Low uptake of flu vaccine among HCWs sparks alarm

Fewer than a third of HSE healthcare staff received an influenza vaccine this winter, raising concerns among health officials and prompting a review of the current strategy. Priscilla Lynch reports

Annual seasonal influenza (flu) vaccination is recommended for all healthcare workers (HCW) in the HSE, to reduce their risk of contracting the flu and onward transmission to their patients. The current target for flu vaccine uptake among HCWs is 75 per cent.

However, figures supplied by the HSE show that the overall uptake among HSE HCWs hit its lowest figure in almost a decade this season.

The most up-to-date data on uptake among a total 107,947 HSE HCWs (between 16/09/2024 to 09/03/2025) show that approximately 34,000 were vaccinated, an uptake of only 32 per cent.

This compares to an uptake of 50.3 per cent in the 2023/24 season, and 54.4 per cent the previous season, according to Health Protection Surveillance Centre (HPSC) data.

This season’s figures represent a sharp drop and a continuation of a worsening downward trend in flu vaccine uptake among HCWs since a peak during the Covid-19 pandemic. The take-up rate among hospital-based staff reached 71.4 per cent in the 2020/21 season.

The last time uptake among HCWs hit such a low was during the 2015/16 season, when just 25.2 per cent of HCWs were recorded as having received the flu vaccine.

Public health experts told the Medical Independent (MI) that this season’s low figure is especially concerning. Ireland recently endured its worst flu season – in terms of variant strength, case numbers, and hospitalisations – since before the pandemic. The flu peaked in the first week of January, with 3,791 laboratory-confirmed cases (CIDR), continuing the upward trend from the previous winter.

Flu-related hospitalisations also put significant pressure on the health system this winter. There were 980 inpatients (49 in ICU) with laboratory-confirmed flu in the first week of 2025. This figure was far above those hospitalised with Covid-19 (67) and respiratory syncytial virus (RSV) (271). For the season to date (weeks 40 2024 to week 10 2025), 219 ICU admissions for flu and 274 deaths attributed to flu have been notified.

While the 2024/25 flu season is ongoing (until the end of May), the cumulative rate of laboratory-confirmed hospitalised flu cases from week 40 of 2024 to week eight of 2025 was 104.6 per 100,000 population, compared to 39 per 100,000 for Covid-19 and 49 per 100,000 for RSV.

Just under 12 per cent, approximately 12,000 HSE HCWs, also received Covid-19 boosters this winter season.

Again, this is well below what health authorities had hoped for. There have been suggestions that the current approach of offering the Covid-19 vaccine alongside the flu vaccine for HCWs may be “off-putting” for some who do not wish to receive the Covid-19 vaccine. They “don’t want to be badgered about it while getting flu vaccine” or may not want to take both vaccines at the same time, one public health expert told MI.

Also, it is understood some HCWs have expressed skepticism about the flu vaccine’s effectiveness, which can only be assessed after each flu season. In some years, effectiveness falls short of expectations due to flu strain mismatches.

Department of Health

MI asked the Department of Health about the implications of the low uptake of the flu vaccine among Irish HCWs this winter.

In response, Interim Chief Medical Officer, Prof Mary Horgan, said: “Vaccination against flu is a key priority of mine generally, but particularly so amongst healthcare workers. It is important to achieve a high uptake of flu vaccine in this group so we can reduce and control the incidence of flu outbreaks in healthcare settings. This will help us to protect the vulnerable both in our families and the wider community. By getting the vaccine, we can reduce demand for health service resources over the winter season.”

She noted that the HSE is responsible for the roll-out of the flu vaccination programme and HCWs can access the flu vaccine for free, usually at their place of work, or in participating GPs and pharmacies. 

“During the flu season, the HSE carries out extensive communications campaigns highlighting the importance of flu vaccination for all eligible groups, including healthcare workers through various media channels.

“The Department also delivers communications to reinforce the important message that those in the at-risk groups, who are eligible to get the vaccine, including healthcare workers, should ensure they do so to get full protection against flu.”

HPSC analysis

Last year, the HPSC published a report on the uptake of seasonal flu vaccine among HCWs in acute hospitals and long-term care/residential facilities (LTCFs) in Ireland from 2011/12 to 2023/24. The report looked at the uptake in HCWs in 55 hospitals (including four private) and 217 LTCFs (157 HSE, 60 private). It provides a more nuanced and detailed picture of uptake than the overall figures and shows significant variation among healthcare facilities, regions, and individual HCW groups.

