A review of health worker vaccination programs in low, middle and upper middle-income countries

Abstract

Objectives: Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Study design: A PubMed Literature search.

Methods: A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Results: The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW.

Conclusions: The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.

Keywords: Health workers; Immunization programs; Low-income countries; Lower-middle income countries; Upper middle-income countries; Vaccination.

Fig. 1

Article selection process (PRISMA diagram). *Reasons for exclusion: Did not mention policies or programs related to HW vaccination = 81, Were not available in English = 7, Were outdated (published before 2000) = 7, Full text was not available = 2.

Fig. 2

Articles origin according to WHO regions (AFR: African region, AMR: region of the Americas, EMR: Eastern Mediterranean region, EUR: European region, SEAR: South-East Asian region, WPR: Western Pacific region.