In the United States, hospital systems have shifted from earlier COVID-19 vaccine mandates toward a voluntary approach. Many hospitals initially required staff vaccination in 2021-2022, bolstered by federal rules at the time. However, with the end of the Public Health Emergency and withdrawal of the federal Centers for Medicare & Medicaid Services (CMS) mandate in 2023, most U.S. hospitals dropped COVID-19 vaccination as an employment requirement [1]. For example, Southern Illinois Healthcare announced that as of July 1, 2023, it “will no longer require COVID vaccination as a condition of employment,” citing the end of the emergency and CMS’s reversal of its mandate [1]. Instead of mandates, hospitals now emphasize education and encouragement. Vaccination remains “the most important tool” to prevent severe illness, and employees are urged to stay up to date with boosters on a voluntary basis [1][2]. While staff are no longer compelled by policy to vaccinate, they are still expected to act responsibly to protect patients, much like with flu shots and other infection control measures.
One consequence of moving to voluntary vaccination has been a notable decline in booster uptake among health care workers. A CDC study found that fewer than one in six health care workers in U.S. hospitals and nursing homes received the 2023–2024 COVID-19 booster during the fall respiratory virus season [3]. This drop-off followed the lifting of the federal vaccine mandate in mid-2023 and the end of broad free vaccine availability [3]. By comparison, flu vaccination rates among hospital staff remained much higher (over 80% in the same period) [3]. Reasons cited include complacency due to past infection or prior doses, lower confidence in the new booster’s benefits, and lack of workplace requirements [3]. The low booster coverage raises concerns, since waning immunity may leave health workers and their patients more vulnerable. Public health officials stress that it is important for health personnel to stay current on COVID-19 vaccination to reduce illness and staffing disruptions [3]. Unlike influenza vaccination (which is strongly recommended every year for health workers and in some cases required by hospitals), COVID-19 shots are now voluntary in most workplaces. This puts the onus on hospital leadership and occupational health teams to promote the vaccine’s value and make it as convenient as possible for staff to receive.
Role of Occupational Health Clinics in Staff Vaccination
Hospital Occupational Health (Employee Health) departments play a pivotal role in providing and tracking vaccinations for health care personnel. With COVID-19 vaccines shifting into a routine preventative measure, Occupational Health clinics are integrating them alongside annual flu shots and other employee health services. These clinics typically organize on-site vaccination programs to ensure easy access for busy hospital staff. For instance, at Vanderbilt University Medical Center, the Occupational Health Clinic provides “several convenient options for employees to receive a 2024–25 COVID-19 vaccine,” including daily walk-in hours at the clinic, pop-up vaccine events, and even mobile OHC visits to hospital departments [2]. Such on-site clinics and flexible scheduling help remove barriers so that clinical and support staff can get immunized during work shifts. Many systems also allow employees to get vaccinated in the community (e.g. local pharmacies or primary care) and then voluntarily report their dose to Occupational Health for record-keeping [2].
Notably, most U.S. hospital employers have made COVID-19 vaccination purely voluntary for staff at this stage. In the Vanderbilt example, “the updated COVID-19 vaccine is currently not required for employees and submission of vaccine documentation is voluntary” [2]. This reflects the broader trend nationwide – COVID shots are encouraged as a matter of employee and patient safety, but not mandated. Occupational Health teams therefore focus on education (e.g. sharing data on vaccine effectiveness and safety), convenient access, and incentives rather than enforcement. They also continue to monitor vaccination rates and infection rates among staff, advising leadership if additional measures are needed. Employer-sponsored vaccination programs remain an effective strategy to boost uptake; by offering COVID-19 vaccines on-site at no cost, hospitals can increase the likelihood that staff will choose to get the booster [4]. Making vaccination part of the workplace culture – akin to hand hygiene or yearly flu vaccination – is a key goal for Occupational Health in the post-mandate era.
Preparing for the 2025 Booster Season
As the health care system heads into 2025, hospital administrators and Occupational Health services are preparing for another COVID-19 booster campaign. COVID-19 is now treated as a seasonal respiratory virus, with updated vaccines formulated annually to target the latest variants – much like the flu vaccine. The CDC currently recommends the 2024–2025 COVID-19 vaccine for most adults (including health care personnel) to bolster protection against evolving strains [5]. In anticipation of the fall 2025 booster season, hospitals are planning to integrate COVID boosters into their annual immunization drives for employees. This means securing an adequate supply of the updated vaccine, scheduling staff clinics, and launching communication efforts to inform all employees about booster availability and eligibility.
