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

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 die 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 die 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 die vaccine but who have not made vaccination a priority.Infect Control Hosp Epidemiol 2012;33(1):63-70

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Correlates of Improved Influenza Vaccination of Healthcare Personnel: A Survey of Hospitals in Louisiana

Infection Control and Hospital Epidemiology ◽

10.1086/670992 ◽

2013 ◽

Vol 34 (7) ◽

pp. 723-729 ◽

Cited By ~ 6

Author(s):

Kayla L. Fricke ◽

Mariella M. Gastañaduy ◽

Renee Klos ◽

Rodolfo E. Bégué

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Influenza Vaccination ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Healthcare Personnel ◽

Patient Contact ◽

Hospital Type ◽

Vaccination Rates ◽

Item Questionnaire

Objective.To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on correlates of increased vaccination rates.Design.Survey.Participants.Volunteer sample of hospitals in Louisiana.Methods.All hospitals in Louisiana were invited to participate. A 17-item questionnaire inquired about the hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.Results.Of 254 hospitals, 153 (60%) participated and were included in the 124 responses that were received. Most programs (64%) required that HCP either receive the vaccine or sign a declination form, and the rest were exclusively voluntary (36%); no program made vaccination a condition of employment. The median vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the most common of which was to require that a mask be worn on patient contact). Hospitals that provided free vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and imposed consequences had the highest vaccination rates (median, 86%; range, 81%–91%).Conclusions.The rate of influenza vaccination of HCP remains low among the hospitals surveyed. Recommended practices may not be enough to reach 90% vaccination rates unless a signed declination requirement and consequences are implemented. Wearing a mask is a strong consequence. Demanding influenza vaccination as a condition of employment was not reported as a practice by the participating hospitals.

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Ethical Considerations and Practical Implications in Romanian Covid-19 Vaccination Campaign

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2021.spiss.105 ◽

2021 ◽

Vol 66 (Special Issue) ◽

pp. 156-157

Author(s):

Petru Sandu ◽

◽

Maria Aluaș ◽

Răzvan M. Cherecheș ◽

◽

...

Keyword(s):

Public Health ◽

Vaccination Campaign ◽

European Countries ◽

Ethical Considerations ◽

Vaccination Rates ◽

One Year ◽

High Level ◽

Vaccination Campaigns ◽

The Impact ◽

Practical Implications

"Besides its undoubtable significant contribution to morbidity and mortality worldwide, the COVID-19 pandemic has had numerous political, social, economic, and public health implications. Vaccination, an already long debated public health ethics theme, has reoccurred in force, as the efforts of the scientific community to curb the pandemic resulted in a viable vaccine less than one year since COVID-19 was declared a pandemic. High-level, international negotiations dictated states’ COVID-19 vaccine availability in the first few months, therefore each national Government had to develop and deploy vaccination campaigns prioritizing certain population categories. This paper aims to present Romanian COVID-19 vaccination campaign, from its inception to the present days, by focusing on the ethical considerations (e.g. prioritization, coercion, non-discrimination) and their practical implications ( e.g. vaccination hesitancy, rates, fake news). Like most countries in the European Community, Romania has initially adopted a Rawlsian approach to vaccination, prioritizing the older adults and the individuals with chronic conditions. However, unlike other European countries, coercion was not considered in any form (e.g. extended mobility facilities for the vaccinated), more recently incentives such as food vouchers being discussed. The impact of these decisions on the vaccination rates and hesitancy are discussed in the context of other European countries examples of vaccination campaigns. "

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Mobility network reveals the impact of geographic vaccination heterogeneity on COVID-19

10.1101/2021.10.26.21265488 ◽

2021 ◽

Author(s):

Yuan Yuan ◽

Eaman Jahani ◽

Shengjia Zhao ◽

Yong-Yeol Ahn ◽

Alex Pentland

Keyword(s):

Computational Models ◽

Negative Impact ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Control Measures ◽

