It’s crucial we address COVID vaccine hesitancy among health workers. Here’s where to start

Holly Seale, UNSW

Health workers are at higher risk of COVID infection and illness. They can also act as extremely efficient transmitters of viruses to others in medical and aged care facilities.

That’s why health workers have been prioritised to get a COVID vaccine when it becomes available in Australia.

But just because health workers are among those first in line to receive a COVID vaccine, it doesn’t necessarily mean they all will.

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Our health systems represent a microcosm of the community. Just like in the broader community, there will be health workers highly motivated to get the COVID-19 vaccine, driven by concern about risk to themselves, their family, and their patients. There will also be those who have medical conditions, those that may not be able to get vaccinated, and staff who are hesitant.

There will also be health workers with questions about the vaccine, who perhaps need further support to help them decide.

Reports from the US track vaccine hesitancy among health workers at around 29%. However, it’s important to note different groups have different reasons for COVID-19 vaccine hesitancy; rates and reasons can vary across and within countries.

Protecting health workers is critical. Achieving high COVID-19 vaccine uptake among health workers will not only protect these critical staff members, it will also support high levels of uptake among the general public.

Personal health workers are the most trusted source of information on the COVID-19 vaccine.

A chart showing how personal health care providers are the most trusted source of Information on the COVID-19 vaccine.

KFF COVID-19 Vaccine Monitor: December 2020, KAISER FAMILY FOUNDATION., CC BY

Health workers can also be complacent and uncertain about vaccination

Decision-making around vaccination can be a complex mix of psychosocial, cultural, political and other factors.

Health workers, just like the broader public, may perceive they are at low risk of acquiring a vaccine-preventable disease. They may have concerns about the safety and effectiveness of a vaccine and/or may find it challenging to get vaccinated.

All these factors may make a health worker reluctant to get the vaccine and communication strategies should be tailored to take these factors into account.

A nurse giving one of her patients a vaccine
Encouraging vaccine confidence among health-care workers will also support high vaccine uptake among the general public.

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How to achieve high and equitable vaccination coverage among health workers

While most health workers understand how vaccines work generally, they may not necessarily be experts across all vaccine types. If we want to ensure they feel comfortable to receive it and advocate for it, then we must address any misunderstanding and concerns health workers may have. This may be focused on the vaccine itself (how it was developed, effectiveness and so on), or the necessity of vaccination.

A group of health-care workers
We need to remember most health workers aren’t vaccine experts.

One strategy that may assist will be to work with middle managers, as they are influential, trusted and can act as vaccine advocates and agents of change. They may also play a role addressing questions or concerns where they arise. If a COVID vaccine becomes an occupational requirement for health workers, hospitals and other organisations need to include middle managers in the development and roll-out of programs. They can then help ensure staff members understand the rationale for the mandate, which staff members are targeted and why.

Investing in the staff responsible for delivering vaccines in the workplace, as well as other potential vaccine allies such as managers, can help reduce COVID vaccine hesitancy among health workers. That will benefit all of us.The Conversation

Holly Seale, Associate professor, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Rising coronavirus cases among Victorian health workers could threaten our pandemic response


Rochelle Wynne, Western Sydney University and Caleb Ferguson, Western Sydney University

Over the past week, we’ve seen a spike in the number of COVID-19 infections among health-care workers in Victoria.

This includes a doctor at Melbourne’s St Vincent’s Hospital, one staff member at Brunswick Private Hospital, nine staff members from the emergency department at Melbourne’s Northern Hospital, and two nurses at the Royal Melbourne Hospital.

Staff at several aged care facilities have also tested positive.

These cases have meant sending many health-care workers regarded as “close contacts” into home quarantine.

The Northern Hospital emergency department has reportedly had to divert patients elsewhere, while Brunswick Private Hospital (where four patients tested positive too) is closed to new admissions.

Keeping health-care workers COVID-free is critical to delivering care to those who need it during a pandemic. So as Victoria’s second wave rolls on, we need to consider what more we can do to protect our health workers.

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Why might this be happening?