Occupational Health departments will typically offer on-site COVID-19 booster clinics in coordination with the hospital’s flu shot campaign. Many are adopting a “one-stop” approach – encouraging staff to get their COVID-19 booster and flu shot during the same visit for convenience. Hospitals are also reviewing lessons learned from the previous year’s low booster uptake. There is recognition that more education may be needed to combat misinformation and apathy. Infection prevention experts emphasize to staff that even if prior vaccination or infection has conferred some immunity, an updated booster can significantly reduce the risk of severe illness, long COVID, and missed work days. To improve participation, some systems are considering small incentives (like free meal vouchers or raffle entries) or providing booster shots at multiple easily accessible sites (e.g. main hospital campus, outpatient centers, night shift rounds). The focus for 2025 is on voluntary but highly encouraged vaccination – framing it as a standard part of protecting health care workers and patients each year. Hospital leadership and Occupational Health will closely monitor booster uptake and COVID case trends, ready to adjust policies if a more dangerous variant emerges. Overall, preparation for the 2025 booster season is about normalizing COVID-19 vaccination as routine preventive care for health workers, without resorting to strict mandates.
International Comparisons: Canada, UK, Australia, EU
COVID-19 vaccination policies for health care workers have followed a similar trajectory in many other countries – initial mandates have given way to voluntary approaches, with Occupational Health or public health agencies now focused on encouragement and booster campaigns rather than enforcement.
Canada: In Canada, vaccine requirements for hospital and long-term care workers were enacted on a provincial basis. Several provinces introduced mandates in late 2021, but these proved contentious. Quebec, for example, backtracked and cancelled its planned mandate for health workers due to fears of staffing shortages, and Ontario likewise decided not to impose a province-wide mandate on hospital staff [6]. Some provinces (e.g. British Columbia) did require vaccination for health facility workers under public health orders, but by 2023 even those policies were being re-evaluated. Most Canadian health authorities have since moved to a voluntary vaccination model for employees, emphasizing strong recommendations. No province today outright requires the new COVID boosters for health care workers, though workers are urged to stay up to date per national guidance. Hospitals across Canada continue to run staff vaccination clinics and campaigns through their Occupational Health services, much as they do for influenza. Uptake of boosters has been variable, but the approach remains one of education and easy access rather than mandates.
United Kingdom: The UK’s National Health Service (NHS) initially considered making COVID-19 vaccination compulsory for front-line staff in England, but the policy was reversed before full implementation. In early 2022 the government announced that NHS and social care workers would no longer be “required by law to get vaccinated,” after concerns that the mandate could exacerbate staffing crises [7]. (England had already mandated the vaccine for nursing home workers in 2021, but that requirement was also lifted in 2022.) Since then, COVID-19 vaccination for health workers in the UK has been voluntary. NHS trusts strongly encourage staff to receive all recommended doses and boosters as a professional responsibility, and Occupational Health departments coordinate free staff vaccination clinics each season. Uptake in NHS hospitals has been modest – similar to the general population trend – but many staff do get the autumn COVID booster alongside the flu jab, which is widely promoted. While no longer mandatory, vaccination is still considered an important part of NHS infection control strategy, and unvaccinated staff may be reassigned away from extremely high-risk patient areas during outbreaks. Overall, the UK has shifted to relying on persuasion, convenient access, and an appeal to health workers’ duty of care to maintain high vaccination coverage.
Australia: In Australia, health care worker vaccination requirements were imposed at the state level during the pandemic emergency. All states and territories mandated COVID-19 vaccination for hospital and aged-care workers in 2021, which was largely accepted at the time. As the situation evolved, states began rescinding these orders. By 2023, for example, Queensland and Western Australia had removed their COVID vaccine requirements for health workers [8]. New South Wales announced in 2024 that it would end its health worker vaccine mandate as well, deeming it no longer necessary given widespread immunity and lower case severity [8]. Victoria also revoked its pandemic orders in late 2024; the state now “strongly recommends” that health care workers remain up to date with COVID vaccines per national guidelines, instead of requiring them [9]. Today, no Australian state maintains a COVID vaccine mandate for health personnel. Hospitals continue to provide the vaccines to staff (often via in-house staff clinics or local GPs/pharmacies) and include COVID boosters in annual staff health programs. Similar to elsewhere, Australian health authorities are focusing on recommending boosters to protect the workforce and patients, rather than enforcing compliance. It is worth noting that flu vaccination is still mandated for certain health care roles in some Australian jurisdictions (e.g. in Victoria, annual flu shots are required for workers in high-risk settings [9]), but COVID-19 shots have transitioned to voluntary status across the country.