Vaccine Uptake ◽

Vaccination Rates ◽

The Impact ◽

Hub Effect ◽

The U.S

ABSTRACTMassive vaccination is one of the most effective epidemic control measures. Because one’s vaccination decision is shaped by social processes (e.g., socioeconomic sorting and social contagion), the pattern of vaccine uptake tends to show strong social and geographical heterogeneity, such as urban-rural divide and clustering. Yet, little is known to what extent and how the vaccination heterogeneity affects the course of outbreaks. Here, leveraging the unprecedented availability of data and computational models produced during the COVID-19 pandemic, we investigate two network effects—the “hub effect” (hubs in the mobility network usually have higher vaccination rates) and the “homophily effect” (neighboring places tend to have similar vaccination rates). Applying Bayesian deep learning and fine-grained simulations for the U.S., we show that stronger homophily leads to more infections while a stronger hub effect results in fewer cases. Our simulation estimates that these effects have a combined net negative impact on the outcome, increasing the total cases by approximately 10% in the U.S. Inspired by these results, we propose a vaccination campaign strategy that targets a small number of regions to further improve the vaccination rate, which can reduce the number of cases by 20% by only vaccinating an additional 1% of the population according to our simulations. Our results suggest that we must examine the interplay between vaccination patterns and mobility networks beyond the overall vaccination rate, and that the government may need to shift policy focus from overall vaccination rates to geographical vaccination heterogeneity.

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Mobility network reveals the impact of spatial vaccination heterogeneity on COVID‐19

10.21203/rs.3.rs-1065491/v1 ◽

2021 ◽

Author(s):

Yuan Yuan ◽

Eaman Jahani ◽

Shengjia Zhao ◽

Yong-Yeol Ahn ◽

Alex Pentland

Keyword(s):

Computational Models ◽

Network Effects ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Control Measures ◽

Vaccine Uptake ◽

Vaccination Rates ◽

Fine Grained ◽

Mobility Data ◽

The Impact

Abstract Massive vaccination is one of the most effective epidemic control measures. Because one’s vaccination decision is shaped by social processes (e.g., socioeconomic sorting and social contagion), the pattern of vaccine uptake tends to show strong social and spatial heterogeneity, such as urban-rural divide and clustering. Examining through network perspectives, here we quantify the impact of spatial vaccination heterogeneity on COVID outbreaks and offer policy recommendations on location-based vaccination campaigns. Leveraging fine-grained mobility data and computational models, we investigate two network effects—the “hub effect” (hubs in the mobility network usually have higher vaccination rates) and the “homophily effect” (neighboring places tend to have similar vaccination rates). Applying Bayesian deep learning and fine-grained epidemic simulations, we show a negative effect of homophily and a positive effect of highly vaccinated hubs on reducing COVID-19 case counts; these two effects are estimated to jointly increase the total cases by approximately 10% in the U.S. Moreover, inspired by these results, we propose a vaccination campaign strategy that targets a small number of regions with the largest gain in protective power. Our simulation shows that we can reduce the number of cases by 20% by only vaccinating an additional 1% of the population. Our study suggests that we must examine the interplay between vaccination patterns and mobility networks beyond the overall vaccination rate, and that accurate location-based targeting can be equally if not more important than improving the overall vaccination rate.

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Maximizing influenza vaccination uptake among healthcare personnel in Israel: lessons learned from mandatory vaccination policy in the United States

Israel Journal of Health Policy Research ◽

10.1186/s13584-019-0326-4 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Rachel Gur-Arie

Keyword(s):

