No jab, no job: Should vaccines be mandatory for health workers?

Editorial Team

Editorial Team

March 16th, 2017

Editorial Team

‘For health professionals, the decision to vaccinate has implications for patients’

Health professionals play a vital role in encouraging patients to have recommended vaccines. However, they are also a key target group for flu vaccination. This is to protect them from getting the flu from their patients, and to reduce the risk that they might spread the flu virus to vulnerable patients.

Despite being considered an ‘at risk group’, not all doctors and nurses have the annual vaccine. In the UK, where detailed data is collected on vaccine uptake, less than half of all frontline health professionals had the flu jab.

Gaelle Vallée Tourangeau at Kingston University, London, has been studying the drivers that influence vaccine uptake in health workers. She says that in the general population, the decision to be vaccinated is based on the perceived risks and benefits for the individual. But in healthcare workers, the patient must also be considered.

“The difference is that it’s not just about your own health,” she says. “For health professionals, getting vaccinated against the flu is important because they need to be there to care for patients but [vaccination] also protects patients from getting the flu.”

Dr Vallée Tourangeau and her team have identified four key areas that influence health workers’ decisions. “We ask them whether they find it to be important, effective, whether they feel they know about vaccination, and whether they see it as a personal choice,” she says.

This helps to identify those who might be hesitant and to understand why. “It might not be that they don’t see vaccination as important or effective; it might be that the don’t know much about it so they don’t act.”

The message from the research, Dr Vallée Tourangeau says, is that hesitancy does not necessarily mean someone is against vaccination.

No jab, no job?

So, if some health professionals are not against vaccination but fail to follow the recommendation that advises them to have the flu jab, is there a case for making it a condition of employment? Surgeons have to wear masks and follow strict sterilisation protocols, why not add vaccination to the list?

From a public health point of view, achieving optimal levels of vaccine uptake would reduce infection rates in the wider community. But Dr Vallée Tourangeau views mandatory vaccination for health workers as a little draconian.

“We are evolved enough as a society that we should involve them in the decision,” she says. “If we get to a place where everybody wants the vaccine, it’s a better society.”

What do you think? Add your comments below.


  1. Peter M B English

    Peter M B English

    March 16th, 2017

    Encouraging something, and making it mandatory are extremely different.

    As soon as you make something mandatory, people feel very threatened. You are taking away their autonomy. Some will respond by fighting back. You need extremely robust data to justify it; and even if you have such data, the impact may not be what you expect or intend. There is a real risk that if you make something mandatory before there is very widespread acceptance of its necessity, you will generate such antagonism that you have the opposite effect – it will be done less.

    It is very hard to generate the sort of high-quality, RCT data that bodies such as the (highly influential) Cochrane collaboration will accept; yet there is sufficient evidence of indirect protecion that there isn’t sufficient “equipoise” for RCTs to be ethical – even if they were practicable.

    But many healthcare workers believe that if Cochrane doesn’t say there’s good evidence, then it can’t work.

    This is a fundamental misunderstanding; but before we can mandate healthcare worker flu vaccination, we’d have to persuade enough of them that it is worthwhile. and if we can do this, we may not need to mandate it.