors associated with COVID-19 vaccine status and recommendation among healthcare personnel. <bold>Results:</bold> Among the 2273 respondents, 93% reported being vaccinated against COVID-19. The analysis revealed that respondents who believed that COVID-19 vaccines were efficacious and safe were three times more likely to be vaccinated and two times more likely to recommend the vaccine to all their patients. Respondents who believed they had received adequate information about COVID-19 vaccination were 10 times more likely to be vaccinated and four times more likely to recommend it to all their patients. <bold>Conclusions:</bold> The study findings suggest that healthcare personnel's COVID-19 vaccine confidence is associated with increased knowledge and holding positive beliefs and attitudes about COVID-19 vaccine safety and efficacy. The results also highlight the importance of healthcare personnel feeling adequately informed and confident in their knowledge to recommend the vaccine to their patients. These findings have important implications for developing strategies to increase COVID-19 vaccine confidence among healthcare personnel and improve vaccine uptake among their patients.