United States ◽

Health Policy ◽

Influenza Vaccination ◽

Influenza Infection ◽

The United States ◽

Lessons Learned ◽

Healthcare Personnel ◽

Vaccination Policy ◽

Vaccination Uptake ◽

Mandatory Vaccination

Abstract Background Maximizing vaccination uptake is crucial in generating herd immunity and preventing infection incidence (Quach et al., Am J Infect Control 11:1017–23, 2013). Vaccination of healthcare personnel (HCP) against influenza is vital to influenza infection control in healthcare settings, given the consistent exposure of HCP to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, Curr Opin Infect Dis 24: 363–369, 2011). Influenza vaccination uptake among HCP remains suboptimal: in 2017–18, 47.6% of HCP who worked in settings where influenza vaccination was not mandatory were vaccinated against influenza in United States (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (94.8% vs. 47.6%) (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Goals The Israel Journal of Health Policy Research has published articles focused on the issues of influenza vaccination (Yamin et al., Isr J Health Policy Res 3: 13, 2014), improving influenza vaccination coverage of HCP (Weber et al., Isr J Health Policy Res 5: 1–5, 2016), influenza vaccination motivators among HCP (Nutman and Yoeli, Isr J Health Policy Res 5: 52, 2016), legal imposition of vaccination (Kamin-Friedman, Isr J Health Policy Res 6:58, 2017), and mandatory vaccination (Gostin, Cell Biosci 8: 1-4, 2018). Each article explores factors influencing disease prevention from different angles within an Israeli context. This article attempts to fuse these topics by investigating how to apply aspects of American mandatory influenza vaccination policy targeted at HCP in an Israeli context. Methods Critical document analysis was conducted on relevant literature and policy discussing influenza prevention interventions among HCP within the United States. Mandatory vaccination policies were highlighted. A discussion of the professional responsibility of HCP to vaccinate against influenza serves as background. Case studies of hospitals in the United States that implemented mandatory vaccination policies for their employees are analyzed. The article concludes with analysis exploring how qualities of mandatory influenza vaccination policy of HCP could take shape in Israel, giving contextual limitations, urging Israeli health policy makers to reflect on lessons learned from the American case study. Main findings and conclusion Mandatory HCP influenza vaccination policies in comparison to non-mandatory interventions are most effective in obtaining maximum influenza vaccination uptake among HCP (Black et al., Morb Mortal Wkly Rep 67: 1050, 2018). Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns. The ethical responsibility of HCP to their patients and work environments to prevent and lower influenza infection incidence arguably overrules such individual objections. Mandatory HCP influenza vaccination policies are an effective method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settings. Still, cultural, social and political sensitivity must be taken into consideration when implementing both full-on mandatory HCP influenza vaccination policies and/or aspects of mandatory policies, especially within an Israeli context.

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The long-term success of mandatory vaccination laws at implementing the first vaccination campaign in 19th century rural Finland

10.1101/2020.12.14.20247577 ◽

2020 ◽

Author(s):

Susanna Ukonaho ◽

Virpi Lummaa ◽

Michael Briga

Keyword(s):

Vaccination Coverage ◽

Vaccination Campaign ◽

Vaccine Hesitancy ◽

Childhood Infections ◽

Health Practitioners ◽

Mandatory Vaccination ◽

Vaccination Campaigns ◽

Public Health Practitioners ◽

The Impact

In high income countries, childhood infections are on the rise, a phenomenon in part attributed to persistent hesitancy towards vaccines. To combat vaccine hesitancy, several countries recently made vaccinating children mandatory, but the effect of such vaccination laws on vaccination coverage remains debated and the long-term consequences are unknown. Here we quantified the consequences of vaccination laws on the vaccination coverage monitoring for a period of 63 years rural Finland's first vaccination campaign against the highly lethal childhood infection smallpox. We found that annual vaccination campaigns were focussed on children up to 1 year old, but that their vaccination coverage was low and declined with time until the start of the vaccination law, which stopped the declining trend and was associated with an abrupt coverage increase of 20 % to cover >80 % of all children. Our results indicate that vaccination laws had a long-term beneficial effect at increasing the vaccination coverage and will help public health practitioners to make informed decisions on how to act against vaccine hesitancy and optimise the impact of vaccination programmes.

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Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.9 ◽

2018 ◽

Vol 39 (4) ◽

pp. 452-461 ◽

Cited By ~ 16

Author(s):

John Frederick ◽

Alexandria C. Brown ◽

Derek A. Cummings ◽

Charlotte A. Gaydos ◽

Cynthia L. Gibert ◽

...

Keyword(s):

Influenza Vaccination ◽

Respiratory Illness ◽

Healthcare Personnel ◽

Respiratory Protection ◽

Vaccination Rates ◽

Medical Centers ◽

Observational Cohort ◽

Mandatory Vaccination ◽

Outpatient Settings ◽

Multivariable Regression Models

OBJECTIVETo determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).DESIGNRetrospective observational cohort study.SETTINGThis study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.PARTICIPANTSThe study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.METHODSTo determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.RESULTSThe proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).CONCLUSIONSThese data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.Infect Control Hosp Epidemiol 2018;39:452–461

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COVID-19 and Influenza: Vaccination Before and During the Pandemic among the Lebanese Adult Population

10.1101/2021.02.10.21251392 ◽

2021 ◽

Author(s):

