Vaccination of health care workers against influenza: is it time to think about a mandatory policy in Europe?

Nosocomial influenza outbreaks and the transmission of influenza to health care workers (HCWs) have been well described. However, vaccine coverage among HCWs still remains low. After three decades of official recommendations that all HCWs be vaccinated against influenza, vaccination rates generally remain below 30% in Europe. Experiences in the USA have shown that mandatory policies achieve a compliance rate of nearly 100%. However, the discussion about mandatory vaccination policies for HCWs has not advanced very far in Europe. This article therefore discusses the question whether it is time to consider mandatory vaccination policies for HCWs in Europe. We further elaborate under which conditions mandatory vaccination polices would be ethically justified and how far these conditions are met in the case of influenza vaccination of HCWs. From a methodological perspective, it would be desirable to have further high-quality RCTs with a lower risk of bias that investigate the effectiveness of HCWs influenza vaccination. From a policy perspective, however, we have to decide whether we have already sufficient (albeit not perfect) evidence to justify mandatory influenza vaccination programs for HCWs. We conclude: Given the available evidence concerning the benefits, burdens and risks of HCWs influenza vaccination and the limited effectiveness of voluntary policies, it is time to consider mandatory vaccination policies for HCWs in Europe.