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Health authority accountability & strengths of influenza programHealth authority accountability & strengths of the program

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In pursuit of specific health objectives, countries, and in some cases, their regions, establish goals to guide their efforts. One commonly set objective is to achieve desired vaccination coverage rates (VCR). This is particularly relevant in the context of vaccines targeting prevalent diseases such as influenza, commonly known as the flu.
For instance, if out of a target population of 100 individuals, 65 have received the influenza vaccine, the vaccination coverage rate stands at 65%. These VCR targets serve as benchmarks to gauge the effectiveness of vaccination programs and to ensure adequate protection against infectious diseases within the population. It is essential that all healthcare professionals involved in vaccination are fully aware of this concept.

Bibliographical references:

  1. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  2. Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, et al. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Hum Vaccines Immunother. 2018;

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

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For individuals to access influenza vaccinations, there needs to be funding provided by either public or private entities. This policy specifically targets funding for flu vaccinations across various social groups for whom influenza vaccination holds particular significance. The information about this free access to vaccination must be disseminated among vulnerable groups.

Bibliographical references:

  1. Ting EEK, Sander B, Ungar WJ. Systematic review of the cost-effectiveness of influenza immunization programs. Vaccine [Internet]. 2017

  2. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  4. WHO. Guidance on the economic evaluation of influenza vaccination. 2016.

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This policy entails the nationwide regular monitoring of patient vaccination coverage rates (VCR) at vaccination sites and healthcare provider (HCP) levels by Health Authorities (HA). In essence, it involves the systematic oversight conducted by health authorities at the national level to track the vaccination coverage rates at individual vaccination sites and among healthcare providers.

Bibliographical references:

  1. European Centre for Disease Prevention and Control (ECDC). Seasonal influenza vaccination and antiviral use in EU/EEA Member States [Internet]. Stockholm; 2018.

  2. Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, et al. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Hum Vaccines Immunother. 2018;

  3. Paul KT, Loer K. Contemporary vaccination policy in the European Union: tensions and dilemmas. J Public Health Policy [Internet]. 2019;40:166–79.

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This policy involves incorporating healthcare provider (HCP) vaccination coverage rates (VCR) against the influenza virus as a component of hospitals' performance criteria. In essence, it means that hospitals evaluate the performance of their staff based on their adherence to influenza vaccination guidelines, emphasizing the importance of healthcare professionals being vaccinated against the flu.

Bibliographical references:

  1. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  2. Lindley MC, Mu Y, Hoss A, Pepin D, Kalayil EJ, van Santen KL, et al. Association of State Laws With Influenza Vaccination of Hospital Personnel. Am J Prev Med [Internet]. 2019;56(6):e177–83.

  3. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  4. Kitt E, Burt S, Price SM, Satchell L, Offit PA, Sammons JS, et al. Implementation of a Mandatory Influenza Vaccine Program: A 10-year experience. Clin Infect Dis. 2020;

  5. Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Influenza vaccination of healthcare workers in Italy: Could mandatory vaccination be a solution to protect patients? Future Microbiol. 2019;14(9s):45–9.

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This policy entails the establishment of a sustainable and resilient procurement system aimed at guaranteeing a consistent vaccine supply to prevent shortages and ensure that all individuals identified as vaccination targets have access to their required vaccine doses.

Bibliographical references:

  1. Grieco L, Panovska-Griffiths J, van Leeuwen E, Grove P, Utley M. Exploring the role of mass immunisation in influenza pandemic preparedness: A modelling study for the UK context. Vaccine [Internet]. 2020;38(33):5163–70.

  2. Farooq MU, Hussain A, Masood T, Habib MS. Supply chain operations management in pandemics: A State-of-the-Art Review Inspired by COVID-19. Sustainability. 2021;13.

  3. Wilsdon T, Lawlor R, Li L, Rafila A, García Rojas A. The impact of vaccine procurement methods on public health in selected European countries. Expert Rev Vaccines [Internet]. 2020;19(2):123–32.

Faccilitated access to vaccinationFaccilitated access to vaccination

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This policy aims to facilitate access to multiple vaccination settings, enabling individuals to receive vaccinations conveniently at various locations.

Bibliographical references:

  1. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  2. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  3. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

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This policy involves coordinating call-to-action communications from multiple stakeholders related to influenza vaccination. The objective is to effectively inform and motivate individuals from diverse target groups to get vaccinated against influenza.

Bibliographical references:

  1. Influenza Diabetes Community, European Scientific Working group on Influenza. Commitment paper of the Influenza/Diabetes Community [Internet]. 2019.

  2. Tailoring Immunization Programmes for Seasonal Influenza (TIP FLU) [Internet]. 2017.

  3. ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. 2015.

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This policy entails healthcare organizations sending pop-up notifications or SMS messages to eligible individuals, reminding them to receive the flu vaccine as recommended.

Bibliographical references:

  1. Loiacono MM, Mitsakakis N, Kwong JC, Gomez GB, Chit A, Grootendorst P. Development and Validation of a Clinical Prediction Tool for Seasonal Influenza Vaccination in England. JAMA Netw open. 2020;3(6):e207743.

  2. WHO. Tailoring Immunization Programmes for Seasonal Influenza (TIP FLU). 2017.

  3. ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. 2015.

Healthcare professional accountability and engagementHealthcare professional accountability and engagement

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This policy ensures that healthcare professionals undergo regular education and training in influenza vaccination. By staying updated, they are equipped to provide accurate information and assistance to individuals seeking guidance on vaccination.

