UNIVERSAL VACCINATION FOR VACCINE-PREVENTABLE DISEASES IN THE HEALTHCARE WORKFORCE

To support policies and mandates that promote universal vaccination for preventable infectious diseases among healthcare workers, including all members of the pharmacy workforce, as a safeguard to patient and public health; further,

To encourage the use of evidence-based risk assessments to determine inclusions in and exemptions from mandatory vaccine requirements; further,

To support employers in establishing and implementing mandatory vaccine requirements for healthcare workers if evidence-based risk assessments determine they are safe and promote patient and public health; further,

To urge healthcare organizations to have policies that address additional infection prevention practices required for exempted healthcare workers; further,

To develop tools, education, and other resources to promote vaccine confidence, increase vaccination rates, and minimize vaccine-preventable diseases among healthcare workers.

Rationale

Vaccine-preventable diseases (VPDs) pose a threat to vulnerable patients, the healthcare workforce, and public health. Vaccines are effective in protecting the healthcare workforce and the patients they care for and with whom they interact.

Voluntary vaccination of healthcare workers (HCWs), supported by employer-offered strategies, increases vaccination rates to some extent. For example, the Centers for Disease Control and Prevention (CDC) estimates that in the 2019-2020 season, approximately 80% of healthcare workers were vaccinated against influenza, with rates over 90% among hospital employees, despite the fact that only approximately 70% of hospitals require an annual influenza vaccination and the CDC has recommended influenza vaccinations for HCWs since 1981.

Mandatory vaccination requirements, in contrast, carry heavier weight and can result in near-universal vaccination rates (Schumacher S et al. Increasing influenza vaccination coverage in healthcare workers: a review on campaign strategies and their effect. Infection. 2021; 49: 387–99. https://doi.org/10.1007/s15010-020-01555-9). The effectiveness of the mandatory approach has led to HCW vaccination requirements from the Occupational Safety and Health Administration, recommendations from the Centers for Disease Control and Prevention (CDC), policy endorsements from numerous professional organizations, and quality measures for federal and commercial payer reporting programs. For example, the CDC Advisory Committee on Immunization Practices proposes recommendations for the immunization of healthcare workforce based on (1) those diseases for which routine vaccination or documentation of immunity is recommended for healthcare personnel because of risks to them in their work settings and, should healthcare personnel become infected, to the patients they serve; and (2) those diseases for which vaccination of healthcare personnel might be indicated in certain circumstances. The current list of VPDs in which healthcare personnel are considered to be at substantial risk for acquiring or transmitting and in which vaccination is recommended includes hepatitis B, influenza, measles, mumps, rubella, pertussis, and varicella. In the future, this list may include vaccination against SARS-CoV-2.

In its recommendations, the CDC considers HCWs to include (but not be limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCWs and patients.

             The vaccination-related policies of various healthcare professional organizations contain similar themes. These policies recognize that mandatory vaccination policies improve vaccination rates, protecting patients and the healthcare workforce; acknowledge the limited circumstances that may preclude an HCW from being vaccinated (e.g., medical contraindications and legally required religious exemptions); express support for following evidence-based practices in determining which vaccines should be mandatory; and support education of the healthcare workforce on the benefits of vaccination.