Mandatory Flu Vaccine for Healthcare Workers: Not Worthwhile

A Scalar Approach to Vaccination Ethics

Should people get vaccinated for the sake of others? What could ground-and limit-the normative claim that people ought to do so? In this paper, we propose a reasons-based consequentialist account of vaccination for the benefit of others. We outline eight harm-based and probabilistic factors that, we argue, give people moral reasons to get vaccinated. Instead of understanding other-directed vaccination in terms of binary moral duties (i.e., where people either have or do not have a moral duty to get vaccinated), we develop a scalar approach according to which people can have stronger or weaker moral reasons to get vaccinated in view of the moral good of vaccination. One advantage of our approach is that it can capture why a person might have strong moral reasons to get vaccinated with Vaccine A, but only weak moral reasons to get vaccinated with Vaccine B. We discuss theoretical strengths of our approach and provide a case study of vaccination against COVID-19 to demonstrate its practical significance.

Vaccine mandates for healthcare workers beyond COVID-19

We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable-and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines.

The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n = 182, 14.9%), pharmacists (n = 161, 13.2%) and dentists (n = 87, 7.1%), among others. About two-thirds of the study sample expressed willingness to receive influenza vaccination if provided free of charge (n = 807, 66.3%), whereas less than one-third were willing to pay for the vaccine (n = 388, 31.9%). The self-reported uptake of the influenza vaccine in the last influenza season was 62.8%. The following factors were significantly associated with higher acceptance of influenza vaccination if provided freely, as opposed to vaccine hesitancy/rejection: male sex; physicians and dentists among HCW categories; higher confidence and collective responsibility; and lower complacency, constraints and calculation. Higher influenza vaccine uptake was significantly correlated with nurses and physicians among HCW categories, older age, a higher monthly income, higher confidence and collective responsibility, lower complacency and constraints and lower embrace of general vaccine conspiracy beliefs. The results of the current study can provide helpful clues to improve influenza vaccine coverage among HCWs in Jordan. Consequently, this can help to protect vulnerable patient groups and reserve valuable resources in healthcare settings. Psychological determinants appeared to be the most significant factors for vaccine acceptance and uptake, whereas the embrace of general vaccine conspiracy beliefs was associated with lower rates of influenza vaccine uptake, which should be considered in educational and interventional measures aiming to promote influenza vaccination.

Influence of critically appraising exemption requests from healthcare personnel along a spectrum of influenza vaccine hesitancy

Objectives:

This study was performed to assess whether an intervention for critically appraising influenza vaccine exemption requests from healthcare personnel (HCP) affected (1) the overall rate of influenza vaccine exemption within a healthcare institution and/or (2) the rates of postintervention vaccine acceptance among those who inconsistently request exemption from annual vaccination and those who consistently request exemption from vaccination.

Design:

Retrospective, before-and-after intervention study.

Setting:

We conducted the study at a single academic medical center.

Participants:

This study included 29,663 HCP.

Methods:

Between 2010 and 2019, HCP were permitted to request an exemption from influenza vaccination without critical appraisal of exemption requests. After January 2019, medical center policy required critical appraisal of exemption requests. Of those employed 3 or more years who requested an exemption at least once during the preintervention period (n = 1,177), those with unchanging exemption reasons annually were termed “consistent exempters.” Those who changed reasons or accepted vaccination n ≥ 1 times were termed “inconsistent exempters.”

Results:

The overall exemption rate from influenza vaccine decreased from 3.8% to 1.2% (P < .001; N = 29,663) after the intervention. Of those requesting exemption at least once before the intervention, 329 (28.0%) of 1,177 were consistent exempters and 878 (72.0%) were inconsistent exempters. Of inconsistent exempters employed after the intervention, 442 (88.9%) of 497 accepted vaccine postintervention compared with 118 (59.6%) of 198 consistent exempters (P < .001). Of all exempters who changed from exemption to acceptance after the intervention, 442 (78.9%) of 560 were inconsistent exempters.

Conclusions:

Critical appraisal of HCP exemption requests promotes influenza vaccine acceptance, and acceptance by inconsistent exempters drives the effect of the intervention. Analysis of changes in annual exemption requests represents a novel objective method for describing those on the spectrum of vaccine hesitancy.

Return to Work: Managing Employee Population Health During the COVID-19 Pandemic

Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has abruptly transformed the outlook of employer health benefits plans for 2020 and 2021. Containing the spread of the virus and facilitating care of those infected have quickly emerged as immediate priorities. Employers have adjusted health benefits coverage to make COVID-19 testing and treatment accessible and remove barriers to care in order to facilitate the containment of the disease. Employers also are introducing strategies focused on testing, surveillance, workplace modifications, and hygiene to keep workforces healthy and workplaces safe. This paper is intended to provide evidence-based perspectives for self-insured employers for managing population health during the COVID-19 pandemic. Such considerations include (1) return to work practices focused on mitigating the spread of COVID-19 through safety practices, testing and surveillance; and (2) anticipating the impact of COVID-19 on health benefits and costs (including adaptations in delivery of care, social and behavioral health needs, and managing interrupted care for chronic conditions).

Influenza vaccination in the COVID-19 era

Influenza spreads globally annually with significant paediatric and adult attack rates and considerable morbidity, mortality and the exacerbation of extant chronic disease. In the northern and southern hemispheres, outbreaks occur mainly in the respective winter seasons. Influenza vaccination is available but only partially effective. In the absence of a vaccine, in winter, novel coronavirus COVID-19 will also circulate in parallel with seasonal influenza. Thus far it appears that with the current strains of these two viruses, the clinical outcome of co-infection is not significantly worse than infection with COVID-19 alone. However, several strains of influenza circulate, including strains still to come. Similarly, COVID-19 has several strains, with probably more to come. This paper discusses these issues and estimates ideal minimum influenza vaccination coverage based on an estimated influenza Basic Reproduction Number (R0) of 0.9-2.1 so as to obtain herd immunity or approach it. There is a strong argument for attempting near universal population coverage with the annual influenza vaccine leading up to next winter.

