Should flu shots be mandatory?
Should flu shots be mandatory?
Experts weigh pros, cons
Cautioning that an influenza pandemic could be looming, officers of Infectious Diseases Society of America (ISDA) and at least one state medical association are urging that health care workers be required to receive the flu vaccine.
"Unfortunately, health care workers caring for sick people often spread patients’ infections," says Andrew T. Pavia, chair of IDSA’s task force on pandemic influenza, and professor and chief of the division of pediatric infectious diseases at the University of Utah Health Sciences Center and Primary Children’s Hospital. "In 2002, only 36% of U.S. health care workers received influenza vaccine."
Pavia told a Congressional committee in May that the ISDA believes patient safety depends on required flu vaccinations for all health care workers who have contact with patients, "to prevent unnecessary deaths and disease, and to provide an example to patients."
Pavia’s comments were made before the U.S. House Energy and Commerce Subcommittee on Health, in hearings that focused on the threat of
pandemic flu and America’s level of preparedness.
Infectious disease experts warn that the H5N1 avian virus, or bird flu, is particularly threatening. According to the World Health Organization, in data available as of early June, at least 97 people had become infected with H5N1 in Asia, resulting in 53 fatalities. If it becomes easily transmissible from person to person, experts say, it could easily spread worldwide. Pavia says compared to the 2.5% to 5% mortality rate of the influenza pandemic of 1918, which killed as many as 100,000 people worldwide, H5N1 currently has a mortality rate of 50%.
"The U.S. population has no immunity and therefore no protection against this deadly virus," says Pavia. The CDC predicts even a mild pandemic could kill at least 100,000 people in the United States if the nation is caught unprepared.
While some view threats like avian flu to be indicators of a need for mandatory vaccine in heath care workers who have patient contact, organizations that represent other groups of health care professionals are resisting the idea.
Mandatory vaccines not popular
Virginia Mason Medical Center (VMMC) in Seattle drew national attention — and the ire of the American Nurses Association (ANA) and other union groups — in 2004 when it attempted to mandate flu vaccines for all of its health care workers. The program died quickly because of threats of legal action and because the national vaccine shortage caused the available doses to be prioritized for other groups.
Kim Davis, the medical center’s communications manager, says the idea has not been dis-carded completely, however. The hospital, including employee representatives, is drawing up a plan for the coming flu season that it hopes will gain greater vaccination rates than were seen last year.
"The American Nurses Association strongly encourages health care workers to be vaccinated," says Carol Cooke, ANA spokeswoman.
Cooke says the ANA’s position is that the current rates of immunization are alarmingly low, given health care professionals’ categorization as an influenza high-risk group, their access to the vaccine, and their daily contact with patients, many of whom also are in flu high-risk categories.
"But we have not changed our position about mandatory vaccinations," she states. "We could not support mandatory vaccinations at this time, and believe it is a nurse’s personal decision."
The California Medical Association (CMA), seeking to improve the rate at which health care workers are immunized against the flu, presented proposals to both the American Medical Association (AMA) and the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO) in recent months. Rather than seeking legislation mandating that physicians, nurses, and others who are in direct patient contact be vaccinated, the California association opted
to push for accreditation and professional standards.
AMA policy requires hospital medical staffs to delineate under what circumstances immunizations are administered. The CMA seeks AMA help in pushing hospitals create systems for maximizing the number of health care workers receiving the vaccine, but does not specifically ask that each and every worker be vaccinated.
Mark Forstneger, spokesman for JCAHO, says the joint commission is contemplating the issue of required vaccinations. He refers to comments made by Robert Wise, MD, vice president of JCAHO’s division of standards, who told the AMA that the commission is going to wait for more scientific information before deciding whether to impose a requirement for vaccinations.
Advocates of mandatory vaccinations say to immunize doctors, nurses, and other health care workers who come in contact with patients would reduce the flu’s transmission to patients, reduce transmission among staff, and reduce the number of staff sick days, thereby avoiding impact on patient care that can be caused by too few staff.
VMMC attempted to mandate flu vaccines for all of its health care workers last year, but the program never got off the ground because of the vaccine shortage and because its nurses union threatened a lawsuit, says Davis. Internal teams are in the process of devising a plan for this flu season, she reports.
Pavia told Congress that the spread of infection, especially the flu, from health care workers to patients can be stemmed.
"The sad truth is that health care workers who care for sick patients can spread infections," he said during the hearing. "Only about one-third of U.S. health care workers received influenza vaccine in 2002. That’s a dismal record and we should not accept it."
The IDSA would like to see legislation requiring health care workers in direct contact with patients to be vaccinated, with waivers permitted in select cases.
The Service Employees International Union (SEIU), which represents some 900,000 people working in health care in the United States, supports education, not mandates, to boost vaccination rates.
Bill Borwegen, MPH, director of occupational health and safety for SEIU, says the union supports "comprehensive flu vaccine education by a knowledgeable presenter within a classroom setting with an opportunity for students to ask questions."
"This is the only way to overcome significant misinformation about the safety and efficacy of this vaccine," he says. "We also support free and easy on-the-job vaccinations. The literature demonstrates that these approaches double the vaccination rates."
Borwegen says mandating vaccinations before trying to boost vaccination rates among health care workers through education and incentives will backfire.
"My conversations with health care workers tells me the crux of this matter is that there are serious misunderstandings about the safety and effectiveness of the flu vaccine that really need to be dealt with first and foremost, with a serious educational effort that has heretofore not occurred in most workplaces," he explains. "Otherwise, how do you explain the very high flu vaccination rates in some hospitals that do have comprehensive education programs and easy vaccine access but do not require workers to sign a declination form [if they refuse]?"
Borwegen says a forced program only will alienate health care workers against not only the flu vaccine, but other vaccine programs (hepatitis, for example) as well."We think it is crazy to start forcing vaccinations before trying these proven methods of education and free availability that have been shown to work," he says.
The CDC has named the following groups as priority recipients of inactivated influenza vaccine:
- all children ages 6-23 months;
- adults ages > 65 years;
- people ages 2-64 years with underlying chronic medical conditions;
- all women who will be pregnant during the influenza season;
- residents of nursing homes and long-term care facilities;
- children ages 2-18 years on chronic aspirin therapy;
- health care workers involved in direct patient care;
- out-of-home caregivers and household contacts of children ages < 6 months.
[For more information, contact:
- Bill Borwegen, MPH, Director, Occupational Health & Safety, Service Employees International Union, 1313 L St. N.W., Washington, DC 20005. Phone: (202) 898-3385. E-mail: [email protected].
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Web: www.cdc. gov/flu.
- Carol Cooke, Senior Public Relations Specialist, American Nurses Association, 8515 Georgia Ave., Suite 400, Silver Spring, MD 20910. Phone: (301) 628-5000. E-mail: [email protected].
- Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5000.] n
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.