In a 2013 survey of hospitals, only 1.3% of Veterans Affairs facilities reported that they require all healthcare workers who provide patient care to receive annual flu vaccination, while the rate was 42.7% for non-VA hospitals. The findings were published in Infection Control and Hospital Epidemiology.

A total of 386 hospitals and 77 Veterans Affairs facilities responded to the survey, according to researchers from University of Michigan Medical School.

According to the research, either the administrations or human resources departments of 22.3% of non-VA facilities did not require vaccination. Other common reasons for not mandating vaccination included policies strongly encouraging vaccines but not requiring them (21.9%), and the use of declination policies, with a signed form and/or mask required (21.4%). Among VA hospitals, 56.6% cited the lack of a federal VA mandate, while 27.6% reported union resistance to mandatory influenza vaccination.