Mandatory Influenza Vaccination

In the current issue of CID, investigators at BJC HealthCare in St. Louis report on a mandatory influenza vaccination policy instituted during the 2008-2009 season. All employees who were not vaccinated or who didn't have an approved exemption, where not scheduled to work beyond Dec 15 and were terminated on January 15th if still not vaccinated. They achieved an impressive true vaccinated proportion of 98.4%. Quite an achievement for patient safety. Only eight employees out of 25,561 were terminated and 321 (1.2%) had approved exemptions.

An editorial by Andrew Pavia provides a nice balanced summary of healthcare worker vaccination policies and successes. Mandatory vaccination policies have been implemented by several organizations including Virginia Mason Medical Center (Seattle, WA), Hospital Corporation of America, Johns Hopkins Health System, University of Iowa Hospitals, Hospital of the University of Pennsylvania, Children’s Hospital of Philadelphia, and the Department of Defense. Dr. Pavia is right to suggest that influenza vaccination targets should be set at 90% or higher; however, it's unlikely these targets can be widely achieved without mandates similar to what BJC has just described.


  1. I think it is worth pointing out that attending physicians (except those working directly for the hospital, such as hospitalists) were not covered by the policy. In addition, the policy apparently did not apply to health sciences students. Thus, there are least large holes in this net, which raises questions of equity and fairness. Moreover, this seems to undermine the entire concept of trying to maximally protect patients. And how much protection patients gain from such policies in the non-pandemic setting remains another large question.

  2. While I like that the University of Iowa was described by Andy as "one of the most prestigious" institutions, I should point out that our mandate was short circuited by a union injunction, which went to arbitration....and the hospital was ordered to exempt all unionized employees from the mandate. So in the interest of fairness we stopped the mandate. By the time it was all resolved, we were over 80% vaccine acceptance and I think are now at about the 90% mark, or a little higher (we are still offering the seasonal vaccine to HCWs, so it is still inching up).

    We've already blogged about how complicated it was to try to begin a mandate this year, what with H1N1 and the limited supply of that vaccine, etc. We also hit a lot of those bumps.

    Time will tell how the hospital approaches this next year....until it is written into the union contract I don't think it will happen.


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