Flu vaccine – CMAJ says it should be mandatory for health care workers

It’s a question of individual rights versus collective rights. The evidence is far from perfect, and the issue highly divisive among health care workers.

The influential Canadian Medical Association Journal raised many eyebrows when it recently took the position that all people who work in a health care institution be vaccinated for influenza.

The CMAJ’s Dr. Ken Flegel says the views are those of the editors of the Journal, not that of the Canadian Medical Association. There’s a good reason for that – most doctors do not get the annual flu shot. Speaking to a Toronto meeting of the National Union’s Canadian Health Professional Secretariat on November 20, Flegel laid down a challenge to the group: increase voluntary vaccination rates to avoid having the flu vaccine made mandatory in your province.

Dr. Ken Flegel

Dr. Ken Flegel, Senior Associate Editor of the Canadian Medical Association Journal.

British Columbia is the first Canadian province to take that step — a move health care workers in that province are challenging. While many support the need for broader vaccination rates, most unions are reluctant to give up the autonomy of health care workers to decide what goes into their body.

In Ontario many health care employers have defacto mandatory requirements – if you don’t get the shot, you don’t work under certain circumstances. Others are more willing to move unvaccinated health care workers to environments where there is less risk to patients or suggest that workers use up vacation credits when an outbreak takes place.

According to Flegel about 40 per cent of Canadian health care workers take the annual vaccine despite the fact that 10 to 20 per cent of health care workers are likely to get the annual influenza.

“Typically our hospital patients are very sick, very elderly and very immuno-suppressed,” said Flegel. He argued the increase in acuity of hospital patients in recent years suggests patients are less able to fight off a new infection or mount an immune response.

That population is particularly at risk given workers can be asymptomatic and still shed the virus.

Each year there are about 20,000 influenza related hospital admissions resulting in 4,000-8,000 deaths.

Flegel admits that research on the effectiveness of the flu vaccine is very limited, but randomized trials suggest that between 5-20 per cent of seasonal mortality could be prevented if staff vaccination rates were improved.

“That’s huge,” he says, although admits the studies have been challenged as being too small to be entirely validated.

While not perfect, there is enough evidence to suggest a significant benefit he says.

Flegel does admit that workers are only one source of the flu virus – estimating that the flu in hospitals is carried 40 per cent by health care workers, 40 per cent by visitors, and 20 per cent by patients.

Nor is taking the vaccine a guarantee that you won’t get the flu – he says recent studies have downgraded the efficacy, but it is still at least 50 per cent.

He says you can’t ask visitors to increase their own rate of vaccination without first setting an example among hospital workers.

Flegel admits there are some people who should never have a flu shot, ranging from those who have a negative physical reaction to those who simply could not sleep at night over the prospect of the vaccine.

While the effectiveness may be at issue, Flegel says the science would indicate the vaccine is “believed by experts to be safe.” In fact, he says, the flu vaccine has less risk than vaccines travelers often receive without question.

Public Health Ontario recently changed its guidelines, suggesting the flu vaccine be made mandatory.

The issue is also clouded by other contradictions.

While hospitals are urging workers to get the vaccine, attendance management programs also encourage workers to come to work sick and place the same patient population at unnecessary risk.

As hospitals routinely discipline workers over issues of patient confidentiality, some Canadian hospitals are violating that same confidentiality by making workers wear stickers saying they have had the vaccine, or wearing a mask to indicate they haven’t.

Others worry that surrendering such personal autonomy will lead to other intrusions by the employer, including mandatory drug testing.

Let us know what you think by commenting below.

5 responses to “Flu vaccine – CMAJ says it should be mandatory for health care workers

  1. How do we fight this ? I will not take a flu shot. I have had 2 and they both almost killed me. I should the right to decide.

  2. I do not agree that Flu shots should be mandatory

    The points raised in “the issue is clouded by other contradictions” is very much understated

    So-called attendance management programs are used by some employers to harass, intimidate, threaten and bully their employee’s into coming to work ill and or injured under threat of loss of sick benefits

    Some front line managers [not the “employer” per say or the employee health department] attempt to contact employee health care providers, that’s doctors etc. “directly” by threatening loss of sick benefits if the employee does not sign a release of confidential medical information direct to their front line manager, “not the employee heath department”
    This behaviour is then backed up by the employer under the heading “Management Rights”
    Doctors notes by definition are also of no use or value to some employers stating quote “employee’s lie to their doctor who then in good faith pass that lie along to the employer”
    Then you have the issue of some employer’s/front line managers requesting more and more information as what your doctor has given them is never enough or so it seems
    At some point your doctor says no, to go further [more medical info to your employer] would violate pt. confidentiality
    You may then be denied sick benefits by some employers for failing to comply with their request for more info on which to base a decision
    Then you have the 5, 10 and 15 phone calls a day from your front line manager and the employee health department making sure you are “Okay” they are worried about you ???????????
    Some employers initiate the above process starting with the notification of denial of sick benefits and a release of confidential medical info form delivered to the employee’s home by currier on the “first” day of illness
    I am sure you are thinking that these people must have horrendous attendance, “sometimes but not always so”
    Some employer’s treat “some” of their staff this way even if they have had perfect attendance for months and years

    Mandatory Flu shots would happily for some employer’s result in the complete elimination of sick benefits for the flu or flu like symptoms on the premise, you had the shot, how can you have the flu, you are a lying !!!!!!

    I know this will not go well, it has been suggested that the only way to deal with this type of employer is to go to work ill
    I assume the hope is that when your employer/manager sends you home ill it is much more difficult for that employer/manager to then deny you sick benefits, they have “witnessed” your illness themselves

    Did some one say Flu Shots help protect Pts. and fellow staff ?
    Kenny G.

  3. What I find stunning is that the latest scientific evidence isn’t factored in IF it goes against the usual pro vaccine dogma?

    People who contracted the Swine flu and who got the seasonal flu vaccine the year before got more severe symptoms . This has just recently been duplicated in follow up studies. This implies that we are only now realizing that we are not fully aware of the implications of mass flu vaccinations. Read this carefully…why aren’t we considering this new information?

    http://www.vancouversun.com/health/Vancouver+researcher+finds+shot+linked+H1N1+illness/7217609/story.html

  4. Are they making it mandatory for the doctors? Always seems to me that they go after nurses, psws, and skip the docs. I remember visiting a hosptial where there was a gastro outbreak. ALl the nurses were there and healthy – but not the docs. Wonder who forgot to wash their hands?

  5. Yes, in BC it applies to health authority staff, doctors, volunteers, students, contractors and vendors who come into contact with patients according to the media.

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