Implementation of a Mandatory Influenza Vaccine Policy: A 10-Year Experience

Abstract

Introduction Influenza vaccination of healthcare workers (HCW) has been recommended for over 30 years. In 2009, HCWs were designated as a priority group by the Centers for Disease and Prevention (CDC). Current HCW vaccination rates are 78% across all settings, and reach approximately 92% among those employed in hospital settings. Over the last decade, it has become clear that mandatory vaccine policies result in maximal rates of HCW immunization. Methods This observational 10-year study describes the implementation of a mandatory influenza vaccination policy in a dedicated quaternary pediatric hospital setting by a multidisciplinary team. We analyzed 10 years of available data from de-identified Occupational Health records from 2009-2010 through the 2018-2019 influenza seasons. Descriptive statistics were performed using Stata v15 and Excel. Results Sustained increases in HCW immunization rates above 99% were observed in the 10 years post implementation, in addition to a reduction in exemption requests and health-care associated influenza. In the year of implementation, 145 (1.6%) HCWs were placed on temporary suspension for failure to receive the vaccine without documentation of an exemption, with 9 (0.06%) subsequently being terminated. Since then, between 0-3 HCWs are terminated yearly for failure to receive the vaccine. Conclusion Implementation of our mandatory influenza vaccination program succeeded in successfully increasing the proportion of immunized HCWs at a quaternary care children’s hospital, reducing annual exemption requests with a small number of terminations secondary to vaccine refusal. Temporal trends suggest a positive impact on the safety of our patients.

Spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for front-line healthcare workers

“…Such action reduces vaccine refusal among FHCWs and improves patient safety. 49 FHCWs who refuse vaccination, other than for genuine and compelling medical reasons, already face the choice of 'no jab, no work'. This might involve annual vaccination certification as a requirement for continued employment, which could be monitored in the same way as other workplace vaccinations and infection control practices.…”

Promising Strategies to Support COVID-19 Vaccination of Healthcare Personnel: Qualitative Insights from the VHA National Implementation

“…14 Even in a medical context, the first year of vaccine mandating can be challenging, with potentially acute impacts on healthcare delivery and staffing. One study of a quaternary pediatric hospital found that 1.6% of HCP were placed on administrative leave in year 1 of a flu vaccine mandate program 13 ; to give a sense of scale, translated to the VHA, at 1.6%, nearly 6000 HCP would be out on leave related to COVID-19 vaccine mandates. This kind of initial vaccine resistance has already occurred in some settings.…”

“…12 At a positive extreme, a 10-year US medical center flu vaccine mandate that included employment termination as a consequence of noncompliance has been highly successful, with 99% HCP immunization and positive impacts on patient safety. 13 Another study comparing six national or statewide mandates recommended strategies to reduce the risk of mandate repeal: pairing mandates with public trust campaigns and exerting minimal coercion. 11 Indeed, vaccine adoption strategies will continue to be needed, since mandate repeals may be an ongoing risk.…”

Promising Strategies to Support COVID-19 Vaccination of Healthcare Personnel: Insights from the VHA National Implementation

“…14 Even in a medical context, the rst year of vaccine mandating can be challenging, with potentially acute impacts on healthcare delivery and sta ng. One study of a quaternary pediatric hospital found that 1.6% of HCP were placed on administrative leave in year 1 of a u vaccine mandate program 17 ; translating to the VHA, nearly 6000 HCP could be out on leave related to COVID-19 mandates in 2022. In rural New York, impacts of HCP COVID-19 vaccine resistance forced a hospital to temporarily close maternity wards in September 2021, when too many maternity staff resigned instead of taking the COVID-19 vaccine.…”

“…16 At a positive extreme, a 10-year US medical center u vaccine mandate that included employment termination as a consequence of noncompliance has been highly successful, with 99% HCP immunization and positive impacts on patient safety. 17 Another study comparing six national or statewide mandates recommended strategies to reduce the risk of mandate repeal: pairing mandates with public trust campaigns, and exerting minimal coercion. 14 Even in a medical context, the rst year of vaccine mandating can be challenging, with potentially acute impacts on healthcare delivery and sta ng.…”