Mandatory flu vax for health workers?

THE low rate of seasonal influenza vaccination coverage among Australian health care workers has prompted a call to consider making vaccinations mandatory.

In the latest issue of the MJA, researchers analysed 10 studies conducted between 1997 and 2008, which found that overall vaccination rates of health care workers in hospitals varied between 16.3% and 58.7%. (1)

The study found that providing free vaccines to health care workers did not seem to affect vaccination rates.

There is no uniform policy for Australian hospitals in terms of providing seasonal influenza vaccines free of charge to health care workers, with each hospital or jurisdiction making its own policy decision.

However, two of the three studies which showed uptake rates greater than 50% were associated with active implementation policies or interventions.

The study showed uptake rates ranged from 29% to 58.3% for physicians; 19% to 56.4% for nurses; 23% to 57.7% for allied health professionals and 18% to 66.7% for ancillary or support staff.

Education and promotion of the benefits of the seasonal influenza vaccine was not working and perhaps it was time for state or institutional policies or mandates to increase uptake, lead author Dr Holly Seale, a research fellow at the University of NSW School of Public Health, told MJA InSight.

“This study shows that at the moment we’ve got such low uptake of the vaccine in some settings that it is time to look beyond the use of education and [promotion]. We just can’t get above these 30%–40% levels so we need to go to the next step of discussing mandatory vaccination”, she said.

Dr Seale said that there was a move towards mandatory flu vaccination in the US. Ten hospitals in Boston recently pledged to adopt policies to mandate seasonal flu vaccinations as a condition of employment. (2)

Most studies which looked at the attitudes of health care workers found that staff had similar misconceptions about the vaccine as the general public, such as questioning its potential side effects, Dr Seale said.

“They have concerns and they’re uncertain about the effectiveness of the vaccine”, she said, adding that research had shown that many health care workers believed that the vaccine could actually cause the flu.

The researchers also said that access issues may be creating a barrier to flu vaccination uptake, citing anecdotal evidence that clinics in hospitals were often only open during limited time periods and had long waiting periods.

One survey from a Victorian hospital that was included in the study found that, when asked what might facilitate and encourage them to receive the vaccination, almost half the doctors who responded said the vaccination service itself needed to be more convenient. (3)

The other most common reasons cited by doctors for not being immunised were being too busy and not being aware how to access the vaccine. The authors of the report said immunisation rates among doctors were inadequate.

- Linda McSweeney

1. MJA 2011; 195: 336-338
2. The Boston Globe, 14 September 2011

3. Commun Dis Intell 2008; 32: 443-448

Posted 19 September 2011