What Is the Impact of Workplace Policies to Promote Influenza Vaccination Among Health Care Personnel?

Fact Sheet

National survey data suggest that for most of the past decade less than half of all health care personnel (HCP) received annual influenza vaccinations. The perception that voluntary vaccination efforts are not enough to generate substantial increases in influenza vaccination among HCP has fueled calls for making such vaccinations mandatory. But, to date, there are no broadly generalizable data on how prevalent efforts are to promote influenza vaccination among HCP and how effective such efforts have been in increasing vaccination rates.

This study presents data from a national survey of HCP describing a broad range of employer efforts to promote influenza vaccination—by voluntary means (such as recommendations through letters); by offering vaccinations in the workplace; and by requiring it, with and without penalties for noncompliance—and their cross-sectional associations with seasonal and H1N1 pandemic influenza vaccination rates during the 2009–2010 influenza season.

Key study highlights include the following:

  • At least two-thirds of HCP were offered worksite vaccination, about one-half received employer reminders to be vaccinated, and only one-tenth worked for an employer who required vaccination, with or without penalties for noncompliance.
  • Compared with HCP in other work settings, hospital employees were most likely to be subject to employer vaccination policies, such as on-site vaccination programs, vaccination recommendations, and vaccination requirements.
  • HCP offered vaccination at work were nearly 30 percentage points more likely to be vaccinated for seasonal influenza (and almost 15 percentage points more likely for pandemic influenza) compared with those not offered vaccination at work.
  • Vaccination requirements had the strongest independent association with vaccination; compared with HCP not required to be vaccinated nor recommended for vaccination, those who had vaccination requirements had increases in seasonal and pandemic vaccination rates of between 31 and 49 percentage points.
  • Vaccination recommendations and receiving vaccination reminders and rewards were, respectively, much less associated with increased probability of vaccination and not significantly associated with it.
  • Front-line personnel—including physicians, physician assistants, nurse practitioners, and dentists—were significantly more likely than support staff and other types of HCP to be vaccinated for pandemic influenza.

The findings provide empirical support for vaccination requirements as a strategy for increasing influenza vaccination among HCP. They also suggest that making influenza vaccination available to HCP at work could increase vaccine uptake and highlight the need to reach beyond hospitals in promoting vaccination among HCP.


This fact sheet is based on:

Harris K, Maurer J, Black C, Euler G, and Kadiyala S, "Workplace Efforts to Promote Influenza Vaccination Among Healthcare Personnel and Their Association with Uptake During the 2009 Pandemic Influenza A (H1N1)," Vaccine, Vol. 29, No. 16, April 5, 2011, pp. 2978–2985, EP-201100-36.


This fact sheet was written by Paul Steinberg.

This product is part of the RAND Corporation research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

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RB-9591 (2011)

Copyright © 2011 RAND Corporation