Europe: Across Europe, countries that once made COVID-19 vaccination compulsory for health workers have largely ended those requirements. France provides a clear example: in 2021 France mandated vaccination for all health and elder-care workers, a rule that led to the suspension of several thousand unvaccinated staff. But by March 2023, France’s Haute Autorité de Santé recommended lifting this obligation, and the government officially rescinded the health worker vaccine mandate while still “strongly recommending” the vaccine [10]. This allowed unvaccinated doctors and nurses to return to work [10]. Italy had a similar trajectory – it mandated COVID vaccination for health care personnel in 2021 (with suspension for non-compliance), but the mandate was dropped in late 2022. The new Italian government reinstated unvaccinated health workers and canceled fines, citing the improved COVID situation and urgent staffing needs [11]. Other EU countries that implemented mandates, such as Greece and Portugal, have also ended or relaxed them by 2023. At present, no EU country has an active blanket COVID vaccine mandate for health workers, though some still require proof of vaccination or regular testing in specific high-risk facilities. European hospitals are now focusing on voluntary booster campaigns; for instance, France and Germany strongly encourage annual boosters for medical staff ahead of winter, delivered through workplace clinics or primary care, but do not enforce it. The European Centre for Disease Prevention and Control (ECDC) continues to advise that health workers maintain up-to-date vaccination status as part of occupational safety, but the approach is through guidance and encouragement. In summary, internationally the trend aligns with the U.S. experience – initial mandates have given way to voluntary vaccination in Occupational Health practice, with an emphasis on protecting health care workers and patients via education, convenience, and ongoing booster recommendations rather than compulsory measures.
References
- Southern Illinois Healthcare – “SIH Removing COVID Vaccination Requirement as Condition of Employment” (Press Release, June 28, 2023). URL: https://www.sih.net/news/2023/sih-removing-covid-vaccination-requirement
- Vanderbilt University Medical Center – “Convenient options for employees to receive 2024-25 COVID vaccine” (VUMC News, Sept. 18, 2024). URL: https://news.vumc.org/2024/09/18/convenient-options-for-employees-to-receive-2024-25-covid-vaccine/
- Axios – “Less than 1 in 6 health workers got COVID booster” (Nov. 4, 2024). URL: https://www.axios.com/2024/11/04/health-workers-covid-booster-rates
- CDC Safe Healthcare Blog – “Healthcare Worker Vaccination is Important for Respiratory Virus Season 2024” (J. Glowicz, RN, posted Jan 31, 2025). URL: https://blogs.cdc.gov/safehealthcare/hcw-vaccination-respiratory-virus-season-2024/
- Centers for Disease Control and Prevention – “Staying Up to Date with COVID-19 Vaccines” (CDC guidance page, updated June 6, 2025). URL: https://www.cdc.gov/covid/vaccines/stay-up-to-date.html
- Angus Reid Institute – “Vaccine Passport or Pink Slip? 70% say health workers, teachers & others should be fired for refusing inoculation” (Nov 8, 2021). URL: https://angusreid.org/covid-firing-booster/
- The Guardian – “Mandatory Covid jabs for healthcare workers in England to be scrapped” (Andrew Gregory, Mar 1, 2022). URL: https://www.theguardian.com/politics/2022/mar/01/mandatory-covid-jabs-dropped-nhs-staff-england-march-health-social-care-workers
- Murdoch Children’s Research Institute (The Conversation) – “NSW may end its COVID vaccine mandate for health workers. That doesn’t mean it was a bad idea in the first place.” (K. Attwell & J. Kaufman, Apr 1, 2024). URL: https://www.mcri.edu.au/news/insights-and-opinions/nsw-may-end-its-covid-vaccine-mandate-for-health-workers
- Victoria Department of Health (Australia) – “Vaccination for healthcare workers – COVID-19 vaccination” (Policy Update, reviewed May 8, 2025). URL: https://www.health.vic.gov.au/immunisation/vaccination-for-healthcare-workers#covid-19-vaccination
- Reuters – “COVID-19 vaccination for health workers no longer mandatory, but favoured, France’s health body says” (Mar 30, 2023). URL: https://www.reuters.com/business/healthcare-pharmaceuticals/covid-19-vaccination-health-workers-no-longer-mandatory-favoured-frances-health-2023-03-30/
- Reuters – “Italy to end ban on health workers not vaccinated against Covid” (Oct 28, 2022). URL: https://www.reuters.com/business/healthcare-pharmaceuticals/italy-end-ban-health-workers-not-vaccinated-against-covid-2022-10-28/