In the absence of a vaccine, subsequent waves of COVID-19 have always been a possibility.

Health-care workers tend not to contract COVID-19 from patients, as appropriate personal protective equipment (PPE) is used in high risk encounters.

But health-care workers are normal people commuting to work and living and interacting in communities. So it’s more likely they contract it outside work.

Undetected, they can then bring it into the hospital or other health-care setting, putting fellow staff and vulnerable patients at risk.

Over the past week, we’ve seen a number of COVID-19 cases among hospital staff.

What are the implications for health care?

At the most basic level, the specialised health-care workforce is core to health-care delivery; without nurses, doctors and allied health staff, there’s no health-care system.

Infections in this group — whether confirmed outbreaks or suspected contamination —will reduce health-care workforce capacity.

High rates of staff off work due to COVID-19 may also increase fatigue and burnout in the remaining workforce, adding to the burden.

The greater the scope of these outbreaks, the greater the strain on the affected hospitals and the health-care system. This will be compounded as they’re faced with increased demand due to COVID-19 cases in the community.

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Australia has had time to prepare its workforce with additional skills and capabilities in critical care. But there are always concerns regarding potential workforce shortages in the height of a pandemic, particularly in areas of specialised practice such as intensive care.

Especially in “hotspots”, as we weather this second wave, there remains a risk demand could outweigh supply.

What can the health system do to cope?

A number of possible interventions could increase system capacity and help manage demand.

This may include decreasing elective or non-urgent surgery, as we saw during the first wave of the virus.

Increasing the use of virtual models of care including phone consultations and telehealth, where appropriate, could also help ease the pressure. Quarantined frontline workers could provide virtual care through telephone support, such as helplines or other telehealth services.

A reduced health-care workforce can put added stress on remaining staff.

Adapting care to minimise the movement and interaction of hospital staff across wards and sites is another important option. For example, some hospitals have shifted from a model where a team of doctors works across multiple wards to a small team of doctors providing care to only one ward.

Most hospitals have also set-up dedicated COVID wards to screen patients for COVID-19 at the first point of contact with the health system.

What about routine testing for health workers?

To sustain a prolonged response to this crisis we need a healthy, COVID-19 free workforce. Especially given we know many positive cases don’t experience symptoms, we should be mass testing health-care workers.

To date, we’ve seen some testing of asymptomatic health-care workers in Victoria, but it has not been commonplace.

Increased routine screening of health-care workers, with or without suspected exposure, will increase the number of days away from work while staff wait for results, reducing service capacity. But the pay-off will be greater — it will limit COVID-19 spread.

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Keeping our health-care heroes safe and well

From this week, staff at several major Melbourne hospitals have been required to wear masks at all times while at work. These precautions have previously been reserved for staff in areas of higher clinical risk such as emergency and intensive care.

This is in addition to a range of guidelines health professionals follow to minimise the spread of COVID-19, including around hand hygiene, cleaning, PPE, and keeping physical distance from patients where possible.

But the responsibility to take precautions and stop the spread falls to all of us.

Hospital patients and visitors are also being encouraged to wear face masks.

In fact, everyone in Melbourne is now advised to wear a mask in public when social distancing is not possible. Hopefully this will go some way to protecting our health-care workers and the entire community.

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The Conversation

Rochelle Wynne, Director, Western Sydney Nursing & Midwifery Research Centre, Western Sydney University and Caleb Ferguson, Senior Research Fellow, Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District &, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Here’s why flu vaccinations should be mandatory for Aussie health workers in high-risk areas

File 20180509 4803 via7fs.jpg?ixlib=rb 1.1
Despite the numerous campaigns promoting the flu vaccine to Australian health workers, uptake has been documented to range from only 16-60%.
Tatiana Chekryzhova/Shutterstock

C Raina MacIntyre, UNSW and Holly Seale, UNSW

On June 1, health workers in New South Wales will be required to have a flu vaccination if they work in high-risk clinical areas, such as wards for neonatal care, transplants and cancer. Otherwise staff are required to wear surgical masks during the flu season or risk being redeployed.

