Drivers and barriers of seasonal influenza vaccination in the European Union and European Economic area (EU/EEA): a systematic reviewAlison McCallum

in British Columbia (the westernmost Canadian province) received seasonal influenza vaccination. Some American hospitals have declared vaccination a ‘condition of employment’ in order to deal with low HCW immunization rates. Policy The Influenza Control Policy (ICP) required all HCW in British Columbia to be vaccinated or wear masks while at work for the entire 2012/3 flu season. Noncompliance with the ICP could result in job suspension. Results For the 2012/3 flu season 63 506 (74%) of 85 438 HCW in BC were vaccinated; compared to 2011/12, vaccination rates are significantly higher (p < 0.0001). However some stakeholders objected to mandatory vaccination; healthcare unions argued that the policy was coercive and violated the Canadian Charter of Rights and Freedoms. Certain scientists were critical of vaccine efficacy. Last, nationwide recall of defective vaccine batches provoked apprehension about drug safety. Due to intense stakeholder resistance, the ICP’s punitive component was put in abeyance. Lessons First, engaging stakeholders early in policy development is crucial to create a sense of shared vision. Administrators must anticipate common objections and be prepared to provide one-on-one HCW education. The legal basis for mandatory vaccination is uncertain as it might violate the Canadian constitutional right to ‘security of person’. Last, vaccination rates were greater with implementation of the ICP than with voluntary policies. Key messages Identifying methods to decrease rates of nosocomial influenza like vaccination are essential to protect patients. Further translational research is required to improve influenza vaccine efficacy. The BC Influenza Control Policy increased vaccination rates, but provoked intense debate amongst stakeholders.