The flu vaccine should be made mandatory for certain healthcare professionals, including all those who work in hospitals or communities with elderly patients and infants, the Royal College of Physicians in Ireland (RCPI) has said.

It noted that the vaccination of healthcare workers against seasonal flu is recommended by a number of key health organisations, including the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention & Control (ECDC).

It acknowledged that the vaccination of healthcare workers is ‘not a silver bullet', but it is ‘one element of the multi-faceted approach recommended to healthcare institutions to minimise spread of the virus'.

The RCPI noted that voluntary vaccination programmes have so far failed to achieve high rates of vaccination among healthcare workers. Uptake in the 2017/2018 season in Ireland was just 45%, which is not enough to provide the so called ‘ring of protective immunity' around vulnerable patients.

Uptake tends to be higher in larger hospitals and is highest in the acute paediatric hospital services group (56%).

The RCPI pointed out that significant resources have already been utilised to encourage vaccination, but uptake remains modest. On the other hand, mandatory vaccination has been used widely in the US, where uptake levels of 90% have been achieved.

As a result, the RCPI's faculties of occupational medicine, pathology, and public health medicine, have said that they endorse the introduction of mandatory seasonal influenza vaccination for certain categories of healthcare workers.

These include all those working in hospitals or the community with elderly patients, infants, and pregnant women, and all those working in high-risk clinical areas, such as intensive care, oncology and Emergency Departments (EDs).

In a position statement, the RCPI said that those who refuse vaccination should sign a declaration form and understand that they may be allocated to a lower risk area for the duration of flu season.

"It is recommended that those healthcare workers without a medical contraindication to influenza vaccination, who decline vaccination, wear a mask for the duration of the influenza season whilst undertaking clinical tasks and/or directly interacting with patients.

"Workers with a medical contraindication to influenza vaccination should provide evidence of same, and may decline vaccination, but may be moved to a low-risk or non-clinical area for the period of the flu season and may be required to wear a mask," it stated.

The RCPI added that mandatory vaccination ‘is the only intervention to date that has been proven to achieve vaccine uptake rates of over 95%'.

The RCPI's position paper can be viewed here