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Fears of a flu pandemic hit the headlines this winter and influenza-confirmed hospitalisations reached a level of ‘very high intensity’. The last flu pandemic in 2009 claimed 500,000 lives globally. During a mild flu season around a quarter of frontline staff may become infected with the virus, of which up to 59 per cent may not realise they are infected, so they could infect others, including the patients they care for. So, flu is not to be sniffed at.
However, only 63.9 per cent of NHS staff chose to take up the offer of a free flu vaccination this year. This begs the question: what more can the NHS do to improve rates of staff vaccination?
A survey of 3,059 health care workers identified a few key beliefs that help to explain low staff uptake of the flu vaccine. The first was that some staff believed that the vaccination might make them unwell, and the second was that it was too much trouble to get vaccinated. Other reasons include the belief that they were at low risk of contracting flu, or that the vaccine was not effective.
The flu vaccine has a dual benefit for the NHS as it protects staff from becoming ill, therefore reducing absenteeism due to illness, and it also protects the vulnerable patients that staff care for.
In an attempt to improve uptake of the vaccine, NHS England offers a tiered financial incentive to providers according to the number of staff vaccinated. Alongside initiatives such as the Flu Fighter campaign, this incentive has helped to gradually increase vaccination uptake.
However, an aggressive campaign motivated by financial incentives may cause some staff members to dig in their heels, especially if the aforementioned barriers to uptake are not addressed.
It is therefore important to address some of these barriers and health beliefs head on.
First, the risk of serious side effects from a flu vaccination is low. The belief that there is a risk of catching flu from the inactivated virus in the vaccination is unfounded. At the time of year that the vaccine is offered, viral respiratory illnesses are rife so people may associate the jab with feeling unwell from other causes.
Second, the belief that it can be difficult to get vaccinated. Frontline workers are often too busy to even take comfort breaks in the winter. It is therefore unsurprising that they find it difficult to prioritise getting their jab over pressing clinical duties. A possible solution could be a roving flu vaccination nurse to allow staff to get their jab without having to leave their ward.
Finally, the efficacy of the flu vaccine is dependent on strain-matching, and the effectiveness of the vaccine in winter 2016/17 was around 40 per cent. It would be disingenuous to sell the vaccine as a panacea to a flu crisis, but there is no doubt that it offers recipients a significant protection advantage over their unvaccinated peers.
So, what needs to be done? A review of interventions revealed that the best way to achieve near universal vaccine uptake in health care workers is to make vaccination mandatory. At present, there are rigid rules for clinical staff who may be affected by other communicable diseases. Those staff who decline the BCG vaccination are not allowed to work in clinical areas with a risk of exposure to tuberculosis to protect themselves. A contractual obligation to be vaccinated against influenza could be seen as a logical extension of these policies. Indeed, mandatory flu vaccination for NHS staff has been suggested by Bruce Keogh, and it will soon be rolled out in Finland.
A discussion would need to take place as to whether patients’ best interests outweigh this infraction of individual autonomy. Regardless, if such a policy were to be unilaterally imposed without taking into account the legitimate concerns of some staff members, it would potentially damage employer-employee relations (a bad move considering the current crisis of morale).
A crucial step forward, therefore, would be to engage with staff and learn more about why uptake of the flu vaccine is poor. There is significant intra-trust variation, ranging from 36 per cent to 86 per cent. Lessons should be learned from the best performers, alongside engagement at a local level to identify each organisation’s unique challenges. A subsequent targeted education programme may help to create a climate where flu vaccination for NHS staff is more widely accepted as a professional responsibility.