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Furthermore, recent reviews highlight the lack of clear evidence to support the benefit of vaccinating HCWs  to prevent the spread of influenza to elderly .
Within high-income countries, influenza vaccination is readily accessible and many jurisdictions have implemented publicly funded programs to cover the cost .
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The purpose of this paper is to identify the likelihood of adopting a policy for mandatory immunization of HCWs in Ontario based on a historical review of barriers to the agenda setting process.
Methods Documents from secondary data sources were analysed using Kingdon’s agenda setting framework of three converging streams leading to windows of opportunity for possible policy adoption.
Background The consequences of annual influenza outbreaks are often underestimated by the general public.However, despite the evidence supporting the value of HCW immunization, alignment of the three agenda setting streams occurred for very short periods of time, during which, opposition lobby groups reacted, making the proposed solution less politically acceptable.Conclusions Prior to the adoption of any new policies, issues must reach a government’s decision agenda.Such learning may be applied to policy issues in other jurisdictions.
In the case of mandatory influenza vaccinations for HCWs in Ontario, it seems highly unlikely that a new policy will be adopted until perception of the problem’s importance is sufficient to overcome the political opposition to implementing a solution and thus, create a window of opportunity that is open long enough to support change. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.
In the United States, individuals who were 65 or older consistently accounted for approximately 90 % of all influenza related deaths between 19 .