Protecting Healthcare Workers Through Vaccination in Low- and Lower-Middle-Income Countries: Barriers and Next Steps

Healthcare workers play a vital role in providing medical care to individuals and communities. However, their work puts them at a higher risk of exposure to infectious diseases, including vaccine-preventable ones, than the general public. Vaccination is therefore an important part of protecting healthcare workers, supporting patient safety, and maintaining resilient health systems.

The World Health Organization (WHO) recommends vaccinations for healthcare workers, including BCG (tuberculosis), hepatitis B, polio, diphtheria, measles, rubella, meningococcal disease, influenza, varicella, pertussis, and COVID-19. Recommendations may vary by vaccine, occupational exposure, and national immunization guidance. Yet, despite established recommendations, health worker vaccination programs are not consistently implemented, particularly in low- and lower-middle-income countries.

The challenge extends beyond vaccine availability. Healthcare workers also need access to affordable vaccination, clear occupational immunization policies, reliable information, and programs that make vaccination part of routine workplace health and safety.

Why Routine Vaccination of Healthcare Workers Matters

Routine vaccination of healthcare workers helps protect them from vaccine-preventable infectious diseases and reduces the risk of transmission to patients and colleagues. It can also help prevent outbreaks that put additional pressure on healthcare systems and increase the costs of treating infected individuals.

Moreover, healthcare workers who are protected against vaccine-preventable diseases are less likely to miss work due to illness or infection, which can support workforce confidence and productivity. This is essential for maintaining quality healthcare and improving overall healthcare system efficiency. Similarly, vaccinated healthcare workers may feel more confident performing their duties, as they are less likely to experience stress and anxiety related to occupational exposure.

Protecting healthcare workers through vaccination is therefore an important component of occupational health and safety. It also demonstrates governments’ and healthcare organizations’ commitment to the people who deliver essential health services.

The WHO’s Implementation Guide for Vaccination of Health Workers provides guidance for countries seeking to establish or strengthen vaccination programs. It is intended for policy-makers, immunization program managers, healthcare facility managers, professional associations, and organizations representing health workers.

Despite the importance of routine vaccination, implementing policies for healthcare workers in low- and lower-middle-income countries still faces several challenges. In a recent article, researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce analyzed these barriers, proposed policy implementation recommendations, and examined the role of partnerships.

Main Barriers to Healthcare Worker Vaccination in Low- and Lower-Middle-Income Countries

According to the WFPHA policy and the research underpinning it, the main barriers to implementing routine vaccination policies for healthcare workers in low- and lower-middle-income countries include insufficient funding, limited vaccine availability, the absence of specific vaccination schedules for healthcare workers, a lack of evidence-based data, vaccine hesitancy, beliefs, and low health literacy.

These barriers are interconnected and can prevent healthcare workers from accessing vaccines even when recommendations and vaccination infrastructure exist.

1. Lack of Funding and Vaccine Availability

Funding shortages are often a major obstacle to introducing and maintaining effective vaccination programs. In low- and lower-middle-income countries, healthcare workers may be expected to pay for their own vaccinations rather than receiving them free of charge through their employer or national health system.

Although Gavi, the Vaccine Alliance, has made significant contributions to global immunization, funding and vaccine availability remain challenges for programs seeking to protect healthcare workers against a range of diseases. A lack of appropriate vaccines can further complicate implementation.

2. Lack of Evidence-Based Data

More research is needed on vaccination among healthcare workers in low- and lower-middle-income countries. Without reliable national data on vaccination coverage, occupational exposure, and the burden of vaccine-preventable diseases among healthcare workers, policy-makers may struggle to identify gaps and allocate resources effectively.

Evidence-based research, including studies examining disability-adjusted life years and quality-adjusted life years, could help inform policy decisions. Meta-analyses could also support developing and implementing appropriate strategies.

3. Vaccine Hesitancy, Beliefs, and Low Health Literacy

Vaccine hesitancy among healthcare workers, including concerns shaped by religious beliefs, misinformation, and limited awareness, is another important barrier to vaccine uptake.

In some settings, medical training does not provide sufficient education or opportunities to develop knowledge about vaccination. Even among trained health professionals, religious views and other personal beliefs can influence attitudes towards vaccines. Understanding these factors is important when designing appropriate awareness, education, and sensitization initiatives.

