1. Policy and Perceptions of Healthcare Worker Flu Vaccination Programs Matthew M. Davis, MD, MAPP Professor of Pediatrics, Internal Medicine, Public Policy, and Health Management & Policy University of Michigan MSIPC Annual Meeting - October 2015

2. DISCLOSURES I have no relevant conflicts of interest to disclose. I previously served as the Chief Medical Executive for the State of Michigan.

3. DISCLOSURES I have no relevant conflicts of interest to disclose. I previously served as the Chief Medical Executive for the State of Michigan. I am a healthcare worker, and I get my flu shot every year.

4. Why isn’t flu vaccination of healthcare workers this simple?

5. Flu Vaccination of Healthcare Workers Continuing to focus on flu Effectiveness of flu vaccination Healthcare workers as a target group for vaccination How to continue progress

6. Why Continue to Focus on Flu?

9. 1990s: estimated 100,000-200,000 hospitalizations annually for flu-related illness After 2000: estimated >200,000 hospitalizations annually for flu-related illness

10. Why Continue to Focus on Flu? 1990s: estimated 100,000-200,000 hospitalizations annually for flu-related illness After 2000: estimated >200,000 hospitalizations annually for flu-related illness If average flu season runs October-March …  More than 1100 hospitalizations for flu- related illness every day in the U.S.

11. Flu isn’t just a challenge for hospitals …

12. Other healthcare settings: Ambulatory care Community-based care (eg, school-based health centers, pharmacies) Long-term care

13. Influenza in the Long-Term Care Setting Data are scarce regarding burden of influenza illness among residents of long-term care facilities But national data indicate that persons ≥65 years old annually account for: Over 50% of flu-related hospitalizations Over 90% of flu-related deaths

14. To Prevent Influenza …

15. Effectiveness of flu vaccination Vaccine effectiveness in preventing influenza infection during 2011-12 flu season among hospitalized adults: 71% among all adults 76% among adults ≥50 years old

16. And then came the flu vaccine of 2014-15 …

17. For most medical/public health interventions, an 18% reduction in incidence would be reason to celebrate! Expectations for flu vaccination are high …

18. Evidence for Benefits of Flu Vaccination of Healthcare Workers

19. Lancet, 2000

23. HCW vaccination rates: If flu vaccine was offered … 49% If flu vaccine not offered … 4% Odds of patient mortality at sites where flu vaccine was offered compared to not offered: OR = 0.60 (95% CI: 0.39, 0.90)

24. Lancet, 2000 HCW vaccination rates: If flu vaccine was offered … 49% If flu vaccine not offered … 4% Odds of patient mortality at sites where flu vaccine was offered compared to not offered: OR = 0.60 (95% CI: 0.39, 0.90) Adjusted for patient’s own vaccination status!

28. Overall effectiveness in preventing influenza A infection: 88% Overall effectiveness in preventing influenza B infection: 89%

29. If flu vaccination of healthcare workers is a no- brainer, then why do some healthcare workers refuse to get vaccinated?

31. From dozens and dozens of studies: healthcare workers who refuse flu vaccination generally … Perceive the risk of influenza as low Perceive the risks of vaccination as high Perceive the convenience of vaccination as low Perceive minimal consequences of being unvaccinated

32. Keys to successful flu vaccination programs Perceive the risk of influenza as low  Share data and stories with staff about risk of influenza for patients … if possible, institution-specific data Perceive the risks of vaccination as high  Share myth-busting information about vaccination Perceive the convenience of vaccination as low  Make healthcare worker vaccination easy Perceive minimal consequences of being unvaccinated  Share data and stories about unvaccinated individuals who contracted influenza

33. Should institutions mandate flu vaccination for healthcare workers? Mandates are the most expeditious way to increase vaccination rates – in any setting A mandate with effective communication / information strategy has the greatest chance of achieving acceptance and ultimately full integration into institutional culture

34. Should institutions mandate flu vaccination for healthcare workers? Mandates are the most expeditious way to increase vaccination rates – in any setting A mandate with effective communication / information strategy has the greatest chance of achieving acceptance and ultimately full integration into institutional culture Perhaps most effective message: It’s about protecting the patients

35. Final comments Influenza remains a major public health threat, and a challenge for healthcare institutions every flu season Flu vaccine is an outstanding approach to preventing flu – even in seasons with a poor match between the circulating strains and the vaccine components Healthcare workers respond to a number of strategies – the tide is turning, supported by implementation of mandates by many institutions It’s about protecting the patients

36. Contact: Matthew M. Davis, MD, MAPP Professor of Pediatrics, Internal Medicine, Public Policy, and Health Management & Policy University of Michigan Email: mattdav@med.umich.edu