Mandatory Influenza Vaccination for Healthcare Workers


Influenza, commonly known as flu, are RNA viruses in the family Orthomyxoviridae that are caused by viruses A and B. These viruses are maintained only in human beings and mainly attack the respiratory system (Spickler, 2010, pp. 1-3). Occasionally, influenza viruses in human populations are transmitted from one person to another through direct contact and are often through respiratory droplets, which spread from infected persons to uninfected individuals through sneezing or coughing. Flu symptoms are generally worse than a cold and often last longer. These symptoms include headache, dry cough, body aches, and dry or sore throat. Nevertheless, the spread of influenza can be prevented through practicing good hand hygene and good health habits including covering the mouth and nose while coughing (WHO, 2006, pp. 8-11).

The impact of Influenza is globally felt it causes an estimated 3-5 million cases of severe disease and 3000 000- 500 000 deaths every year. Also, it is estimated that influenza infections and complications causes an average of 226 000 hospital admission every years in the United States. Deaths from influenza occur in all age categories including elderly people, infants, and middle aged. These vulnerable populations are likely to enter healthcare settings and enhance the spread of influenza in such settings. Because of this, a number of healthcare institutions nowadays implement policies for compulsory annual vaccination of influenza for healthcare workers. This paper discusses on the background of mandatory influenza vaccination policy for healthcare workers and related policy issues.

Background of Influenza Vaccination of healthcare workers

The article titled “Counterpoint: In Favor of Mandatory Influenza Vaccine for All Health Care Workers,” (2006) written by Backer covers the increased risk of exposure and spread of influenza to vulnerable patients and contact employees in health facilities. According to the article increased contact and exposure to influenza results in 40,000 deaths and 200,000 hospitalizations in health facilities. The greatest toll is on employees and patients who come in contact with influenza viruses and other related infections. Therefore, mandatory vaccination is the primary means of preventing the spread of influenza. Mandatory vaccination of healthcare workers aim at preventing the spread of influenza, prevents staff absenteeism due to illness, and protects vulnerable patient population from the increased mortality and morbidity that influenza carries.

The article “AMMI Canada Position Paper: 2012 Mandatory influenza immunization of health care worker,” (2012) written by Bryce and collegues covers ethical issues of influenza to the elderly people. According to the article, outbreaks of influenza are common in long-term care homes for the elderly, occurring in approximately 50% of these institutions annually. In acute care, precisely for the fragile elderly, hospital acquired influenza occurs at an estimated rate of 3 to 8 per 1000 patient admissions and has 7% to16% estimated case fatality rate. For this reason, compulsory health care worker vaccination is recommended not only of these at-risk populations, but also of caregivers and other close contact employees who may transmit influenza to these fragile populations.

In the article “Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice,” (2010), a study on BJC Healthcare, a large Midwestern health care organization, indicated that mandatory vaccination program successfully increased vaccination rates at the organization. Previous efforts including most recommended practices to maximize vaccination rates, such as easily available vaccine, leadership support, and incentives had failed to realize optimal influenza vaccination rates. These findings are vital to health facilities in implementing mandatory influenza vaccinations.CDC, The Healthcare Infection Control Practices Advisory Committee (HICPAC), and the Advisory Committee on Immunization Practices (ACIP) recommended that all U.S healthcare workers get vaccinated each year against influenza. Some of the recommended efforts include free and easily available vaccines, rewards and incentives, and leadership support. However, these efforts have failed to realize a much high vaccination levels in U.S health care institutions. For instance in 2006-2007, vaccination levels among U.S healthcare workers was 40%.

Although various efforts are made towards increasing influenza vaccination among healthcare workers there are opposing factors that impede such efforts. There emerge adversarial and legal disputes between healthcare workers and institutions when coercive measures are used to mandate influenza vaccination. In the article “Influenza Vaccination in Healthcare Workers: Should it be Mandatory?” (2010) written by Sullivan,despite the efforts of Virginia Masson Medical Center mandating influenza vaccination of employees, the nurses at the center, with the help of the Washington Nurses Association, succeeded in having the individual vaccination repealed. During the 2007 flue vaccination program at the center, 90% of the registered nurses voluntarily received the flue vaccination, implying that voluntary vaccination can result in a higher percentage of healthcare workers being vaccinated. Barriers to vaccination including religion, philosophical, and medical reasons need to be identified and addressed in healthcare institutions to strengthen mandatory influenza vaccination programs. Individual freedom and the right to refuse vaccination for a valid reason need to be respected to effectively remove barriers to voluntary immunization and enhance the effectiveness of compulsory vaccination programs that will aid in achieving and sustaining high rates of healthcare worker vaccination.