Bibliographical references:

  1. Goldstein AO, Kincade JE, Gamble G, Bearman RS. Policies and Practices for Improving Influenza Immunization Rates Among Healthcare Workers. Infect Control Hosp Epidemiol. 2004;25(11):908–11

  2. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  3. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  4. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

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This policy ensures fair and specific compensation for healthcare organizations and professionals for each vaccination administered in order to guarantee their engagement.

Bibliographical references:

  1. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  2. Gazmararian JA, Coleman M, Prill M, Hinman AR, Ribner BS, Washington ML, et al. Influenza vaccination of health care workers: Policies and practices of hospitals in a community setting. Am J Infect Control. 2007;35(7):441–7.

  3. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

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This policy mandates the vaccination of healthcare professionals, making it a requirement for them to receive the vaccine.

Bibliographical references:

  1. Short E, Zimmerman PA, van de Mortel T. Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review. J Infect Prev. 2020;21(6):212–20.

  2. Rashid H, Yin JK, Ward K, King C, Seale H, Booy R. Assessing interventions to improve influenza vaccine uptake among health care workers. Health Aff. 2016;35(2):284–92.

  3. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Netw open. 2018;1(2).

  4. Paul KT, Loer K. Contemporary vaccination policy in the European Union: tensions and dilemmas. J Public Health Policy [Internet]. 2019;40:166–79.

  5. Lindley MC, Mu Y, Hoss A, Pepin D, Kalayil EJ, van Santen KL, et al. Association of State Laws With Influenza Vaccination of Hospital Personnel. Am J Prev Med [Internet]. 2019;56(6):e177–83.

  6. Kitt E, Burt S, Price SM, Satchell L, Offit PA, Sammons JS, et al. Implementation of a Mandatory Influenza Vaccine Program: A 10-year experience. Clin Infect Dis. 2020;

  7. Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Influenza vaccination of healthcare workers in Italy: Could mandatory vaccination be a solution to protect patients? Future Microbiol. 2019;14(9s):45–9.

  8. Wang TL, Jing L, Bocchini JA. Mandatory influenza vaccination for all healthcare personnel: A review on justification, implementation and effectiveness. Curr Opin Pediatr. 2017;29(5):606–15.

  9. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  10. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

Awareness of the burden and severity of the diseaseAwareness of the burden and severity of the disease

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This policy involves a coordinated effort among various entities, both public and private, related to influenza vaccination, to create comprehensive awareness and communication campaigns. These campaigns aim to educate the public on the importance of influenza virus vaccination, including the involvement of patient advocacy groups (PAGs).

Bibliographical references:

  1. Influenza Diabetes Community, European Scientific Working group on Influenza. Commitment paper of the Influenza/Diabetes Community [Internet]. 2019.

  2. Maltezou H, Poland G. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare. 2016;4(3):47.

  3. Chevalier-Cottin EP, Ashbaugh H, Brooke N, Gavazzi G, Santillana M, Burlet N, et al. Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases. Infect Dis Ther. 2020;9:467–80.

  4. WHO Europe. Vaccination and trust [Internet]. Copenhagen; 2017.

Belief in influenza vaccination benefitsBelief in vaccination benefits

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This policy advocates for positive media coverage of influenza vaccination, ensuring that the media adequately covers and promotes the importance of vaccination against influenza.

Bibliographical references:

  1. European Observatory on Health Systems and Policies. The organization and delivery of vaccination services in the European Unit. 2018.

  2. Kumar S, Xu C, Ghildayal N, Chandra C, Yang M. Social media effectiveness as a humanitarian response to mitigate influenza epidemic and COVID-19 pandemic. Ann Oper Res [Internet]. 2021;

  3. Bonnevie E, Rosenberg SD, Kummeth C, Goldbarg J, Wartella E, Smyser J. Using social media influencers to increase knowledge and positive attitudes toward the flu vaccine. PLoS One [Internet].

Target Population

We acknowledge that some of the policies are already in partial implementation in the selected country, despite presenting room for improvement.

 
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Complementary Bibliographical References

national vaccin cov total
1523977
national vaccin cov children
16702
national vaccin cov elderly
1149596
national vaccin cov pregnant
2432
national vaccin cov hcw
67929
national vaccin cov highrisk
186051
national vaccin cov other
101266
influenza infect total
1551779
influenza infect children
254051
influenza infect elderly
287017
influenza infect pregnant
14491
influenza infect hcw
30457
influenza infect highrisk
353733
influenza infect other
612030
flu-rel hosp total
6807
flu-rel hosp children
160
flu-rel hosp elderly
2975
flu-rel hosp pregnant
38
flu-rel hosp hcw
51
flu-rel hosp highrisk
2520
flu-rel hosp other
1063
flu-rel gp visits total
473495
flu-rel gp visits children
56666
flu-rel gp visits elderly
28158
flu-rel gp visits pregnant
5865
flu-rel gp visits hcw
15630
flu-rel gp visits highrisk
152071
flu-rel gp visits other
215105
product loss d total
1984204
product loss d children
0
product loss d elderly
0
product loss d pregnant
28893
product loss d hcw
59911
product loss d highrisk
730706
product loss d other
1164694
flu-rel deaths total
1885
flu-rel deaths children
33
flu-rel deaths elderly
1360
flu-rel deaths pregnant
2
flu-rel deaths hcw
15
flu-rel deaths highrisk
237
flu-rel deaths other
238
hosp due cvd total
835
hosp due cvd children
0
hosp due cvd elderly
798
hosp due cvd pregnant
0
hosp due cvd hcw
0
hosp due cvd highrisk
26
hosp due cvd other
10
deaths due cvd total
35
deaths due cvd children
1
deaths due cvd elderly
25
deaths due cvd pregnant
0
deaths due cvd hcw
0
deaths due cvd highrisk
4
deaths due cvd other
4
Year
3
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