Influenza Vaccination for Health Care Personnel in Long-Term Care Homes: What Restrictions of Individual Freedom of Choice Are Morally Justifiable?

Abstract

Empirical evidence indicates that vaccination of health care personnel (HCP) in long-term care facilities might reduce all-cause mortality and morbidity in the elderly. However, vaccination rates of HCP have remained generally rather low. This raises the question of what strategies are ethically appropriate to achieve sufficiently high coverage rates among HCP. We first define five conditions for the moral legitimacy of public health interventions: (1) proven effectiveness, (2) a favourable benefit–harm ratio, (3) an acceptable cost–benefit ratio, (4) the lowest possible restrictiveness, and (5) a fair and transparent decision process. Based on the available empirical evidence, we then assess how far these conditions are met for influenza vaccination of HCP. Despite imperfect evidence on the effectiveness of HCP influenza vaccination on disease-specific morbidity and mortality in the elderly, it is justified not only to offer and recommend influenza vaccination to HCP but also to use incentives to increase the vaccination rate among HCP. The potential benefits of vaccinating HCP against influenza for the target population are rather large – reduced all-cause morbidity and mortality – compared to the burdens and risks for vaccine recipients. Mandatory influenza vaccination for HCP, however, can only be justified if the available empirical evidence on the effectiveness is more conclusive and all other less restrictive measures have failed to achieve a sufficiently high vaccination rate.