Reference: April 2025 | Issue 4 | Vol 11 | Page 37
Annual seasonal influenza (flu) vaccination is recommended for all healthcare workers (HCW) in the HSE, to reduce their risk of contracting the flu and transmitting it onward to their patients. The current target for flu vaccine uptake among HCWs is 75 per cent. However, new HSE figures show that the overall uptake of the annual flu vaccine among HSE HCWs hit its lowest figure in almost a decade this season.
The most up-to-date data on flu vaccination uptake among 107,947 HSE HCWs from 16 September 2024 to 09 March 2025 show that around 34,000 were vaccinated, which represents 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 figure represents 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. In the 2020-21 season the take-up rate among hospital-based staff reached 71.4 per cent.
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 say 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, continuing the upward trend from the previous winter.
Flu-related hospitalisations also put significant pressure on the healthcare system this winter. There were 980 inpatients (49 in ICU) with laboratory-confirmed flu in the first week of 2025. This figure far exceeded the number hospitalised with Covid-19 (67) or respiratory syncytial virus (RSV) (271). From week 40 2024 to week 10 2025, 219 ICU admissions for flu and 274 deaths attributed to flu were notified.
While the 2024-2025 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, or around 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 HCWs the Covid-19 vaccine alongside the flu vaccine may be ‘off-putting’ for those who do not wish to get the Covid-19 vaccine.
Also, it is understood that some HCWs have expressed skepticism about the flu vaccine’s effectiveness, which can only be assessed after each flu season. In some years, effectiveness has fallen short of expectations due to flu strain mismatches.
Interim Chief Medical Officer, Prof Mary Horgan, said: “Vaccination against flu is a key priority of mine generally, but particularly so amongst HCWs. 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 rollout 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 HCWs, through various media channels,” Prof Horgan said
“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 HCWs, should ensure they do so to get full protection against flu.”
HPSC analysis
Last year, the HPSC published a report on the uptake of the seasonal flu vaccine in acute hospitals and long-term care residential facilities (LTCFs) in Ireland from 2011-2012 to 2023-2024. The report looked at uptake among HCWs in 55 hospitals (including four private facilities) 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, flu vaccine uptake in the 2023-24 season was highest in Dublin northeast hospitals, southeast hospitals, and paediatric hospitals, all exceeding 50 per cent. In contrast, uptake remained consistently lower in west and northwest 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.
Although uptake in LTCFs was generally highest among medical and dental staff, 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 despite the vulnerability of these patients.
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.
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).
The final figures for 2024-25 are being carefully reviewed to ensure consistency and accuracy with previous data collection methods, particularly in light of the significant drop to just 30.4 per cent. 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.
The HSE did not provide figures on uptake of flu vaccination among GPs, practice nurses, pharmacists, and other community-based HCWs. Dr Scott Walkin, the Irish College of General Practitioners’ 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.”
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 has declined since the pandemic.
During the 2018-2019 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 Royal College of Physicians of Ireland (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.
The RCPI was asked 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 that the RCPI “recommends that all HCWs 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.”
A spokesperson for the HSE said the Executive has developed and delivered extensive education and training materials for HCWs. It added that the HSE 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 onsite vaccination. Additionally, HCWs have access to flu vaccines via GPs and pharmacies free of charge.”
The HSE facilitated more than 1,600 onsite flu (and Covid-19 vaccine) clinics for HCWs this season.
The spokesperson confirmed that the HSE will review the 2024-2025 winter vaccination programme to inform the planning and implementation of the 2025-2026 winter vaccination programme.
HSE Chief Clinical Officer Dr Colm Henry described the poor uptake rate of flu vaccine among HCWs this winter as “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 that Irish HCWs made during the Covid-19 pandemic” during what was a very difficult time for the health service and the “huge efforts they made in administrating 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 willing participants.”
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 HCWs is therefore crucial, the HPSC has noted. Concerted efforts are required, not to just maintain vaccination rates but, to actively improve on them.
Prof Sam McConkey, Head of the Department of International Health and Tropical Medicine at the RCSI, and Consultant Physician in Infectious Diseases at Beaumont Hospital, Dublin, agrees that flu vaccination of HCWs is very important, and said 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 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 or settings. He said the issue is worthy of further discussion and consideration.
“However, I fear that [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,” he said.
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. He said “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 the 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.”
Irish healthcare workers’ attitudes to flu vaccination
During the 2016-17 flu season, a small study was carried out to investigate the attitude of HCWs towards, and beliefs about, seasonal flu vaccination in an Irish residential care facility for older adults. It found that of those who responded to the study survey, 57 per cent (20) were vaccinated.
Primary predictors of vaccination acceptance included protection of self and family, protection of patients, and agreement with mandatory vaccination. Reasons for vaccination avoidance included misconceptions about the need for vaccination among healthy HCWs (67 per cent); efficacy of the vaccine (60 per cent); lack of trust in the vaccine (47 per cent); and a belief that the vaccine may cause flu (47 per cent).
The study authors concluded that addressing HCWs’ beliefs relating to the personal benefits of vaccination while simultaneously correcting misconceptions may help to increase uptake among those working in residential care settings for older adults.
A larger, more recent, study of almost 600 participants, looking at attitudes to flu and Covid-19 vaccination, had similar findings. This study, which was published in the Irish Medical Journal (IMJ), highlighted that Irish HCWs have a good knowledge around requirements for vaccination. However, a sizeable minority believed vaccination would make them unwell and cause serious side effects.
Interestingly, 51 per cent said ‘yes’ when asked if they believed flu vaccination should be mandatory for HCWs, and 84 per cent said ‘yes’ when asked if people working in healthcare should have the flu vaccination every year. In addition, the IMJ study found that a large minority of HCWs would attend work while unwell with flu (32.77 per cent). Broken down by HCW role, medical and dental HCWs were more likely to attend work when unwell (55 per cent).