On the same note, a letter drafted by the Association of American Physicians and Surgeons (AAPS) to Colorado public health officials, opposed a ruling requiring employees in healthcare institutions to have an annual influenza vaccination or risk losing their jobs. The AAPS’s basis for the refusal of the ruling was some employees have their own religious and medical reasons for not engaging in mandatory vaccination and as such workers who have medical or religious exemption should be allowed to wear mask in patient care areas to prevent the spread of influenza. According to the views of AAPS letter, influenza and other related illnesses can be transmitted or spread to other people by both immunized and nonimmunized individuals.

Also, in the article titled “ANA Asks Court to Accept Aminus Brief in Support of the Washington State Nurses Association,” (2006), the mandatory flu vaccination is opposed. According to the article, the Washington State Association disputed against an area hospital over mandatory vaccination demanding that the hospital’s unilateral implementation of the requirement was in violation of the nurses’ collective bargaining agreement. The court ordered the hospital to stop registered nurses from receiving mandatory flu shots and promote voluntary vaccination programs. This article is vital to nurses since it sensitizes them on their rights in relation to vaccination programs.

Influenza vaccination in Toronto

The CDC, in its online constant publications, provides national laws regarding state and regional vaccination including influenza vaccination of healthcare workers. However, as of October 2013, the city of Toronto did not have specific laws for mandatory influenza vaccination of health care workers. Findings indicate that for the year 2012/2013, influenza vaccination for health care workers in Torornto remained unacceptably low when compared to 2011/2012 (Toronto, 2013). The Medical Officer in Toronto, since 2009 has constantly reported annually to the Board of Health on low rates of health care worker influenza vaccination in the city’s healthcare facilities. In the report presented to the Board of Health in Toronto in August 26 2012, the Medical officer indicated that seasonal influenza outbreaks were reported each year ranging from acute care hospital to complex continuing care hospital. The increased risk of influenza to patients, employees, and residents in health facilities was related to their underlying health problem, advanced age, and settings in which they are cared for in close proximity to a range of health care workers. These findings show that mandatory influenza vaccinations are needed in the city’s health facilities. In the Mandatory Health Programs and Services Guidelines (1997), an annual facility-wide influenza immunization coverage rate of 70% for health care workers in facilities was suggested. Therefore, mandatory influenza vaccination programs that include exemption provisions need to be introduced in Toronto health facilities to achieve very high rates of health care worker vaccination. An initiative to introduce mandatory influenza vaccination in Toronto can start with the House of Communicable Disease and Control led by Barbara Yaffe.


This paper reviews several previous articles that discusses on mandatory influenza vaccination. The information evaluated discusses the risk of exposure and spread of influenza, the social, ethical, and legal issues, supporters and opposers of mandatory vaccination, and recommendations for effective mandatory vaccination programs. The analysis reveals that influenza in health institutions can result in pronounced flue spread and transmission, employee absenteeism, lower individual productivity, longer hospital stay, and increased medical costs. Employee influenza vaccination can reduce the prevalence of these factors in health facilities. Research reveals that mandatory influenza vaccination has proven an effective measure to realize high employee vaccination rates in hospitals. Thus, it is the responsibility of state and local governments to ensure that flexible mandatory vaccination laws and programs are implemented in hospitals to achieve higher rates of employee vaccination.




AAPS (2011) Physicians Oppose Mandatory Flu Vaccine for Health Workers. Retrieved from: <>

American Nurses Association (2006) ANA Asks Court to Accept Amicus Brief in Support of WSNA (5/3). Retrieved from: <>

Backer, h. (2006) Counterpoint: In Favor of Mandatory Influenza Vaccine for All Health Care Workers. Retrieved from: <>

Bryce, E. et al (2012). ‘AMMI Canada Position Paper: 2012 Mandatory Influenza Immunization of Healthcare Workers,’ Canadian Journal Infectious Disease Med Microbiology, 23(4), pp. 93-96

CDC (2013) Seasonal Influenza. Retrieved from: <>

Mandatory Health Programs and Services Guidelines (2013) Retrieved from: <>

Spickler, R. A. (2010) Influenza Importance. Retrieved from: <>

Sullivan, L., P., (2010). ‘Influenza Vaccination in Healthcare Workers: Should it be Mandatory?’ The Online Journal of Issues in Nursing, vol. 15. Retrieved from: <>

Toronto (2013).2012/2013 Influenza Immunization of Healthcare Workers in Toronto Healthcare Facilities. Retrieved from: <>

WHO (2006).Review of Latest Available Evidence on Potential Transmission of Avian Infleunza (H5N1) through Water and Sewage and ways to Reduce the Risks to Human Health. Retrieved from: <>

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