Elsevier

Public Health

Volume 158, May 2018, Pages 61-63
Public Health

Short Communication
Ethical considerations in the uptake of influenza vaccination by healthcare workers

https://doi.org/10.1016/j.puhe.2018.01.020Get rights and content

Highlights

  • We explored the views of healthcare workers on the current UK influenza vaccination scheme.

  • Vaccination uptake rates in this group fell far below the NHS target of 75%.

  • All speciality groups studied reported a degree of external pressure/coercion to be vaccinated.

  • Ethics must be considered in voluntary as well as mandatory vaccination schemes.

Abstract

Objectives

The World Health Organization (WHO) recommends annual seasonal influenza vaccination of healthcare workers (HCWs). Under the current voluntary scheme in England, uptake of vaccine in this group remains well below the 75% target. A mandatory scheme may improve rates, but raises the ethical issue of imposed vaccination. However, the existing voluntary scheme could also potentially infringe autonomy if those not wanting to join feel pressured or coerced into vaccination. The aim of this study was to explore HCW views and experiences with the current influenza vaccination programme.

Study design

Questionnaire survey.

Methods

Between March 2015 and April 2016, a total of 140 questionnaires were completed across seven HCW groups, with the demographic, vaccination and opinion data statistically analysed using the chi-squared test, Kruskal-Wallis test and Mann–Whitney U-test as appropriate.

Results

No staff group met the national influenza vaccination target of 75% and vaccination rates varied between HCW groups. All groups reported some degree of external pressure to be vaccinated and there were mixed views on the concept of mandatory vaccination, with a lack of certainty over the vaccine's efficacy and/or a lack of information the most common reasons for not supporting it.

Conclusion

The current voluntary influenza vaccination scheme has a number of flaws. Improvements in the quality and availability of information provided to employees may help Trusts increase vaccination rates, or achieve acceptance of any proposed mandatory programme.

Section snippets

Acknowledgements

The authors wish to thank Professor Angus Dawson from the School of Public Health, The University of Sydney and the study healthcare workers for their contribution to this research.

Ethical approval

Not required (according to National Research Ethics Service/Local Research Ethics Committee guidance/advice re staff surveys; registered with Trust Audit Department).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Competing interests

None declared.

References (6)

  • WHO

    Seasonal influenza factsheet

    (November 2016)
  • Seasonal influenza vaccine uptake amongst frontline healthcare workers (HCW) in England: winter season 2013–2014

    (12 June 2014)
  • Seasonal influenza vaccine uptake amongst frontline healthcare workers (HCW) in England: winter season 2014–2015

    (21st May 2015)
There are more references available in the full text version of this article.

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    Finally, Carter and Yentis explored the experiences of seven HCP groups over a one-year period employed in a United Kingdom hospital with voluntary vaccination programs [58]. Beyond gaps in the availability and quality of information about vaccination, all HCP groups experienced external pressure to get vaccinated, mostly from their hospital Trust, managers, and colleagues [58]. The authors argue that “a mandatory vaccination program would be better than a voluntary vaccination program with wide-spread coercion” [58].

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    Other objections have been raised on the grounds of undermining personal autonomy, coercion, and damage to staff morale [7,11,23], and that the resources involved in enforcing mandatory vaccination may not be justified [26]. A recent study conducted with HCWs in the UK found that several HCWs opposed the idea of influenza vaccination being compulsory despite having no concerns about being required to be vaccination against hepatitis B [27]. This highlights that HCWs’ views on the importance and acceptability of vaccination can vary by disease [28,29], as can support for mandatory vaccination [21,30,31].

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