Employee influenza vaccination in a large cancer center with high baseline compliance rates: comparison of carrot versus stick approaches

Am J Infect Control. 2015 Mar 1;43(3):228-33. doi: 10.1016/j.ajic.2014.11.025.


Background: Influenza is a major complication in patients with cancer and hematopoietic cell transplant recipients. We set out to maximize influenza vaccination rates in health care personnel at our large ambulatory cancer center with high baseline compliance and to assess alternatives to mandatory policies.

Methods: Baseline influenza vaccine compliance rates at our center were >85%. During 2011 an incentive-based "carrot" campaign was implemented, and in 2012 a penalty-based "stick" approach to declining staff was required. Yearly approaches were compared using Kaplan-Meier survival estimates.

Results: Both the incentive and penalty approaches significantly improved the baseline rates of vaccination (2010 vs 2011 P = .0001 and 2010 vs 2012 P < .0001), and 2012 significantly improved over 2011 (P < .0001). Staff with direct patient contact had significantly higher rates of vaccination compared with those with indirect and minimal contact in every campaign year, except in the penalty-driven campaign from 2012 (P < .001, P < .001, and P = .24 and P < .001, P < .001, and P = .17, respectively).

Conclusions: A multifaceted staff vaccination program that included education, training, and active declination was more effective than a program offering incentives. Improvements in vaccination rates in the penalty-driven campaign were driven by staff without direct care responsibilities. High compliance with systemwide influenza vaccination was achieved without requiring mandatory vaccination.

Keywords: Compliance; Health care personnel; Occupational health; Vaccine.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Behavior Therapy*
  • Cancer Care Facilities
  • Cohort Studies
  • Female
  • Guideline Adherence*
  • Health Personnel*
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / prevention & control*
  • Male
  • Middle Aged
  • Vaccination / statistics & numerical data
  • Young Adult


  • Influenza Vaccines