Among public hospital-based HCWs, flu vaccine uptake increased from 18.1 per cent (across 36 participating hospitals) in the 2011/12 winter season to a peak of 71.4 per cent (49 hospitals) in 2020/21, before declining to 50.8 per cent in 2023/24 (51 hospitals). In private hospitals, uptake ranged from 22 per cent (one hospital) to a peak of 60.3 per cent in 2020/21 (three hospitals), dropping to 41.2 per cent in 2023/24 (four hospitals).

Regionally, HCW flu vaccine uptake in the 2023/24 season was highest in Dublin north-east, south-east, and paediatric hospitals, all exceeding 50 per cent. In contrast, uptake remained consistently lower in west and north-west hospitals throughout the period, reaching 39.7 per cent in 2023/24.

By staff grade, medical and dental staff had the highest uptake in 2023/24 at 65.8 per cent, followed by health and social care professionals and nursing staff. Uptake was lowest among patient and client care staff, as well as management and administration.

In LTCFs, flu vaccine uptake among HCWs has declined in recent years. In HSE LTCFs, uptake declined from a peak of 66.3 per cent in the 2020/21 winter season to 42.2 per cent in 2023/24. Similarly, in private LTCFs, uptake fell from 60.9 per cent to 43.8 per cent over the same period. However, it is worth noting that in both public and private LTCFs, uptake remained below 20 per cent for the three years preceding the 2013/14 season.

In terms of staff grade, uptake in LTCFs was generally highest among medical and dental staff, though rates varied widely, ranging from 0 to 100 per cent depending on the facility and season. General support staff consistently had the lowest uptake.

Overall, uptake of flu vaccines among LTCF HCWs remains lower than that of hospital HCWs.

Mr Tadhg Daly, the CEO of Nursing Homes Ireland (NHI), which represents private nursing homes, said the body “has consistently promoted high levels of flu vaccine uptake among nursing home staff”. He said NHI will continue to prioritise vaccination as a key measure in protecting the health of nursing home residents and staff alike.

Caveats

It should be noted that between the 2022/23 and 2023/24 seasons, overall flu vaccine uptake among hospital-based HCWs declined from 54.2 per cent to 50.3 per cent, while participation in the HPSC survey increased from 49 to 55 hospitals (public and private). Sources told MI that the final figures for 2024/25 will be carefully reviewed to ensure consistency and accuracy with previous data collection methods, particularly in light of a significant drop to just 32 per cent this winter. It has also been noted that some HCWs may have received a free flu vaccine from their GP or pharmacist, which may not have been recorded.

Other HCWs

The HSE did not provide figures on uptake of flu vaccination among GPs, practice nurses, pharmacists and other community-based HCWs. MI asked the Irish College of GPs for its position on the topic. In response, Dr Scott Walkin, the College’s Antimicrobial Resistance and Infection Control Clinical Lead, said: “Flu vaccination is the best way to protect ourselves, to protect the services we provide, and to protect our patients against influenza each winter. Vaccination is one of the most effective interventions in the modern medical toolkit. My key message: Vaccinate, vaccinate, vaccinate.”

A case for mandatory vaccination?

Questions about whether flu vaccination should be mandatory for HCWs have again been raised in light of the poor uptake this winter.

Those opposed to such a move caution that it could negatively impact staff morale, undermine individual autonomy, and potentially increase resistance, citing various studies to support this view (see panel).

Those in favour of mandatory flu vaccination for HCWs argue that it would offer better protection for both patients and staff. They say it is unacceptable to expose vulnerable individuals to preventable health risks when effective protective measures, such as flu vaccines, are available. They also point out that tolerance for a ‘hands-off’ approach to infectious disease prevention – such as the flu and Covid-19 – has declined since the pandemic.

During the 2018/19 flu season in Ireland, flu vaccine uptake among hospital-based HCWs was 53.2 per cent. For HCWs in LTCFs, it was even lower at 42.2 per cent – well below the then-target of
65 per cent.

At the time, the RCPI called for the introduction of mandatory seasonal flu vaccination for HCWs in high-risk clinical settings.

However, health authorities opted not to pursue this approach. Instead, they focused on improving uptake through enhanced access to vaccination, as well as awareness and education campaigns.

MI asked the RCPI if it still supported mandatory flu vaccination for HCWS in high-risk clinical settings. In response, a College spokesperson said the HSE National Immunisation Office would be best placed to comment.

However, they added the RCPI “recommends that all healthcare workers receive seasonal vaccinations in line with NIAC [national immunisation advisory committee] advice that states: In relation to HCWs, immunisation should be regarded as one part of good infection prevention and control practices, which include hand washing and universal precautions when dealing with body fluids. Immunisation is an essential component in preventing transmission of infections.”

