Healthcare workers are at high risk for flu but vaccination rate remains surprisingly low

#TogetherAgainstFlu - 10/02/22

Healthcare workers are committed to improving the health of their patients even in the most critical times such as the current pandemic. Every year, the flu season leads to increased pressure on hospitals and healthcare settings including the staff. This is in part  due to the 3 to 5 million serious cases of flu, some of which will require hospitalisation, but also staff sick leave and loss of productivity1.  

Healthcare workers (HCWs) are generally more exposed to the influenza virus than the general population. They risk not only getting sick with the flu, but also transmitting the infection to patients some of whom are particularly vulnerable because of an already low immune system. Studies show that an estimated 20% of HCWs are infected with the flu virus every year2 

Stay fit at frontline during the flu season 

The World Health Organization (WHO) considers HCWs a risk-group* for flu and recommends the annual flu vaccination to protect patients, themselves, their families and to reduce absenteeism at work3. The UK government recommends in particular all frontline health and social care workers be vaccinated to avoid any disruptions in the frontline services during the flu season4

“I got vaccinated against the flu as I have had flu before and was very ill. I have a flu vaccine every year and encourage all my team in the pharmacy to get vaccinated to protect themselves and to reduce sick hours in the pharmacy. 

Harsha Vara, Pharmacist, UK

A Canadian study found that flu is a cause of absence from work among HCWs while influenza vaccination has a significant protective impact on it. The study found that unvaccinated HCWs in winter had twice as much absenteeism due to all-cause illness than vaccinated staff.5  

Low vaccination rates despite recommendations 

The influenza vaccination coverage among HCWs is relatively low worldwide6 and the vaccine uptake varies from country to country. Latest comparative data at the EU level (2017/18 influenza season) shows that the vaccine coverage rates for HCWs in 12 EU countries were less than 40%, whereas in the UK** the rate was slightly above 60%7. A recent study on nurses in Europe and vaccination uptake (2021), conducted by the European Specialist Nurses Organisation (ESNO), showed relatively higher figures, where 53.4% of the respondents had the flu vaccination in 2018, and demonstrated an increase the following year to 55.2% in 20198.  

In the US, the flu vaccination coverage was 95% among HCWs in hospitals, versus 68% among HCWs in long-term care settings (2018/19 influenza season). Here, the highest rates are seen in healthcare settings that require mandatory vaccination as a condition for employment9.  

Contrary to the US, in most other countries, flu vaccination for HCWs is voluntary10. Most EU countries’ official vaccination recommendations comply with the 2009 Council Recommendation and 2012 WHO SAGE Recommendations, and target at-risk groups. ​​However, recommendations vary from country to country with regards to occupation or setting. In a study of 30 EU/European Economic Area (EEA) Member States, 29 countries recommended vaccination for health care workers. 23 Member States reported that influenza immunization was recommended for all HCWs, and 5 countries recommended vaccination for some HCWs (e.g. those working in out-patient, in-patient, and long-term care departments)11

“I get vaccinated for the good of my patients, for my own, for my community, and for contributing to the proper functioning of the health system”. 

Raquel Cabrero, General Practitioner, Spain

Key factors for an effective vaccination program 

Certain barriers to flu vaccination have been identified, which include: considering the flu as a mild disease capable by their immune system; relying on protection from last year’s flu vaccination; not considering themselves a risk to infection; fear of contracting flu from vaccination; fear of side effects; lack of time; and disbelief in vaccine safety and efficacy. On the other hand, HCWs that are vaccinated are primarily motivated by protecting their patients, their families, and themselves, as well as avoiding being sick and generating an increase in workload. Understanding barriers can help create effective vaccination programs12

“If you are a healthcare professional, you have a duty of care to your patients. If you don’t get vaccinated, then how can you care for patients if you were to feel ill. Also, how can you encourage patients who are at risk to get vaccinated with confidence?”

Harsha Vara, Pharmacist, UK

A benchmark study from four high-performing countries with high flu vaccine coverage rates (Australia, Canada, UK and US), points at key factors for a successful vaccination program for HCWs13,14

  • Regular education and training to increase the knowledge about flu vaccination and its benefits; 
  • Fair and specific financial compensation 
  • Assess and reporting regularly on VCR 
  • Use of role models where senior medical staff and opinion leaders can influence on vaccination 
  • Access to vaccination at times and locations convenient 
  • Mandatory/strongly recommended HCW vaccination 
  • HCW associations endorsing influenza vaccination 

“ESNO calls for a ‘health professional domain’ “climate change” regarding tackling infections and future pandemics so that a motivated, sustainable, and competent nurses’ workforce can be relied upon.” 

Ber Oomen, Interim Executive Director, European Specialist Nurses Organisation (ESNO) 

Take the flu vaccination early autumn to stay fit 

So finally, when should HCWs get vaccinated? HCWs are recommended to get their annual flu shot every year in the autumn, before the flu season starts14, and thus help improve the protection against flu – for their patients, their families, themselves – as well as to keep up the workforce at hospitals and in healthcare settings. 

* Besides HCWs, other at-risk groups include people with higher risk for severe disease or flu-related complications, such as pregnant women, children under 59 months, older people, individuals with chronic medical conditions and immunosuppressive conditions. #TogetherAgainstFlu has previously published an article about people at-risk here 

** At the time of the study, the UK was part of the EU. 


  1. World Health Organization: Influenza (Seasonal)
  2. Why flu vaccine is important for healthcare workers (HCWs)
  3. World Health Organization: Influenza (Seasonal)
  4. What healthcare workers need to know about the flu vaccine
  5. Influenza Vaccination Programs for Healthcare Personnel: Organizational Issues and Beyond
  6. Influenza vaccination and healthcare workers: barriers and predisposing factors. A literature review
  7. ECDC: Seasonal influenza vaccination and antiviral use in EU/EEA Member States – Overview of vaccine recommendations for 2017–2018 and vaccination coverage rates for 2015–2016 and 2016–2017 influenza season
  8. ESNO: Results ESNO Survey to Nurses in Europe on Vaccination Uptake
  9. CDC: Overview of Influenza Vaccination among Health Care Personnel
  10. Influenza Vaccination Programs for Healthcare Personnel: Organizational Issues and Beyond
  11. ECDC: Seasonal influenza vaccination and antiviral use in EU/EEA Member States – Overview of vaccine recommendations for 2017–2018 and vaccination coverage rates for 2015–2016 and 2016–2017 influenza seasons
  12. Influenza vaccination and healthcare workers: barriers and predisposing factors. A literature review
  13. Key policy and programmatic factors to improve influenza vaccination rates based on the experience from four high-performing countries
  14. WHO: Protecting vulnerable groups from influenza