Debate: Flu vaccine

2018 is the centenary of the influenza pandemic, commonly known as the Spanish Flu, that followed the end of the First World War and saw the deaths of 50-100 million people. Influenza is an acute viral infection that can spread rapidly among people who are in close contact with each other – especially during the winter months.

The means of preventing the spread of seasonal flu have moved on greatly since 1918-19. One of the key methods since the 1960s (along with good public health information) has been to vaccinate people at risk of contracting the infection, such as the elderly and immunocompromised, or those more likely to spread the disease. Frontline health care workers are encouraged to have the vaccination, to protect themselves but also because they may become infected but be asymptomatic and unwittingly spread the virus to those at more risk of serious illness.

The data shows that health care workers, including nursing staff, have a relatively low uptake rate for the seasonal influenza vaccination in comparison with other groups. This is despite employers offering the vaccine to employees free of charge and the good safety record of the vaccination itself. The low uptake is surprising, since nurses are required to have other vaccines, for example the hepatitis B vaccine, before they work in certain clinical areas and may face restrictions on their practice if they do not comply. While the rates have been gradually going up among health care staff over the last few years, there is still significant variation between countries and across individual organisations.

In England, the uptake rate for 2016/17 was 63.2% of frontline health care workers, compared with 50.6% in 2015/16 and 54.9% in 2014/15, representing a steady rise. Rates went up across all staff groups, including a significant increase for nurses and practice nurses (Public Health England, 2017).

In Scotland, the Cabinet Secretary for Health and Sport estimated during a debate in the Scottish Parliament in January 2018 that around 40% of health care workers in Scotland had been vaccinated. She noted that this figure cannot be compared to England, as the Scotland figure covers patient-facing and non-patient-facing staff, whereas the England figure covers only frontline health care workers. She has made it clear to NHS Scotland that free seasonal influenza immunisations should be offered by NHS organisations, including primary care employers, to all employees who are directly involved in delivering care (Scottish Parliament, 2018).

In Northern Ireland, according to the Public Health Agency, the uptake of the seasonal influenza vaccination by frontline health care workers within the five HSC trusts in Northern Ireland was 29.0% during 2016-2017, compared with 24.6% the previous year and 22.6% in 2014-2015 (Public Health Agency, 2017).

Wales has a seasonal influenza campaign and there is always a debate on how to meet the annual target to increase the uptake for nurses, with input from each Health Board. Uptake of influenza immunisation in Health Board and NHS staff, reported by Health Board Occupational Health Departments, continues on a positive trend and was 49.2% during 2016/17. Uptake in staff with direct patient contact was 51.5% exceeding 50% in five Health Boards and one NHS Trust (Public Health Wales, 2017).

The aim of this Matter for Discussion is to explore some of the reasons for the relatively low uptake and the wide variation seen across organisations and countries; why nurses might be reluctant to have the vaccination, or what the specific organisatiomal accessibility or cultural barriers to having the vaccine might be; and to discuss nurses’ ideas for improving the uptake of the vaccine in any of the settings in which they work. This is important in order to protect ourselves, our families and our patients. 

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