NSW is the only state to make flu vaccination mandatory for some health workers. It aims to protect vulnerable patients and the health system from another disastrous flu season like in 2017. While the federal government has told aged care providers they must offer the flu vaccine to their staff this winter, there is no requirement for staff to accept the vaccine.

Despite the numerous campaigns promoting the flu vaccine to Australian health workers, uptake has been documented to range from only 16-60%, with an even lower rate reported among aged-care workers.

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The most effective way to improve vaccination rates among health workers is to make it mandatory. State, territory and Commonwealth governments should consider making the flu shot mandatory for all health workers in high-risk clinical areas and aged care facilities.

Why health workers need to be vaccinated

For most of us, vaccination is for individual protection. In the case of those caring for sick and vulnerable people such as children and the elderly, vaccination protects others from devastating illness, complications and even death.

Hospitals and aged care facilities can experience explosive outbreaks of influenza.
Aged care facilities may have to close their doors to new admissions, which can also have a significant economic impact. It’s also important that staff absenteeism in hospitals is kept low, especially in areas with limited specialist expertise.

Some argue vaccination of health workers is a moral duty, while others state individual freedom of choice is more important than protection of patients.

Mandating vaccination

The use of immunisation mandates for health-care workers is not new in Australia. In most states and territories, staff are required to have vaccines for (or show evidence of protection against) measles, mumps, rubella, diphtheria, tetanus, pertussis, hepatitis B, and varicella (chicken pox).

NSW, for example, introduced mandatory vaccination of health care workers for several vaccines (but not the flu) in 2007. NSW health workers generally accepted this change in policy, with only 4% objecting.

Making the flu shot mandatory, as NSW has done this year, would simply add the the list of vaccinations health workers are required to have.

NSW is the only state to make flu vaccination mandatory for some health workers.

The evidence suggests it’s worth it; a five-year study in one hospital in the United States showed mandatory hospital policies can raise coverage rates to close to 100%.

Institutions that have implemented a mandatory policy have dramatically reduced employee sick days as well as flu in hospitals, thereby improving patient safety and reducing health care costs.

Staff vaccination programs

Most workplaces run intensive vaccination programs, which may include mass immunisation clinics, mobile carts, posters and email reminders. But in most cases, these programs aren’t successful at boosting vaccination levels above 60%.

Some hospitals have been able to achieve higher vaccination rates in the short term through easy access to vaccines, education, reminders and multiple opportunities for vaccination. But these initiatives require ongoing resources and continual efforts – a one-off vaccination day is not enough.

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The Victorian health system used a slightly different approach in 2014 when it made high rates of flu vaccination a hospital performance target. The government also provided the vaccine free to all Victorian hospitals.

This raised vaccination rates among Victorian hospital staff from 60% to 75% overall (higher in some hospitals). But higher rates may be achieved through mandatory flu vaccination.

But it’s not always the best policy

For each situation, we need to consider the overall risks and benefits of mandatory vaccination, as well as the gains in protection and vaccination coverage.

For infant vaccination, for example, vaccination rates are already at a high baseline of more than 93%. So, the risk of coercive policies may be greater than the relatively small gains achieved by coercive methods. Similar results may be achieved through other methods.

There’d be little point mandating vaccines for infants since they already have high rates of vaccination.

In the case of health and aged-care workers, however, we start with a lower base of vaccine coverage, of 16-60%. Adding financial incentives or disincentives, or making it mandatory, would result in much larger gains in vaccination rates.

Vaccinating health-care workers also has benefits beyond their individual protection: it reduces the risk of their patients contracting influenza and maintains the health workforce capacity. This shifts the balance in favour of mandatory vaccination.

The ConversationGiven large potential gains and low resource requirements, mandatory flu vaccination for all health workers in high-risk areas is a good idea. Governments should consider this and other strategies to improve flu vaccination rates health and aged care workers.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, UNSW and Holly Seale, Senior Lecturer, UNSW

This article was originally published on The Conversation. Read the original article.