Will Healthcare Workers Refuse the Swine Flu Vaccine?

The first doses of vaccine for the Influenza A H1N1 virus (“swine flu”) should be available in October of 2009. Due to an initial limited supply, the World Health Organization (WHO) recommends that healthcare workers should be first in line to receive the vaccine. Immunizing healthcare workers against the H1N1 virus not only provides personal protection for the workers, but also protects patients and reduces absenteeism in healthcare settings. Unfortunately, a recent study published by the British Medical Journal (BMJ) reports that less than half of healthcare workers surveyed are willing to be vaccinated against pandemic flu.

The BMJ “fast track” study surveyed healthcare workers — physicians, nurses, and allied health professionals — in the first several months of 2009 to assess their willingness to receive a flu vaccine as part of pre-pandemic planning. When the WHO pandemic alert was phase 3, indicating limited human-to-human transmission, less than one-third (28.4%) of workers were willing to receive a vaccine. At phase 5 alert level, an indicator that a global pandemic is imminent, less than half (47.9%) were still willing to do so.

The most common reasons that healthcare workers who were willing to receive the vaccine included the desire to be protected against the virus, and compliance with the recommendations of healthcare authorities. Also, healthcare workers who received seasonal flu vaccines in the past, and those who perceived an increased risk of becoming infected, were more likely to be willing to receive the vaccine. Fear of possible side effects, as well as questions regarding the effectiveness of the vaccine, limited the willingness to receive the vaccine.

The results of this study are similar to those of a survey recently conducted by Nursing Times that reported only 37% of nurses with direct patient contact were planning to be vaccinated against H1N1 flu. Additionally, 33% were undecided, but 30% of nurses were not planning on being vaccinated. The same reasons reported in the BMJ study are cited as reasons in favor of or opposition to vaccine acceptance.

Overall rates of healthcare worker vaccination are low, with only 42% of healthcare workers typically receiving seasonal flu vaccines. In many hospital settings, this vaccine is recommended by the Centers for Disease Control and Prevention, as well as hospital administrators, but is not mandatory. In contrast, immunization requirements for healthcare workers have resulted in near-100% coverage against measles, mumps, rubella, and tuberculosis screening. A required flu vaccine — seasonal or H1N1 — could have the same outcome, according to the recent position paper by the Association of Professionals in Infection Control and Epidemiology.

With a flu pandemic almost certain according to most health organizations, hospitals will face many decisions regarding protective measures against the flu. Ordering extra surgical masks, providing family support for affected hospital staff, reinforcing infection control procedures, limiting unnecessary visitors to the hospital, and limiting procedures that may increase the spread of the flu virus are all potential strategies to keep healthcare workers and patients safe.

The acceptance of flu vaccines by healthcare workers limits the spread of the disease to vulnerable patients and keeps the healthcare system running at optimal levels. Moreover, healthcare workers also influence the vaccination of patients and people in the community at large. According to research among children and adults, healthcare providers are very influential in the decision to vaccinate or not. Most importantly, healthcare workers must be confident that flu vaccines are safe and effective, and be motivated to pass this information on to the community.

The media hype and conflicting information since the first cases of H1N1 flu appeared in the spring of 2009 has prevented many people — healthcare workers included — from fully understanding the risks of H1N1 flu or how to prevent it. Complete and accurate information needs to be provided to healthcare workers as hospitals make decisions about vaccine requirements and other flu prevention strategies.


Baeyens JP, Lang PO, Michel JP. Willingness to vaccinate and to be vaccinated in adults. Aging Clin Exp Res. Jun 2009;21(3):244-249.

Jordan, R., & Hayward, A. (2009). Should healthcare workers have the swine flu vaccine? BMJ, 339 (aug25 2) DOI: 10.1136/bmj.b3398

Jordan, R., & Hayward, A. (2009). Should healthcare workers have the swine flu vaccine? BMJ, 339 (aug25 2) DOI: 10.1136/bmj.b3398

Smith, P., Kennedy, A., Wooten, K., Gust, D., & Pickering, L. (2006). Association Between Health Care Providers’ Influence on Parents Who Have Concerns About Vaccine Safety and Vaccination Coverage PEDIATRICS, 118 (5) DOI: 10.1542/peds.2006-0923

Use of Influenza A (H1N1) 2009 Monovalent Vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. August 28, 2009 2009;58(RR10):1-8.

Zarocostas, J. (2009). Healthcare workers should get top priority for vaccination against A/H1N1 flu, WHO says BMJ, 339 (jul15 1) DOI: 10.1136/bmj.b2877

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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