Needed: less influenza vaccine hesitancy and less presenteeism among health care workers in the COVID-19 era

Grech, Victor; Borg, Michael; Gauci, Charmaine; Barbara, Christopher; Montalto, Simon Attard; Agius, Steve; Falzon, Celia

Seasonal influenza causes significant morbidity and mortality, and healthcare-associated disease is particularly problematic as it affects high-risk groups. For this reason, annual vaccination against influenza is generally recommended for all healthcare workers, thereby embracing the twin principles of beneficence and non-maleficence. The cost and burden of influenza vaccination is minimal, and it has been argued that employing institutions are under an obligation to ensure that employees are universally vaccinated. Presenteeism, i.e. reporting for work when unwell, is another significant cause of nosocomial infection and may easily occur as even in the hypothetical ideal situation of 100% vaccination coverage, the influenza vaccine is not 100% effective. This paper reviews the combined benefits of increased vaccination rates and reduced presenteeism rates in healthcare workers, particularly in the event of a winter surge in COVID-19 infections that will result in simultaneous infection with influenza and COVID-19, with potentially severe consequences.