title: Nudges or mandates? The ethics of mandatory flu vaccination.
abstract: According to the CDC report for the 2012-2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011-2012, to 72% in 2012-2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.
authors: REIDS Fellow, Center for Interdisciplinary Research on AIDS Yale University, New Haven, CT 06510, USA; Florida Hospital Celebration Health, 400 Celebration Ave, Celebration, FL 34747, USA. Electronic address: oleksandr.dubov@yale.edu.
authors: Alex
authors: A
authors: Dubov
authors: University of Chicago Section of Hematology/Oncology School of Medicine, 5841 South Maryland Ave., MC 2115, Chicago, IL, USA. Electronic address: cphung@medicine.bsd.uchicago.edu.
authors: Connie
authors: C
authors: Phung
mesh_terms: D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D037141:Mandatory Programs / Q000941:ethics*; D013997:Time Factors; D014611:Vaccination / Q000941:ethics* / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines
keywords: Behavioral economics; Choice architecture; Healthcare professionals; Influenza vaccination; Vaccination mandates