Policy and Perceptions of Healthcare Worker Flu Vaccination Programs Matthew M. Davis, MD, MAPP Professor of Pediatrics, Internal Medicine, Public Policy, and Health Management & Policy University of Michigan MSIPC Annual Meeting - October 2015 DISCLOSURES I have no relevant conflicts of interest to disclose. I previously served as the Chief Medical Executive for the State of Michigan. DISCLOSURES I have no relevant conflicts of interest to disclose. I previously served as the Chief Medical Executive for the State of Michigan. I am a healthcare worker, and I get my flu shot every year. Why isnt flu vaccination of healthcare workers this simple? Flu Vaccination of Healthcare Workers Continuing to focus on flu Effectiveness of flu vaccination Healthcare workers as a target group for vaccination How to continue progress Why Continue to Focus on Flu? 1990s: estimated 100, ,000 hospitalizations annually for flu-related illness After 2000: estimated >200,000 hospitalizations annually for flu-related illness Why Continue to Focus on Flu? 1990s: estimated 100, ,000 hospitalizations annually for flu-related illness After 2000: estimated >200,000 hospitalizations annually for flu-related illness If average flu season runs October-March More than 1100 hospitalizations for flu- related illness every day in the U.S. Flu isnt just a challenge for hospitals Other healthcare settings: Ambulatory care Community-based care (eg, school-based health centers, pharmacies) Long-term care Influenza in the Long-Term Care Setting Data are scarce regarding burden of influenza illness among residents of long-term care facilities But national data indicate that persons 65 years old annually account for: Over 50% of flu-related hospitalizations Over 90% of flu-related deaths To Prevent Influenza Effectiveness of flu vaccination Vaccine effectiveness in preventing influenza infection during flu season among hospitalized adults: 71% among all adults 76% among adults 50 years old And then came the flu vaccine of For most medical/public health interventions, an 18% reduction in incidence would be reason to celebrate! Expectations for flu vaccination are high Evidence for Benefits of Flu Vaccination of Healthcare Workers Lancet, 2000 HCW vaccination rates: If flu vaccine was offered 49% If flu vaccine not offered 4% Odds of patient mortality at sites where flu vaccine was offered compared to not offered: OR = 0.60 (95% CI: 0.39, 0.90) Lancet, 2000 HCW vaccination rates: If flu vaccine was offered 49% If flu vaccine not offered 4% Odds of patient mortality at sites where flu vaccine was offered compared to not offered: OR = 0.60 (95% CI: 0.39, 0.90) Adjusted for patients own vaccination status! Overall effectiveness in preventing influenza A infection: 88% Overall effectiveness in preventing influenza B infection: 89% If flu vaccination of healthcare workers is a no- brainer, then why do some healthcare workers refuse to get vaccinated? From dozens and dozens of studies: healthcare workers who refuse flu vaccination generally Perceive the risk of influenza as low Perceive the risks of vaccination as high Perceive the convenience of vaccination as low Perceive minimal consequences of being unvaccinated Keys to successful flu vaccination programs Perceive the risk of influenza as low Share data and stories with staff about risk of influenza for patients if possible, institution-specific data Perceive the risks of vaccination as high Share myth-busting information about vaccination Perceive the convenience of vaccination as low Make healthcare worker vaccination easy Perceive minimal consequences of being unvaccinated Share data and stories about unvaccinated individuals who contracted influenza Should institutions mandate flu vaccination for healthcare workers? Mandates are the most expeditious way to increase vaccination rates in any setting A mandate with effective communication / information strategy has the greatest chance of achieving acceptance and ultimately full integration into institutional culture Should institutions mandate flu vaccination for healthcare workers? Mandates are the most expeditious way to increase vaccination rates in any setting A mandate with effective communication / information strategy has the greatest chance of achieving acceptance and ultimately full integration into institutional culture Perhaps most effective message: Its about protecting the patients Final comments Influenza remains a major public health threat, and a challenge for healthcare institutions every flu season Flu vaccine is an outstanding approach to preventing flu even in seasons with a poor match between the circulating strains and the vaccine components Healthcare workers respond to a number of strategies the tide is turning, supported by implementation of mandates by many institutions Its about protecting the patients Contact: Matthew M. Davis, MD, MAPP Professor of Pediatrics, Internal Medicine, Public Policy, and Health Management & Policy University of Michigan