With a new study finding that virtually none of the nation’s 150 Veterans Health Administration hospitals have mandatory flu shot policies for healthcare workers — leaving vaccination rates languishing in the 55% range — the VA system is considering a vaccine mandate to protect patients and coworkers, Hospital Employee Health has learned.
Given the repeated calls by leading medical groups for mandatory flu vaccination of healthcare workers to protect patients, the issue has taken on an air of historical inevitability that suggests the controversial matter is all but resolved. Not by a literal long shot. The recently published study1 suggests that healthcare worker immunization levels at VA hospitals have plateaued well below the Department of Health and Human Services goal of a 90% vaccination rate by 2020. Overall flu vaccination rates for healthcare workers nationally were estimated at 75%, but exceed 95% at facilities with mandatory policies, the authors reported.
Researchers at the University of Michigan Medical School and the Ann Arbor VA Healthcare System surveyed infection preventionists (IPs) at 386 non-VA hospitals and 77 VA facilities. Of the non-VA hospitals, 43% of the IPs responding said their facility mandated flu vaccination of all healthcare providers. Though the hospitals were not named, a 1.3% level of mandatory policies at the VA hospitals translates to a single outlier among the 77 federal facilities. Something short of a mandate appears to be in place at many hospitals, though the survey did not ask respondents to go into detail about the specifics of their policies. Overall, about one-fifth of hospitals without mandatory policies said unvaccinated staff had to sign declination forms and/or wear a mask while seeing patients during flu season. For example, the Ann Arbor VA has such a masking policy for care givers who decline immunization.
UNIONS IN PLACE
There are also pockets of entrenched resistance, as 28% of the IPs at VA hospitals said worker unions were a factor in the lack of a flu vaccine requirement. That could set the stage for labor negotiations and legal challenges if a mandate is enacted. Currently, the VA system does not have a national policy to mandate flu immunization of healthcare workers, and many hospitals are apparently waiting for the green light before pushing such policies. More than half of IPs in the 77 VA hospitals said they could not mandate the vaccine because they were part of a federal system that had no such national directive.
Since the survey was taken in 2013, the VA system has continued to encourage its hospitals to work toward near-universal vaccination by 2020, but voluntary immunization efforts historically have shown little evidence of the kind of dramatic, sustainable increase that would be necessary to take the health system from 55% to a 90% vaccination rate.
“I can tell you in conversations with our people at the Ann Arbor VA that they believe there have been recent developments at the [VHA] National Leadership Council — they may be moving toward mandatory vaccination of VA employees in the near future,” says M. Todd Greene, PhD, MPH, lead author of the study and a research investigator at the University of Michigan and the Ann Arbor VA.
There are tens of thousands of healthcare workers in the VA system, so mandating flu seasonal shot would no doubt be controversial. It would also be a monumental endorsement of public health in the face of a national anti-vaccine movement that has brought measles out of exile and threatens to erode critical coverage of other vaccines. The VA national office had not responded to a request for comment as this issue of HEH went to press, but it is no secret the VA has been considering a mandate for several years — particularly after it fell well short of an 80% immunization goal in 2011.2 Among the obstacles that have been cited are that the VA is larger than any organization that has implemented mandatory flu vaccination, adequate supply of vaccine could be an issue, and there are limited data definitively linking vaccination of healthcare workers with reduced influenza-related illness in patients.3 Another factor is the unwillingness of some hospital administrators to open this can of worms, as about 22% of those surveyed overall said simply that hospital leadership would not mandate the vaccine.
“To put it bluntly, American hospitals have a lot of work to do,” says Sanjay Saint, MD, MPH, senior author of the study.
In that regard, the VA system may conclude that it is time to get on the right side of history as more and more facilities mandate seasonal flu shots. Among the continuing calls for mandatory flu vaccine policies were two by highly influential groups in 2015; the American Nurses Association and the American Academy of Pediatrics (AAP).4,5 (See the Oct. 2015 and Jan. 2016 issues of HEH for more information.)
REFERENCES
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Greene MT, Fowler KE, Krein SL, et al. Influenza vaccination requirements for healthcare personnel in the U.S. hospitals: Results of a national survey. Infect Control Hosp Epidemiol. Published online: November 27 2015. DOI: http://dx.doi.org/10.1017/ice.2015.277.
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U.S. Department of Veterans Affairs. Office of Research & Development. Why do some health care workers decline flu vaccination? http://www.research.va.gov/news/features/flu_vaccination.cfm.
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Schult TM1, Awosika ER, Hodgson MJ, et al. Innovative approaches for understanding seasonal influenza vaccine declination in healthcare personnel support development of new campaign strategies. Infect Control Hosp Epidemiol 2012 Sep;33(9):924-931.
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American Nurses Association. Position Statement on Immunizations. July 21, 2015: http://bit.ly/1hsszCU.
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Bernstein HH, Starke JR. American Academy of Pediatrics Committee on Infectious Diseases, 2015–2016.Influenza Immunization for All Health Care Personnel: Keep It Mandatory. Pediatrics 2015;136:809-818.
