Mandating influenza vaccinations for health care workers: analysing opportunities for policy change using Kingdon's agenda setting framework.
BACKGROUND
The consequences of annual influenza outbreaks are often underestimated by the general public. Influenza poses a serious public health threat around the world, particularly for the most vulnerable populations. Fortunately, vaccination can mitigate the negative effects of this common infectious disease. Although inoculating frontline health care workers (HCWs) helps minimize disease transmission, some HCWs continue to resist participating in voluntary immunization programs. A potential solution to this problem is government-mandated vaccination for HCWs; however, in practice, there are substantial barriers to the adoption of such policies. The purpose of this paper is to identify the likelihood of adopting a policy for mandatory immunization of HCWs in Ontario based on a historical review of barriers to the agenda setting process.


METHODS
Documents from secondary data sources were analysed using Kingdon's agenda setting framework of three converging streams leading to windows of opportunity for possible policy adoption.


RESULTS
The problems, politics, and policies streams of Kingdon's framework have converged and diverged repeatedly over an extended period (policy windows have opened and closed several times). In each instance, a technically feasible solution was available. However, despite the evidence supporting the value of HCW immunization, alignment of the three agenda setting streams occurred for very short periods of time, during which, opposition lobby groups reacted, making the proposed solution less politically acceptable.


CONCLUSIONS
Prior to the adoption of any new policies, issues must reach a government's decision agenda. Based on Kingdon's agenda setting framework, this only occurs when there is alignment of the problems, politics, and policies streams. Understanding this process makes it easier to predict the likelihood of a policy being adopted, and ultimately implemented. Such learning may be applied to policy issues in other jurisdictions. In the case of mandatory influenza vaccinations for HCWs in Ontario, it seems highly unlikely that a new policy will be adopted until perception of the problem's importance is sufficient to overcome the political opposition to implementing a solution and thus, create a window of opportunity that is open long enough to support change.
McMaster University, Hamilton, ON, Canada.
Angela
A
Jackson-Lee
McMaster University, Hamilton, ON, Canada.
Neil G
NG
Barr
McMaster University, Hamilton, ON, Canada. randalg@mcmaster.ca.
Glen E
http://orcid.org/0000-0003-3169-3922
GE
Randall
Agenda setting; Health care workers; Health policy; Influenza; Vaccination
Clin Infect Dis. 2013 Jun;56(12):1774-7
23449269
Health Law J. 2009;17:297-337
20608322
J Hosp Infect. 2011 Dec;79(4):279-86
21978606
Soc Sci Med. 2014 May;108:147-55
24641879
Aust N Z J Public Health. 2016 Jun;40(3):281-3
27028703
Clin Infect Dis. 2010 Feb 15;50(4):459-64
20064039
Clin Infect Dis. 2009 Sep 1;49(5):757-8
19624279
Cochrane Database Syst Rev. 2016 Jun 02;(6):CD005187
27251461
CMAJ. 2010 Sep 7;182(12):E542-8
20643836
Cochrane Database Syst Rev. 2014 Mar 13;(3):CD001269
24623315
Infect Control Hosp Epidemiol. 2004 Nov;25(11):908-11
15566022
Can J Infect Dis Med Microbiol. 2012 Winter;23(4):e93-5
24294284
PLoS Med. 2010 Apr 06;7(4):e1000256
20386727
PLoS One. 2011;6(10):e26239
22028840
J Natl Med Assoc. 2016 Feb;108(1):99-102
26928494
Vaccine. 2005 Oct 25;23(44):5133-43
16039762