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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel

Kathleen Quan RN, David M. Tehrani BS, Linda Dickey RN MPH, Eugene Spiritus MD, Denise Hizon, Kristie Heck, Pamela Samuelson RN, Elliott Kornhauser MD MBA MPH, Raja Zeitany PharmD, Susan Mancia MA, Lauri Thrupp MD, Susan M. Tiso DNP NP-BC and Susan S. Huang MD MPH
Infection Control and Hospital Epidemiology
Vol. 33, No. 1 (January 2012), pp. 63-70
DOI: 10.1086/663210
Stable URL:
Page Count: 8
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Voluntary to Mandatory: Evolution of Strategies and Attitudes toward Influenza Vaccination of Healthcare Personnel
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Background. Assessing the relative success of serial strategies for increasing healthcare personnel (HCP) influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.Objective. To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe HCP attitudes toward vaccination and reasons for declination.Design. Retrospective cohort study.Methods. We assessed the impact of serial vaccination campaigns on the proportions of HCP who received influenza vaccination during the 2006–2011 influenza seasons. In addition, declination data over these 5 seasons and a 2007 survey of HCP attitudes toward vaccination were collected.Results. HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of 6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts. Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of the surveyed HCP were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.Conclusions. A mandatory influenza vaccination program for HCP was essential to achieving high vaccination rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience. Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to receipt of the vaccine but who have not made vaccination a priority.

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