Background and Methods. Vaccination of all healthcare workers is widely recommended by health authorities and medical institutions and support for mandatory vaccination is increasing. This paper presents the relevant literature and examines the evidence for patient benefit from healthcare worker vaccination. Articles identified by Medline searches and citation lists were inspected for internal and external validity. Emphasis was put on RCTs. The literature on self-protection from vaccination is also presented. Results. Published research shows that personal benefit from vaccinating healthy nonelderly adults is small and there is no evidence that it is any different for HCWs. The studies aiming to prove the widespread belief that healthcare worker vaccination decreases patient morbidity and mortality are heavily flawed and the recommendations for vaccination biased. No reliable published evidence shows that healthcare workers' vaccination has substantial benefit for their patients—not in reducing patient morbidity or mortality and not even in increasing patient vaccination rates. Conclusion. The arguments for uniform healthcare worker influenza vaccination are not supported by existing literature. The decision whether to get vaccinated should, except possibly in extreme situations, be that of the individual healthcare worker, without legal, institutional, or peer coercion. 1. Introduction Vaccination of all healthcare workers (HCWs) is widely recommended by health authorities and medical institutions [1–3]. This recommendation is based on the argument that because of their proximity to patients, HCW vaccination protects themselves and their patients from influenza. The growing pressure on HCWs to vaccinate as part of their ethical professional responsibility is illustrated by the statement by the Canadian National Advisory Committee on Immunization for the 2010-2011 season that “in the absence of contraindications, refusal of HCWs who have direct patient contact to be immunized against influenza implies failure in their duty of care to patients” [2]. The fact that this is being taken even a step further with recommendations and pressure on institutions to mandate such vaccination at the expense of individual freedom and as a condition for continued employment [4] increases the urgency of examining the evidence. Is it sufficient for such draconian measures? The argument in favor of vaccinating all HCWs is based primarily on their obligation to protect their patients. However, in order to give a complete picture, the evidence base concerning personal HCW
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