Opting-in vs. opting out

In this week's JAMA, there's a research letter evaluating two strategies for achieving healthcare worker compliance with influenza vaccination. HCWs (n=480) were randomized to an "opt-in" group or an "opt-out" group. In the opt-in strategy the HCWs received an email with a link to a website where they could schedule their vaccinations. In the opt-out strategy, the HCWs  were sent an email with a scheduled appointment for vaccination. Compliance with vaccination was 33% in the opt-in group versus 45% in the opt-out group (P=.008). The authors conclude that automatic scheduling of vaccination may be an effective method for increasing compliance with influenza vaccination. While that may be true, what is striking to me is the abysmal compliance rates in both groups. We are aware of hospitals that are achieving >90% compliance without mandating vaccination, but by actively promoting vaccination and providing incentives. At my hospital, we recently decided that for the upcoming season we would not mandate vaccination, but more aggressively promote vaccination, make vaccination even more convenient, and aggressively promote the message that ill healthcare workers should stay at home. Like handwashing, keeping ill HCWs at home is a multipotent intervention that will not only reduce the potential for spread of influenza but for other respiratory pathogens as well.