Influenza vaccine uptake and attitudes of healthcare workers in Ireland

BACKGROUND

Influenza vaccination uptake by Irish healthcare workers remains sub-optimal despite local initiatives to increase it.

AIMS

To investigate hospital workers' attitudes to influenza vaccination and how this influenced their decisions about vaccination.

METHODS

A questionnaire survey of Irish hospital workers, measuring uptake of and attitudes to influenza vaccination.

RESULTS

There were 747 responders, of whom 361 (48%) reported having received influenza vaccination. Attitudes predicting vaccination uptake included a belief that vaccination would protect family members (P < 0.0005, CI 1.191-1.739), a perception of susceptibility to 'flu (P < 0.0005, CI 1.182-1.685), a belief that all healthcare workers should be vaccinated (P < 0.005, CI 1.153-1.783), perceived ease of getting 'flu vaccination at work (P < 0.0005, CI 1.851-2.842) and encouragement by line managers (P < 0.05, CI 1.018-1.400). Attitudes negatively associated with vaccination uptake included fear of needles (P < 0.05, CI 0.663-0.985) and a belief that vaccination would cause illness (P < 0.0005, CI 0.436-0.647). Medical staff were significantly more likely to be vaccinated. Healthcare students were least likely to be vaccinated (P < 0.0005).

CONCLUSION

Addressing specific barriers to influenza vaccination in healthcare workers may improve uptake.

Should influenza vaccination be mandatory for healthcare staff?

Emeritus Professor Alan Glasper, from the University of Southampton, discusses government concerns about the low uptake of flu vaccination among frontline healthcare staff

Factors Influencing the Implementation of Flu Vaccination in Healthcare Professionals: Pros and Cons

Introduction:

Vaccination is the best method for microbial and viral infections prevention. Especially for health professionals, flu vaccination is the best method to protect them, and the same applies for the patients and the general population from being infected. One of the most important preventive measure is vaccination and the main types of vaccines available, the limitations and side effects are briefly presented.

Aim:

The aim of this paper is to present the necessity of the healthcare professionals to conceptualize the importance of flu vaccination ifor themselves and the general population. Healthcare professionals are influenced by their knowledge, attitudes, and beliefs. Epidemiological surveys on this issue are presented for Greece, European Union, and the USA.

Methods:

A broad scope literature review was conducted based on a strict selection process of articles referring to the general population and the healthcare professionals with emphasis on the time period from the fall of 2018 until the spring of 2020 across Greece. The method used in this research obtained information through bibliographical references throughout Europe, USA, and relevant studies in Greece.

Results:

The results of this research indicated that influenza vaccination among healthcare professionals in Greece in the time period 2018-2019 was higher in primary health centers (PHCs) with a percentage of 43.8% than in Hospitals which was 30.6%. In addition, in the time period 2019-2020 flu vaccination among health professionals was higher in PHCs with a percentage of 57.9% rather than in Hospitals with a percentage of 38.8%. Specifically, flu vaccination rate which took place in hospitals was higher among physicians than in other healthcare personnel. Furthermore, the fundamental reasons for recommending flu vaccination in healthcare professionals are presented, and issues related to denial or acceptance of it are highlighted. Measures and strategies are proposed in order to increase flu vaccination coverage in healthcare facilities in Greece.

Conclusions:

Based on this research review healthcare professionals (HCPs) especially the ones working in ICUs, in ICUs for newborn children, in Departments for acute care infections, in Departments caring of persons with immunodeficiency or Units for transplantation, Oncology and Haematology Departments, and finally, in Emergency Care Units need directly to be vaccinated for the flu virus. Different measures have been undertaken to promote flu vaccination and the percentage of implementation has been highlighted.

Barriers and beliefs among health-care workers regarding seasonal influenza vaccine in Al-Qassim region, Saudi Arabia

This study aimed to assess the seasonal influenza vaccine (SIV) coverage rate, and to assess knowledge, attitudes, and practice of health-care workers (HCWs) concerning the SIV. In this multicenter cross-sectional study conducted in Qassim region, Saudi Arabia, a validated questionnaire was distributed randomly among HCWs. Of 523 responses from HCWs across different institutions, 282 (53.9%) respondents were females and most respondents were aged between 30 and 39 years. Overall, 48.6% of participants had been regularly vaccinated with the SIV, and 70% were willing to be vaccinated in the coming season. Reasons for HCWs' non-adherence to the SIV included their having previously had influenza, which was not severe (20.7%), and that they were young and healthy (19.2%). Belief in the effectiveness of the SIV (72.3%) and knowledge that the SIV should be administered yearly (86.6%) was high among respondents. Less than 50% of respondents believed that vaccine safety concern is the main barrier preventing health-care institutions from providing the SIV to patients. Our study results showed suboptimal SIV coverage among HCWs in Qassim region. Educational programs and campaigns regarding the risk of influenza infection, as well as the provision of adequate information, and highlighting the importance of HCWs being vaccinated are essential. Easy access to and availability of the SIV in each region is crucial for improved vaccine coverage. Health-care institutions need to more actively encourage staff to undergo influenza vaccinations on a regular basis, especially during the influenza season.