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Content analysis of requests for religious exemptions from a mandatory influenza vaccination program for healthcare personnel
  1. Armand H Antommaria1,
  2. Cynthia A Prows2,3
  1. 1 Ethics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3 Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Armand H Antommaria, Ethics Center, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA; Armand.Antommaria{at}


Objective Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why.

Methods Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season.

Results Twelve of 15 260 (0.08%) employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors voluntarily identified their religious affiliation, and most were Christian (n=9). Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1–5 (mean 2.6) categories. The most frequently cited category (n=9) was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals (n=6) also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved.

Conclusions Less than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors’ concerns.

  • influenza vaccines
  • immunisation programmes
  • mass vaccination
  • health personnel
  • mandatory programmes
  • religious exemptions

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  • Contributors AHA conceived and drafted the work. AHA and CAP designed the study methods, analysed and interpreted the data and granted final approval for the version to be submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Marquitashua Meatchem and AHA acquired the data. CAP and William Ford III revised it critically for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available.

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