In support of the claims of those who assert the uselessness or the harmfulness of vaccinations, the presumed non-inclination of the majority of health professionals (doctors, nurses and other operators) to get vaccinated and/or to refuse to vaccinate their children is sometimes used as an argument1.
It is argued that this attitude is proof of the danger of vaccinations as it is put into practice by those who are most aware of the reality of the facts. In addition, it has been argued that most health professionals actively advise their clients against vaccinations2.
Analysis of the evidence available
As regards the first point, it is obviously not possible to state that all health professionals are in favour of vaccinations and have received them, given the existence of associations of health professionals who are opposed to vaccinations and actively engaged in the fight against them1.
If we refer to the scientific literature, however, the studies available on the subject do not give reason to support the claim that the majority of health professionals are against vaccination and choose not to undertake it; on the contrary, they seem to suggest the existence of a widespread propensity of health professionals towards the practice of vaccination. These studies largely concern the annual influenza and H1N1 vaccinations, as these are recommended or required for health professionals by the health systems or hospitals they work for,7. Nonetheless, there is also a smaller number of articles concerning other vaccinations recommended/required for health professionals by their employers, such as Hepatitis A, Hepatitis B, and varicella8,10.
In general, these studies show that the rates of adherence to vaccinations among health workers, while generally high, never reach 100% (3,5,6). In this regard, however, it must be remembered that the recommended or required vaccination of health workers have - in addition to the normal aim of vaccinations - the significant objective of guaranteeing the continuity of healthcare facilities even in periods when some communicable diseases are particularly widespread and during epidemics, thereby limiting the absences from work of healthcare professionals11,12. Therefore, at least in part, the phenomena that can be observed among health professionals regarding vaccination practices - in one way or another - must be interpreted taking into account specific and particular variables and considerations, which cannot be attributed to the motivations that push those not involved in healthcare to get vaccinated or to refuse vaccination. In this regard, some authors have shown that among the factors that negatively affect vaccination rates among health professionals is their belief that they are already immune due to their long exposure to different antigens, or that they have in any case acquired a greater immunocompetence than the general population6,13. Other authors instead report a generic distrust among health professionals towards the organisation of the health system they fall under3. Others report the desire to reserve the possibility of taking time off work due to illness among the reasons given by health professionals for their choice not to get vaccinated themselves14. It is evident, that none of these reasons for refusing vaccination have anything to do with a presumed conviction among health workers of the uselessness/harmfulness of the vaccines.
However, also worth mentioning are studies citing the lack of information available about the vaccine and about the agent against which it is administered among the factors that reduce the adhesion of health workers to vaccination; this phenomenon concerns H1N1 in particular5,9,10,15.
Despite this, numerous studies report that one of the main reasons given by health professionals for choosing to get vaccinated is precisely the desire to protect their patients5,16, an attitude that is obviously not compatible with an alleged belief in the uselessness of vaccines.
In any case, the articles that compared the adherence rates to vaccinations for health professionals with those of the susceptible general population report that the vaccination rates for health workers are higher or much higher than those of the general population, even in health systems that do not have mandatory vaccinations for health workers4,8.
This data alone seems sufficient to debunk the claim that there is a general propensity among health professionals to refuse vaccination.
There are no studies available in the literature which make it possible to state that health professionals tend not to vaccinate their children. On the contrary, there are studies that show how the desire to protect their children and family members is one of the main factors behind the decision of health professionals to get vaccinated5,8,14.
Regarding the second point of the initial hypothesis, it is not possible to state that no health worker actively works to convince his patients not to get vaccinated, given the existence of health workers’ associations set up with this intention. However, the scientific literature offers no evidence that healthcare professionals who proactively promote the vaccination boycott are any more than a tiny minority.
The available studies show that health workers have higher or much higher vaccination rates than the general population and that among the factors that most influence the decision of health professionals to get vaccinated is the will to protect their patients. The reasons that health professionals cite when deciding not to get vaccinated do not refer to a presumed ineffectiveness or riskiness of the vaccinations themselves but to other factors, usually connected to organisational problems of the health system. There is no evidence to support the hypothesis that health professionals do not vaccinate their children: on the contrary, one of the most frequently reported reasons by health professionals who decide to get vaccinated is the wish to protect their families.
There is no evidence to suggest that the majority of health professionals advise their patients against vaccinating.
Sources / Bibliography
- Sinclair I. Vaccination, the hidden facts. 1992, Sinclair Ed, Ryde-Australia.
- Blasi F, Aliberti S, Mantero M, Centanni S. Compliance with anti-H1N1 vaccine among healthcare workers and general population. Clinical Microbiology and Infection 2012; 18(5):37-41.
- Steward AM. Using State Laws To Vaccinate The Health-Care Workforce.Public Health Reports 2012; 127(2):224-227.
- Prematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. Factors influencing pandemic influenza vaccination of healthcare workers-a systematic review. Vaccine 2012; 30(32):4733-43.
- Blasi F, Palange P, Rohde G, Severin T, Cornaglia G, Finch R. Healthcare workers and influenza vaccination predicts pandemic H1N1 vaccination an ERS-ESCMID Web-based survey. Clin Microbiol Infect 2011;17(8):1223-5
- Amodio E, Tramuto F, Maringhini G, Asciutto R, Firenze A, Vitale F, Costantino C, Calamusa G. Are medical residents a "core group" for future improvement of influenza vaccination coverage in health-care workers? A study among medical residents at the University Hospital of Palermo (Sicily). Vaccine 2011;29(45):8113-7
- Maltezou HC, Katerelos P, Poufta S, Pavli A, Maragos A, Theodoridou M. Attitudes toward mandatory occupational vaccinations and vaccination coverage against vaccine-preventable diseases of health care workers in primary health care centers. American Journal of Infect Control. 2013;41(1):66-70.
- Simone B, Carrillo-Santisteve P, Lopalco PL. Healthcare workers role in keeping MMR vaccination uptake high in Europe: a review of evidence. Eurosurveillance 2012; 17(26).
- Attaullah S, Khan S, Naseemullah, Ayaz S, Khan SN, Ali I, Hoti N, Siraj S. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan. Virology Journal 2011; 8:275.
- CDC. Prevention and control of inﬂuenza: recommendationsof the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR. 2007;56(RR-6):1-54.
- Ministero della Salute. Piano Nazionale Vaccini 2005-2007.
- Opstelten W, van Essen GA, Heijnen ML, Ballieux MJ, Goudswaard AN. High vaccination rates for seasonal and pandemic (A/H1N1) influenza among healthcare workers in Dutch general practice. Vaccine 2010; 28(38):6164-8.
- Festini F, Biermann KP, Neri S, Reali MF, de Martino M. Influenza vaccination of nurses in an Italian pediatric hospital: effects on absenteeism and on costs, factors associated with vaccine uptake and analysis of personal motivations. A prospective cohort study. Assist Inferm Ric. 2007;26(1):5-13.
- Zhang J, While AE, Norman IJ. Knowledge and attitudes regarding influenza vaccination among nurses: A research review. Vaccine. 2010 Oct 18;28(44):7207-14.
- La Torre G, Mannocci A, Ursillo P, Bontempi C, Firenze A, Panico MG, Sferrazza A, Ronga C, D'Anna A, Amodio E, Romano N, Boccia A. Prevalence of influenza vaccination among nurses and ancillary workers in Italy: systematic review and meta analysis. Human Vaccines 2011;7(7):728-733.