PHLR 2013: What Works to Convince Health Workers to get Their Flu Shot?

Jan 18, 2013, 1:53 PM

The timeliest presentation at this year’s Public Health Law Research Program annual meeting taking place this week in New Orleans was likely the study presented by Richard Zimmerman, MD, MPH, and a professor of family medicine at the University Of Pittsburgh School Of Medicine. Zimmerman’s research looked at factors—including hospital policies—that help drive health workers to get a flu shot. The study looked at 429 hospitals in 41 states and found that 31 employed a mandate that fired workers who refused a flu shot, while 131 has other types of mandated requirements. For example, a health worker who refused the flu shot was required to wear a mask at all times while on the job during flu season.

NewPublicHealth: Tell us about your study.

Dr. Zimmerman: It was essentially a nationwide study that looked at the worker vaccination rate and what policies to use to increase vaccination rates. Factors associated with the highest rates are hospital mandates, either making vaccination a condition of employment or requiring safeguards such as mandating that health workers who don’t get a flu shot wear a mask during the flu season. The U.S. Centers for Disease Control and Prevention goal for the percentage of health workers getting flu shots is 90 percent, but many institutions achieve rates in the 60 percent to 75 percent range.

NPH: How do you increase that?

Dr. Zimmerman: It’s a high bar. We see over a decade that we’ve moved from the 40s to the 60s, but I fear we are going to plateau at the 65 to 75 percent ranges.

NPH: What reasons do workers, and the general public, give for not getting the flu vaccine

Dr. Zimmerman: A small percentage—less than 1 percent—is allergic and can’t take the vaccine. Then we have groups of “always vaccinated,” “never vaccinated” and “some seasons yes, but some seasons no.” For that last group, if we make it convenient we have a chance to sway them.  For those who are really against it, it’s a hard task. That’s quite the challenge.

The most common reason people give for not taking the flu shot is that someone they know had a bad reaction. And while it’s true that older products were less pure, it’s been about three decades since we used the older technology. But there are persistent myths, and only very rare cases of serious reactions. The most common reaction is a sore arm, and for those who take the live vaccine as a spray in the nose, half may experience a stuffy nose. And some people feel they’re not at risk for the flu, though, in fact, one in ten people come down with it in a typical year.

NPH: Not all hospitals are implementing mandates. What are some of the others dong to increase flu vaccine rates among their workers?  

Dr. Zimmerman: Many hospitals do want to get their rates up and are spending a lot of time and resources to get to get to 70 percent, including incentives such as gift cards and other prizes. They also try to provide a wide range of times when the free vaccines are given to make it as convenient as possible.

NPH: Would more health workers getting the shot have made this flu season less severe for the general population?

Dr. Zimmerman: Unlikely. It’s being spread primarily in the community from outside the hospital from such sites as day care, school and public settings. But vaccinating health workers is vital for reducing the risk of getting the flu for hospital and health facility patients for whom the danger posed by flu—death and very serious illness—is greatest.

We need to get the message across that while many of the 24,000 deaths each year from flu are largely in older people and in people with underlying conditions, the flu can make a healthy adult feel very ill and put them out of work for days.

It might help if people picture this image: those 24,000 caskets span more than the length of a marathon course.

This commentary originally appeared on the RWJF New Public Health blog.