Tailoring Seasonal Influenza Immunization Programmes for

Health Care Workers

Pernille Jorgensen Influenza and other Respiratory Pathogens

High-level hearing on seasonal influenza vaccination

Luxembourg | 30 April 2015

Background

Low influenza vaccination uptake among key target

groups in many countries

Reasons for non-vaccination are complex and

multiple

Females

13-26

years

HPV vaccination

Influenza vaccination

Addressing low influenza vaccination

uptake in the WHO European Region

First phase: Health care workers

Higher infection rates than other adults

Transmission to patients/nursing home residents

…Continue to work while sick

…Subclinical infections

Lost work days, postponed surgery

Vaccinated HCWs more likely to

offer vaccine to their patients

Photo: Cassandra Butu, WHO, Romania

Influenza vaccination uptake (%) in

HCWs, WHO European Region

Vaccination coverage from 2011/2012 or 2012/2013 season, depending on latest available data

Source: VENICE collaboration, ECDC, and WHO/Europe

Vaccination coverage

is generally low

Monitoring of

vaccination uptake

lacking (or not being

reported)

Tailoring Immunization Programmes

(TIP) to increase influenza vaccination

Step-by-step tool grounded in

behavioural science and

social marketing theories

Use qualitative and

quantitative research

Key steps in TIP

Identify and prioritize target groups

Diagnose demand- and supply-side barriers

and motivators to vaccination

Design evidence-informed interventions to

assist decision-makers in tailoring services to

close “immunity gaps”

Results from quantitative and qualitative

research

Application of TIP in Montenegro

Montenegro, quick facts

Population: 625 000, of which

187 000 live in Podgorica

Healthcare system predominantly

public sector

TIP implemented in the Primary

Health Care Centre of Podgorica

(~400 HCWs, serves 1/3 of the

population)

Identify and prioritize target

groups

Generally, low levels of vaccination among

both doctors and nurses

Similar across departments, gender,

seniority, education etc..

1 in 5 HCWs vaccinated

against seasonal influenza

Diagnose situation – SWOT

Strengths ‒ Well-working child immunization program ‒ SIV guidelines, with defined risk groups ‒ Well-functioning procurement and

distribution system for SIV ‒ Well-respected Public Health Institute ‒ Vaccination free of cost

Weaknesses ‒ Low SIV uptake among HCWs ‒ Low perception of SIV benefits ‒ Lack of clarification on effectiveness and safety ‒ Need for greater political and managerial

commitment to HCW vaccination at facility level ‒ Low motivation of medical staff to get SIV as part

of their routine professional practice

Opportunities ‒ No strong barriers to SIV among HCWs ‒ Quality improvement and patient safety

strategic priorities for MoH; opportunity to promote vaccination among HCWs

‒ Decisive role of HCWs in SIV in risk groups

Threats ‒ Nosocomial outbreaks in health care settings ‒ Anti-vaccine sentiment in media and distrust after

2009 pandemic (general public, parents, HCWs) ‒ No institutional platform to address vaccination

concerns and hesitancy on digital media platforms ‒ Low sense of importance of HCWs’ role in

transmitting seasonal influenza

Diagnose barriers and

motivators

I suffer from diabetes

It’s my duty as manager to get

vaccinated

My colleagues don’t get

vaccinated

Vaccines are unsafe

Immunity through infection is better than the vaccine

I am afraid of needles

I am way too busy

Influenza is not severe

Where do I get the flu shot?

Barriers

“I have been working for almost 30 years.

So far, I have not caught influenza. I think my immune system is good”

(nurse, not vaccinated, age 44)

“Because I think I am in good shape, in good health”

(doctor, not vaccinated, age 40)

0% 10% 20% 30% 40% 50% 60%

Not serious/no risk

Acquire immunity through work

Natural infection better immunity

Vaccine side effects

Other reasons

Vaccine not effective

Time/access

Results from quantitative (survey questionnaire, N=300)

and qualitative (semi-structured interviews, N=25) studies

Motivators (facilitators)

0%

20%

40%

60%

80%

100%

Protect self Protectfamily

Protectpatients

Afraid of flu Flu in thepast

Seriousdisease

Other Encouragedby media

Encouragedby family

Rec byemployer

Rec bycolleague

“I suffered from flu, that’s the first reason why I get

vaccinated. I work with infected patients and am exposed

to the risk every day. Also I’ve heart problems and

influenza could deteriorate my health”

(nurse, vaccinated, age unknown)

36% 55-65 yrs vaccinated

8% 18-24 yrs vaccinated

Results from quantitative (survey questionnaire, N=300)

and qualitative (semi-structured interviews, N=25) studies

Categorize facilitators and

barriers Environmental Social/community Personal

Conceptual map

Facilitates identification of factors that courage or

discourage vaccination in a given context

Helps identify how and what the programme should

focus on to trigger positive behaviour change

Design and implement

interventions (mix of strategies)

Set objective

Design evidence-informed strategies

Monitor & evaluate

Current and future activities

• Publication of TIP FLU for HCWs

and Montenegro case study

• Development of TIP FLU for

pregnant women

• Annual Influenza Awareness

Campaigns in collaboration with

Member States

Acknowledgements

HProImmune Agoritsa Baka, Pania Karnaki, Greece

TIP FLU expert working group, Montenegro Mensud Grbovic, Ministry of Health

Nebojsa Kavaric, Primary Health Care Centre Podgorica

Natasa Terzic, Institute of Public Health

HCWs at Institute of Public Health; Primary Health Care Centre Podgorica; Adult

Infectious Disease, Pediatrics, and Gynecologists and Obstetricians clinics at the

Clinical Centre of Montenegro; Duga Long-term Care Facility, and national nurses’

associations and networks.

TIP FLU for HCWs guide Nathalie Likhite, independent consultant

Photo: Cassandra Butu, WHO