Vaccination as a condition of employment decreases hospitalizations and job absences – employees say yes.

The consequences of the SARS-CoV-2 pandemic have been far-reaching, particularly among health care personnel (HCP) and within health care settings. HCP have been directly affected, sustaining occupationally acquired COVID-19 infections, and indirectly through a substantial alteration in health care delivery. With the advent of highly effective and safe SARS-CoV-2 vaccines, case rates and hospitalization rates are declining, and the promise of a return to some semblance of pre–COVID-19 health care is growing. Recently, several medical centers have announced a requirement for SARS-CoV-2 vaccination of all HCP (allowing for medical and religious exemptions), and the impending licensure of the mRNA SARS-CoV-2 vaccines (following the previous Emergency Use Authorization [EUA]) will move many other centers to consider a similar policy. A recent outbreak in a skilled nursing facility attributed to an unvaccinated HCP member clearly illustrates the risk unvaccinated HCP can pose to their patients and other HCP.1

The recognition of HCP vaccination as an essential component of patient and HCP safety programs emerged in the mid-2000s with a focus on influenza vaccination. Prior to the 2009-2010 influenza season, despite increased awareness of the importance of HCP influenza vaccination and large-scale, resource-intensive voluntary vaccination campaigns, vaccination rates remained very low. While HCP influenza vaccination was first recommended by the Advisory Committee on Immunization Practices in 1978, innovative, patient safety–focused programs at hospitals like Virginia Mason Medical Center paved the way for stronger expectations surrounding HCP vaccination.2 The success at these institutions, professional society endorsements of influenza vaccination as a condition of employment policies, and the addition of HCP influenza vaccination as a publicly reported quality measure were associated with increases in vaccination rates from around 45% to nearly 80%, with higher rates among acute care facilities, physicians, and nursing personnel.3 During the 2019-2020 season, the percentage of hospital-based HCP who reported working under an employer influenza vaccination requirement reached 72.1%.3 Very few HCP have had their employment terminated due to policy refusal, particularly considering the thousands encompassed by these policies.

Mandatory influenza vaccination programs for HCP have been associated with high vaccination rates and a significant decrease in HCP absenteeism and health care–associated influenza among hospitalized patients.4 The importance of mandatory influenza vaccination for HCP is best reflected by the decision of the National Patient Safety Foundation board to establish the inaugural “must do” list for all HCP to ensure patient safety: hand washing and HCP influenza vaccination.5