What is the HSE doing?

In response to queries from MI about what steps it is taking to improve uptake of flu vaccine among HCWs, a HSE spokesperson said the Executive has developed and delivered extensive education and training materials for HCWs.

It added the Executive has supported the training of vaccinators, including peer vaccinators.

“The HSE is actively promoting flu vaccine uptake locally and nationally among HCWs and is facilitating access to vaccination through workplace clinics, mobile vaccination units and on-site vaccination. Additionally, HCWs have access to flu vaccines via GPs and pharmacies free of charge.”

The HSE facilitated over 1,600 onsite flu (and Covid-19 vaccine) clinics for HCWs this season.

The spokesperson confirmed that the HSE will review the 2024/25 winter vaccination programme to inform the planning and implementation of the 2025/26 winter vaccination programme.

Speaking to MI, HSE Chief Clinical Officer Dr Colm Henry acknowledged the poor uptake of flu vaccine among HCWs this winter had been “very disappointing”. Dr Henry admitted it was “a big drop compared to last year… despite our efforts to really bring the vaccine to them”.

As part of its strategy to improve flu vaccination uptake among HCWs, as well as for other infectious diseases and cohorts, the HSE will establish regional vaccination committees, he confirmed. These committees will be established in line with the new regional health areas.

“This is a significant priority. We want to increase uptake of the vaccine nationally among all HCWs, but particularly among those working with vulnerable patients.”

Dr Henry said that people sometimes forgot the impact of vaccination on disease burden globally, and what a powerful tool it is for protecting patients, HCWs themselves, and healthcare services.

“One of the single biggest health achievements in our lifetime is the millions of lives saved from vaccination, eradication of smallpox, near eradication of polio, and other diseases.”

He stressed the “enormous contribution” of HCWs in Ireland during the Covid-19 pandemic and the “huge efforts they made in administering and advocating for uptake of Covid-19 vaccines in a massive national effort, which saw an amazing uptake of 96 per cent”.

Asked about the possibility of mandatory flu vaccination for HCWs, Dr Henry said while it is always an option it is currently not favoured and not the approach he would advocate.

“It is always better in the long run to persuade people and have them be willing participants.”

Why flu vaccination matters

Healthcare staff are up to 10 times more likely to get the flu compared to the general population. It is estimated that at least 20 per cent of HCWs are infected with the flu every year and many continue to work despite being ill, which increases the risk of spread to their colleagues and patients.

As an infection control measure, achieving a high uptake of flu vaccination among healthcare workers is therefore crucial, the HPSC has noted. Concerted efforts are required, not to just maintain vaccination rates, but to actively improve on them.

Speaking to MI, Prof Sam McConkey, Head of the Department of International Health and Tropical Medicine at RCSI, and Consultant Physician in Infectious Diseases, Beaumont Hospital, Dublin, agrees that flu vaccination of HCWs is very important. Prof McConkey stressed that more needs to be done to improve uptake rates.

“During the Covid-19 pandemic flu vaccine uptake increased and its importance in protecting patients was really seen. Things have changed and Covid has reduced, but flu has increased and that same awareness is not there sadly,” he commented.

Asked if he was in favour of mandatory HCW vaccination, Prof McConkey said it is a complex consideration. He noted that support and incentivisation has traditionally been seen as the best approach. Prof McConkey acknowledged that childhood vaccinations are mandatory in many childcare settings and some vaccines are mandatory for HCWs in many countries/settings.

“However, I fear that it [mandatory flu vaccination for HCWs] would go down very badly and many would react against being forced into it…. I fear the reaction to that could make things worse than the imposition of that would make it better.”

However, Prof McConkey added that perhaps restricted practice would have to be considered for unvaccinated HCWs working with patients very vulnerable to flu, like in nursing homes. “They already do that in relation to hepatitis B vaccination. We do have obligations for HCWs to be tested for certain diseases, so perhaps restrictions on practice for those most vulnerable to flu may be an option and might be more acceptable.”

Prof McConkey confirmed he gets vaccinated against flu every season and “making flu vaccine as accessible as possible [is key]”.

“Bringing it to the staff so they don’t have to go out of their way to get it, and ongoing highlighting of the severity of clinical cases of flu, particularly in the older population and immunocompromised, is also important. Some of the mortality and morbidity from influenza may well be miscoded as things like heart attack, delirium or heart failure or flu was marked as incidental or the patient wasn’t tested for flu.”