Influenza Vaccine

How Health Care Workers Feel About Mandatory Influenza Vaccinations

Overall, 61% of health care workers worldwide agree with mandatory influenza vaccination, according to the results of a recent systematic review and meta-analysis.1

To examine the acceptance of this proposed practice, researchers included a total of 40 studies on the topic. The results indicated that while a majority of health care workers were accepting of the idea of mandatory influenza vaccination, the results varied based on location, profession, and prior vaccination of the participants.

Lead study author Gianluca Voglino, MD, with the department of public health and pediatric sciences at the University of Turin, in Torino, Italy, answered our questions about the study.


Consultant360: Your study examined the attitudes of health care workers on mandatory influenza vaccinations, as mandatory vaccination has been proposed due to low vaccination rates in this population. Why is vaccination coverage for health care workers low?

Gianluca Voglino: This is a tough question. The answer is not unique, and this is the reason why similar studies are very important. Unfortunately, different factors play a crucial role in determining vaccine hesitancy among health care workers, mainly connected to the unbalance between the perceived risk of the diseases and the perceived benefit of the vaccination. The influenza vaccine is perceived like a possible threat in front of a minimal risk of serious complications in healthy subjects. But what about the risk of spreading the infection to frail patients? We need to protect our patients first. 

C360: Your results showed that health care workers who were vaccinated against influenza were more likely to favor mandatory vaccination. In your opinion, do you think vaccination of any kind will become mandatory in the United States?

GV: Mandatory vaccination policies have been debated in the last couple of years, and some countries tried to implement such policies. Since the acceptance level is not unanimous, it will be pretty hard to adopt similar policies in the United States. In the European context, National Health Services and systemic cost-benefit analyses could support national government choices. Realistically, policies promoting vaccinations by economic incentives are more likely to be implemented in the United States.

C360: Your study notes there was heterogeneity between participants living on different continents, as well as different types of health care professionals. Did any other characteristics make a difference in your results, such as age or sex? 

GV: Yes. Interestingly we noticed that health care students were more in favor of mandatory vaccination policies compared with health care workers. As discussed in the paper, we think these results are promising. Health care students are the health care worker of the future, and they can push colleagues to vaccinate. Additionally, this means that the education process is raising awareness on the role of vaccination in preventing disease. 

C360: Your study mentions that mandatory vaccination will be considered more frequently as pandemics with similar symptoms become widespread. Did the COVID-19 pandemic, which has similar symptoms to influenza, play a role in these results?

GV: The COVID-19 pandemic did not play a role in our results, as the studies included in the review were conducted before the COVID-19 outbreak. Nevertheless, the results can play a role in determining the policies in response to the pandemic. Preventing influenza can be crucial for several reasons, such as avoiding hospital overcrowding, health care worker absenteeism, and saving resources to face the pandemic. We do not want to waste energy fighting preventable diseases. The majority of health care workers favored this view even before the pandemic, in relatively peaceful times. Now we are fighting a war.

C360: What are the key take-home messages from your study? How can they be implemented into clinical practice?

GV: We can say that most of the health care workers favor mandatory influenza vaccination policies. These can lead to an increase in their implementation, from local to national government levels.

Additionally, we saw that students are more in favor of these policies. This can be associated with an increased awareness of the role of vaccination in the young generations and could lead to long-term benefits if the academic world is able to maintain this increased awareness.

C360: What is the next step for research concerning mandatory influenza vaccination in health care workers?

GV: Our research tries to summarize the existing evidence on this topic. Nevertheless, as physicians we used a biomedical approach to address the issue and to give a quantitative measure of the acceptance of this specific vaccination. Further research should be performed in order to assess different aspects of the topic. In particular, it would be interesting to involve sociologists, psychologists, and anthropologists to evaluate the cultural aspects of vaccination, even more so if studying the topic on a worldwide scale. Furthermore, it would be of great interest studying how the COVID-19 pandemic influenced the opinion of health care workers on this topic.  



  1. Gualano MR, Corradi A, Voglino G, et al. Healthcare workers’ (HCWs) attitudes towards mandatory influenza vaccination: a systematic review and meta-analysis. Vaccine. 2021;39(6):901-914. doi:/10.1016/j.vaccine.2020.12.061