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Margaret McCartney: Mandatory flu vaccination won’t fix the NHS

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k402 (Published 06 February 2018) Cite this as: BMJ 2018;360:k402

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Re: Margaret McCartney: Mandatory flu vaccination won’t fix the NHS

Mandates versus incentives for healthcare worker influenza immunization

In my recent doctoral study (Hale 2016) on healthcare worker influenza immunisation I concluded that the difficulties of mobilising a mandatory programme in the UK are considerable - social, cultural and economic in nature; my healthcare worker research participants proposed that these difficulties would be worsened by exemptions. With some even suggesting that a mandatory programme would result in lower uptake. However, others drew attention to the ‘in actu’ mandatory influenza immunisation in intensive care wards, the mandatory nature of other occupational health procedures in the NHS, particularly HBV vaccination, and to mandatory health requirements in other professions. I established that HCW immunisation, including influenza, is ‘in potentia’ mandatory already but that this potential is not being mobilised because of the difficulties already mentioned.

Incentives for HCW influenza immunisation to potential vaccinees and vaccinating organisations were proposed as an alternative to a mandatory programme by some of my participants, who highlighted that other healthcare workers and organisations have access to these. I concluded that such incentives could, given certain circumstances, be successfully utilised in the UK. Given the evidence for HCW influenza immunisation being economically effective (Burls et al 2006), it would seem that an incentive programme could also prove economically beneficial for healthcare organisations if the incentive was adequate enough to facilitate the flow of sufficient vaccines into HCWs.

References
Burls, A., Jordan, R., Barton, P., Babtunde, O., Wake, B., Albon, E. and Hawker, J. (2006) ‘Vaccinating healthcare workers against influenza to protect the vulnerable – Is it a good use of healthcare resources? A systematic review and an economic evaluation’, Vaccine, 24: 4212-4221.
Hale, R. (2016) An actor-network analysis of the healthcare worker influenza immunisation programme in Wales: 2009-2011. PhD thesis, University of Nottingham.

Competing interests: No competing interests

12 February 2018
Rachel Hale
Research Fellow
University of Warwick
Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL