Table 1 Windows of opportunity for policy change (mandatory vaccination of health care workers)

Problems

(perception there is a problem that needs to be acted addressed)

▪ ER overcrowding due to heavy flu season resulting in reduced access to care

▪ SARS (severe acute respiratory syndrome) outbreak

▪ H1N1 outbreak/pandemic

▪ Growing calls from experts for mandatory HCW immunization

Politics

(events promoting or inhibiting political action)

▪ Heightened media attention pressures government to act

▪ Court challenges in opposition to mandatory HCW vaccination

▪ Production delays, low vaccine supplies and rationing

▪ H1N1 outbreak turns out to be mild (loss of public interest)

▪ Evidence of cost-effectiveness of flu vaccination

▪ Other jurisdictions adopting mandatory policies for HCWs

Policies

(availability and feasibility of options)

▪ Wide availability of public vaccination programs

▪ Favorable arbitrator ruling on mandatory HCW vaccinations

▪ Favorable court rulings on mandatory HCW vaccinations