Justification for mandating annual influenza vaccination

Influenza and pneumonia are the 8^th leading causes of death in the United States, with influenza causing an average of 23,600 deaths annually. Deaths from influenza often exceed those from motor vehicle crashes. What is especially tragic is that much of the impact from influenza is preventable. It is estimated that even with influenza vaccine rates of under 50%, during the 2012-2013 influenza season, vaccine resulted in 79,000 (17%) fewer hospitalizations and averted 6.6 million illnesses and 3.2 million medically attended illnesses due to influenza.

Since 2010 public health authorities have recommended universal vaccine against influenza for those 6 months and older. While vaccine rates have risen, they remain at overall low rates of 50% or under. Even among health care workers, rates are about 72%, despite educational efforts. 

While immunizations against influenza like other preventable diseases, provide necessary primary prevention for individuals, stronger efforts to increase vaccine rates to achieve levels that at least offer herd immunity is important for the public’s well-being and improving the health status of populations, as well as for reducing lost productivity and rising health care costs. Simply put, influenza prevention is simply cost effective on multiple fronts for both individuals and communities.

Given the tragic annual impact of influenza, the authors recommend mandated annual influenza vaccine, especially in schools and colleges, health care settings, and many workplaces, where disease transmission impacts large population groups, many of whom may often face higher risks, suffer from compromised immune systems, or have other illnesses. Such requirements should come from the private sector as well as the public sector. Rates are higher when vaccines are mandated. For instance, rates among health care workers rise to 97% when employers mandate its use. And, such vaccination, even among healthy populations, saves lives. Mandates should provide for reasonable exceptions such as for medical and religious reasons.

The authors analyze and provide ethical, legal, and public health reasons to justify these strategies, and use the effectiveness of other mandated vaccines and public health interventions as models. While mandating vaccinations may be viewed by some as limiting individual liberties, assuring it reduces health disparities and promotes social justice, beyond simply reflecting sound public health practice.