Anthony Elia ◽

Nedal Taha ◽

Sima Tokajian

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Influenza A ◽

Adult Population ◽

Vaccine Uptake ◽

Cross Sectional ◽

Effective Measure ◽

Health Crisis ◽

Vaccination Rates ◽

The Impact

AbstractInfluenza is a common respiratory tract disease that has been around for years. Vaccination remains the most cost-effective measure to avoid infection. Influenza vaccination rates in Lebanon, like elsewhere in the world, are known to be suboptimal. The emergence and spread of SARS-CoV-2 led to a global health crisis. This study aimed at assessing the impact of the COVID-19 pandemic on the tendency of the general adult population residing in Lebanon to vaccinate against influenza. A quantitative cross-sectional study was conducted between November and December 2020 using a structured questionnaire passed on 1055 individuals to determine factors influencing vaccination habits prior to and during the COVID-19 pandemic. The factors were analyzed using univariate, bivariate, and multivariate analyses. The majority (69.7%) of the study participants never received the influenza vaccine within the last 5 years, 20% vaccinated occasionally, and only 10.3% were yearly vaccinated. Among individuals who never got the influenza vaccine within the last 5 years, 20.7% reported their willingness to vaccinate this winter significantly increasing the vaccination percentage. Participants concerned about the COVID-19 pandemic showed an enhanced willingness to vaccinate against both. Influenza and COVID-19 vaccination rates, nevertheless, are still considerably lower than the recommended coverage. The COVID-19 pandemic caused a significant increase in the tendency to vaccinate against influenza. Yet, urgent vaccination strategies should be implemented to boost vaccine uptake across all demographics to consequently diminish the burden conflicted by influenza, COVID-19, and ultimately other infectious diseases.

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Measuring the Impact of Exposure to COVID-19 Vaccine Misinformation on Vaccine Intent in the UK and US

10.1101/2020.10.22.20217513 ◽

2020 ◽

Cited By ~ 3

Author(s):

S. Loomba ◽

A. de Figueiredo ◽

S. J. Piatek ◽

K. de Graaf ◽

H. J. Larson

Keyword(s):

Age Groups ◽

Vaccine Uptake ◽

Major Step ◽

Vaccination Rates ◽

The Us ◽

Nationally Representative ◽

The Uk ◽

Vaccination Campaigns ◽

The Impact ◽

Intent To Vaccinate

The successful development and widespread acceptance of a SARS-CoV-2 vaccine will be a major step in fighting the pandemic, yet obtaining high uptake will be a challenging task, worsened by online misinformation. To help inform successful COVID-19 vaccination campaigns in the UK and US, we conducted a survey to quantify how online misinformation impacts COVID-19 vaccine uptake intent and identify socio-economic groups that are most at-risk of non-vaccination and most susceptible to online misinformation. Here, we report findings from nationally representative surveys in the UK and the US conducted in September 2020. We show that recent misinformation around a COVID-19 vaccine induces a fall in vaccination intent among those who would otherwise “definitely” vaccinate by 6.4 (3.8, 9.0) percentages points in the UK and 2.4 (0.1, 5.0) in the US, with larger decreases found in intent to vaccinate to protect others. We find evidence that socio-econo-demographic, political, and trust factors are associated with low intent to vaccinate and susceptibility to misinformation: notably, older age groups in the US are more susceptible to misinformation. We find evidence that scientific-sounding misinformation relating to COVID-19 and vaccines COVID-19 vaccine misinformation lowers vaccination intent, while corresponding factual information does not. These findings reveal how recent COVID-19 misinformation can impact vaccination rates and suggest pathways to robust messaging campaigns.

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Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign

Vaccines ◽

10.3390/vaccines9080889 ◽

2021 ◽

Vol 9 (8) ◽

pp. 889

Author(s):

Matteo Riccò ◽

Pietro Ferraro ◽

Simona Peruzzi ◽

Federica Balzarini ◽

Silvia Ranzieri

Keyword(s):

Vaccination Campaign ◽

Vaccine Hesitancy ◽

Occupational Physicians ◽

Vaccination Rates ◽

Attitudes And Practices ◽

Immunization Rates ◽

Vaccination Campaigns ◽

The Impact ◽

Occupational Settings ◽

Knowledge Attitudes And Practices

Vaccinations used to prevent coronavirus disease (COVID-19)—the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060–11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

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