The COVID-19 pandemic momentum: can it be used to support improvements in healthcare worker influenza vaccination?

KEYWORDS:

• Immunization: healthcare workers
• influenza
• hospitals
• COVID-19
• pandemic

In the last five years, there have been several attempts to map the inclusion of health workers in national policies for influenza vaccination. In summary, of the 68 countries that completed the survey for Maltezou and colleagues in 2010 (representing 52% of all eligible countries), 50% (35/68) had a national influenza vaccination policy which included health workers. In Europe, 29/30 countries (except Sweden) recommend seasonal influenza vaccination of health workers [1,2]. Across the WHO Regional Office for the Americas, only 13/22 countries (noting not all countries completed the survey) reported having a policy [3]. In comparison to the other WHO Regions, the countries in the African Region were significantly less likely to include health workers in their national influenza vaccination policy [3]. In South-East Asia, 3 out of 4 countries that completed the survey reported having a policy [2]. However, there are 11 countries in the WHO South-East Asia Region, which is home to over a quarter of the world’s population. A similar finding was recorded for the Western Pacific region with 4 of the 6 countries (out of a total of 9) reporting that a policy existed. A subsequent and more extensive review identified that 27/42 countries from the Asia-Pacific region included health workers as a key group for influenza vaccination [4]. At the time of the study, there were no guidelines available for Cambodia, Indonesia, Lao People’s Democratic Republic, Myanmar, and Papua New Guinea. Whilst in other settings, including Cambodia, Cook Islands, Singapore and Vietnam, vaccines for health workers are only available through private purchase [5]. There are also variations in the workplace settings covered by the policy. For example, there is very little detail about whether health workers from private healthcare settings are included, or whether recommendations also extend to community or home based carers or those working in aged care settings [3]. Lastly, family members caring for a sick family member (and providing physical assistance) while staying with them at the bedside is a norm in many Asian countries [6]. Very little is known about whether volunteers are also recommended and supported to have influenza vaccination.

It is important to note that even amongst those countries with a policy, there is variation in terms of the categories of ‘health workers’ that are captured by the national policy (and/or funded immunization programs). Traditionally the language tends to focus on those in clinical roles working in primary and tertiary care. The same can be said about the published literature examining immunization coverage, barriers to vaccination, change in policy etc. However, the term ‘health worker’ extends beyond those in a clinical role to also include people (paid and unpaid) who are engaged in work actions where the primary intent is to improve health (as per the WHO). This can include staff working in acute and tertiary care, long term care, public health, community-based care, social and home care etc. The document suggests that this should include health service providers, such as: doctors, nurses, midwives, public health professionals, lab-, health-and medical and non-medical technicians, personal care workers, community health workers, healers, and practitioners of traditional medicine. It also includes health management and support workers, such as cleaners, drivers, hospital administrators, district health managers and social workers, and other occupational groups in health-related activities [7]. Based on the WHO definition of health worker, there is a need to undertake mapping exercises to further elucidate which health workers are included in policy, which staff have access to free influenza vaccines (and onsite vaccination clinics) and what is the coverage of influenza across the different categories of staff in tertiary, primary, community and aged care settings.

Every country is currently attempting to protect their vulnerable populations against severe COVID-19 outcomes through vaccination. To ensure high coverage amongst health workers, countries may need to invest in supporting hospitals and other settings where health and aged care is delivered, to implement a COVID-19 immunization program onsite. Once COVID-19 vaccine programs mature, there may an opportunity to leverage these onsite vaccine clinics to promote and/or deliver other recommended vaccines including influenza to health workers. Within an individual healthcare setting, the release of the COVID-19 vaccine may also provide an opportunity to review strategies used to communicate with staff members, to work with staff members to co-design new or improve current education/communication/delivery mechanisms or perhaps to identify champions to promote acceptance and uptake of the COVID-19 vaccine and seasonal influenza. In settings with more mature and functioning staff health vaccine programs, there may be an opportunity to monitor uptake and check compliance with other recommended antigens including measles, mumps, rubella, varicella, and hepatitis B (and possibly TB screening). In many settings, this is going to be a stretch goal but in high resource settings, this should be feasible if investments are made in technology to support data collection and timely reporting. Lastly, but probably most importantly, governments must invest in systems to support staff members who are tasked with delivering occupational vaccine programs within healthcare settings to have conversations with vaccine hesitant health workers. This is going to be critical for the COVID-19 vaccine, given that it is a new vaccine and there will be questions and possible concerns around safety and effectiveness. Ensuring that these questions are appropriately answered is key to ensuring that those staff members go on to promote the new vaccine to their patients. By training the staff members tasked with delivering health worker vaccine programs to effectively communicate and engage with individuals about how to promote, this will have long-term returns in supporting improvements in influenza vaccine coverage.

As part of the 4^th strategic priority in the WHO’s Immunization Agenda 2030, there is a need to promote changes in legislation to extend the national focus beyond early childhood immunization [8]. As part of this process, there is a need to mobilize support and ensure that stakeholders are aware of the benefits of vaccination across the lifespan (with health workers explicitly mentioned, page 38). This is a relevant key step, especially given the fact that ‘lack of priority’ was stated as the key reason for not having a national influenza vaccination policy for health workers among 33 low-and middle- income countries. This response was followed by ‘no financial capacity to support influenza vaccination programs’ [3]. Seasonal influenza vaccine programs continue to be confined to middle- and high-income countries and there is wide variation in policy and delivery worldwide. The COVID-19 pandemic represents an opportunity to focus efforts on endorsing the need for health worker vaccination and for efforts to be made to ensure that funding is provided to support planning and management, to ensure robust programs are developed.

Declaration of interest

H Seale has previously received funding from drug companies for investigator driven research and consulting fees to present at conferences/workshops and develop resources (Seqirus, GSK and Sanofi Pasteur). She has also participated in advisory board meeting for Sanofi Pasteur. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.