4. Lack of Dedicated Vaccination Schedules for Healthcare Workers

Another challenge is the lack of specific vaccination schedules and policies for healthcare workers. When immunization programs focus mainly on children and pregnant women, healthcare workers may not be recognized as a priority group requiring dedicated vaccination services.

Without clear schedules, designated funding, and institutional responsibility, vaccination can remain inconsistent across healthcare facilities and professional groups.

Recommendations for Improving Healthcare Worker Vaccination Policies

The WFPHA policy highlights several recommendations to address these barriers and strengthen routine vaccination programs for healthcare workers in low- and lower-middle-income countries.

These include:

• Expanding existing vaccination initiatives: Explore opportunities to extend the COVAX initiative to cover healthcare workers and build on vaccination infrastructure established during the COVID-19 pandemic.
   
• Building strategic partnerships: Strengthen collaboration with the WHO, Gavi, governments, universities, and communities to support policy development, funding, and implementation.
   
• Improving access and affordability: Consider mandatory insurance for healthcare workers that includes vaccination, and work towards providing recommended immunizations free of charge to recipients.

   

• Collecting national data: Develop systems to collect and monitor data on healthcare worker vaccination to help policymakers identify gaps and evaluate progress.
   
• Increasing awareness and health literacy: Strengthen vaccination education at university level and partner with health-related student organizations to improve awareness among future healthcare professionals.
  
  
• Strengthening advocacy: Promote action at different levels, from hospitals and healthcare institutions to national governments, through public health associations, academic institutions, and professional networks.
  
  
• Establishing dedicated vaccination schedules and funding: Introduce specific vaccination schedules and allocate resources for healthcare workers, as is done for other priority groups, including children and pregnant women.
  
  
• Integrating vaccination into occupational health and safety: Include healthcare worker vaccination in occupational safety plans and workplace health policies.

The Role of Partnerships in Implementing Vaccination Policies

Partnerships are essential to overcoming the challenges associated with healthcare worker vaccination. The WHO, Gavi, the World Bank, UNICEF, national governments, universities, public health associations, and healthcare organizations all have a role.

Ministries responsible for implementing vaccination policies should be involved from the beginning. Early engagement can help ensure recommendations align with national priorities, clarify implementation responsibilities, and consider necessary resources.

National public health associations can also support advocacy efforts by working with governments, ministries of health, healthcare professionals, and academic institutions. Collaboration with universities and schools of public health can strengthen education and awareness, while partnerships with health-related student organizations can help introduce vaccination literacy early in professional training.

At the healthcare facility level, public health specialists can work with hospital directors and occupational health teams to drive local progress. Once governments develop the necessary plans and policies, public health professionals should be trained to support implementation.

The WHO’s Implementation Guide for Vaccination of Health Workers provides further guidance on establishing and strengthening these programs. In addition, a review of health worker vaccination programs in low-, middle-, and upper-middle-income countries identified the use of existing immunization infrastructure, including the WHO Expanded Program on Immunization, and effective program management as important facilitators.

These findings reinforce the value of building on existing systems and partnerships rather than developing vaccination programs in isolation.

Turning Recommendations into Action: The Importance of Government Commitment

Implementing these recommendations requires governments’ genuine commitment to protecting healthcare workers. Regrettably, many governments have yet to prioritize protecting healthcare workers as essential to their nations’ well-being and prosperity. Consequently, this lack of prioritization hinders the successful implementation of the proposed recommendations, despite their potential for positive outcomes.

The WFPHA policy aims to support national public health associations and professionals worldwide in their advocacy efforts with governments and other organizations. Routine vaccination of healthcare workers aligns with international recommendations and standards set by organizations such as the WHO and the Centers for Disease Control and Prevention.

A dedicated policy for routine vaccination would send a clear message that governments and healthcare organizations are committed to the health and safety of their workers and the communities they serve. By implementing such policies, governments and organizations can encourage vaccine uptake, reduce outbreak risk, and strengthen protection across healthcare settings.

The WFPHA calls on governments to prioritize immunizing healthcare workers within national vaccination programs. This includes ensuring access to recommended vaccines free of charge, establishing dedicated vaccination schedules, collecting reliable data, and integrating immunization into occupational health and safety plans.

Protecting healthcare workers is an essential investment in health system resilience. Those who care for others must have access to the protection they need to work safely. Governments, public health associations, healthcare organizations, and international partners all have a role in turning this commitment into action.

Find the original article here.