Influenza vaccination policies for health workers in low-income and middle-income countries: A cross-sectional survey, January-March 2020

Helena C. Maltezou, Kalliopi Theodoridou, Maria Tseroni, Vasilios Raftopoulos, Amanda Bolster, Alison Kraigsley, Joseph Bresee, Philipp Lambach

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


INTRODUCTION: The World Health Organization (WHO) recommends vaccination of health workers against influenza, but uptake in low-resource settings remains low. To complement routine global data collection efforts we conducted a detailed survey on influenza vaccination policies for health workers in low-income and middle-income countries (LMICs) in early 2020.

METHODS: Health worker vaccination policy data were collected via a web-based survey tool sent to Expanded Programme on Immunization managers or equivalent managers of all eligible countries. High-income countries and countries with active civil war were excluded from the participation. The survey was sent by email to 109 LMICs in all WHO Regions to invite participation. Data were analyzed by World Bank income category and WHO Region. Statistical methods were applied to assess mean vaccination rates across countries.

RESULTS: Sixty-eight (62%) out of 109 invited LMICs were studied. Thirty-five (51.5%) reported to have a policy for influenza vaccination of health workers. Vaccinations were voluntary in 23 countries (66%), mandatory in 4 (11%), while in 8 countries (23%) mixed vaccination policies existed. A mechanism to estimate vaccine uptake existed in 26 countries (74%). Low-income and African Region countries were less likely to have influenza vaccination policies for health workers (p-values < 0.001 and 0.009, respectively). The most common reason for not having a vaccination policy for health workers was influenza not being a priority (48.5%).

CONCLUSIONS: Despite policies being in place in more than half LMICs studied, gaps remain in translating vaccination policies to action, particularly in low-income and African Region countries. To optimize the operationalization of policies, further research is needed within countries, to enable evidence-based introduction decisions, categorization of health workers for vaccination, identification of factors impacting effective service delivery, strengthening monitoring and estimation of vaccination uptake rates and ensure sustainability of funding.

Original languageEnglish (US)
Pages (from-to)7433-7439
Number of pages7
Issue number47
StatePublished - Oct 3 2020

Bibliographical note

Funding Information:
This work was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention, under the terms of Cooperative Agreement Number U50CK000431 .

Publisher Copyright:
© 2020 Elsevier Ltd


  • Health workers
  • Healthcare personnel
  • Influenza
  • Occupational
  • Policies
  • Vaccination

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.


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