CUPE
encourages health care workers to get an influenza vaccination if they can
safely do so. But making flu shots mandatory
for health care workers is a serious intrusion on the freedom and personal
autonomy of health care workers that may sometimes have detrimental effects on their
own health.
Forcing
people to take flu shots against their will may well undermine public
confidence in vaccination programs, even vaccination programs with an excellent
results and high safety standards.
Employers
do not provide any sick leave to half of CUPE hospital workers. So when those workers have an adverse
reaction to the vaccination, they will lose pay. Even those workers who do qualify for sick
leave may be harassed by employers if they take days off as, under austerity,
hospitals are increasingly driven by cost cutting and are sharply targeting
sick leave for reduction.
But,
along with increased attacks on sick leave, some health care employers are
demanding that health care workers get vaccinated or be fired.
Research:
A recent report from the prestigious medical journal, The Lancet Infectious Diseases, has
thrown more doubt on mandatory flu vaccines for health care workers. Instead of providing the comprehensive
protection commonly supposed, the systematic review by Osterholm (and
colleagues) found
that, at best, the influenza vaccine provided moderate — about 60% — protection
from laboratory-confirmed disease in healthy adults. The experts added that such protection was
greatly reduced or absent in some seasons.
In a
subsequent policy paper, Osterholm and
coauthors
conclude that recent expanded recommendations for influenza vaccination are
based on expert and organizational opinion rather than on data. They also state that systematic overestimation
of vaccine effectiveness has hampered the identification of better solutions.
Moreover,
they note that if “the general public or professional groups such as health care
workers perceive that public health officials have ‘oversold’ the effectiveness
of the current influenza vaccines, substantial backlash and mistrust could
occur. Efforts now to increase
vaccination rates must be consistent with building a strong and lasting
foundation for vaccine acceptance over time, which will be even more valuable
as new and better vaccines become available.”
Canadian medical experts reviewing this and
other research have come out opposed to mandatory flu shots for health care
workers — while still encouraging health care workers to get the flu shot. Drs. Michael Gardam and Camille
Lemieux
from the Infection Prevention and Control Unit, University Health Network and the
University of Toronto argue “that it is of paramount importance to critically
analyze the benefits of influenza vaccination before making a decision that
justifies the suspension of a health care worker’s right to refuse to be
vaccinated.”
They cite
a 2010 study (by Thomas [1]et. al.) involving
20,000 patients over the age of 60 who lived in long-term care facilities. The study concluded that the vaccination of
health care workers was not associated with a significant reduction in
influenza-specific outcomes: “We conclude there is no
evidence that vaccinating HCWs (health care workers) prevents influenza in elderly residents in
LTCFs (long term care facilities).” On this basis,
there was insufficient evidence to support the vaccination of health care
workers as a method of protecting patients in long-term care facilities.
Drs. Gardam
and Lemieux note that it can be challenging to determine whether influenza
actually played a direct or indirect role in mortality and most influenza-like
illnesses in any given year are caused by other pathogens.
Medical
proponents of mandatory vaccination suggest that even with 60% effectiveness,
mandatory vaccination will provide more protection to patients than voluntary
vaccinations, as more workers will be vaccinated.
Gardam
and Lemieux however, note that “influenza in immunized individuals can cause
milder disease... In this circumstance one wonders whether immunized health care
workers may mistake influenza symptoms for a more benign illness and continue
to work. Further, three recent large
European vaccine effectiveness studies demonstrated that effectiveness waned to
near zero or zero within roughly three months after vaccination for the
2011-2012 season.”
Finally,
the authors note that “a small number of American facilities that have
implemented mandatory vaccination and have seen their immunization rates
increase to well over 95%. What we have
not seen is evidence that these policies have brought about a significant
reduction in both nosocomial influenza and influenza-related deaths.”
New Attempts to Impose Mandatory Flu Shots
In
British Columbia, mandatory flu shots or wearing a mask will be required for
hospital and care home staff, and visitors as well.
The
original B.C. policy, introduced in August 2012, included provisions requiring
health care workers to wear an identifying badge if they had the flu shot and
to notify a supervisor if they knew of someone violating the policy. With the June 2013 revised policy, there is no
requirement to wear a badge and workers are now “expected” rather than
“required” to report non-compliance.
All
health care workers in hospitals and residential care facilities and in
community health are covered by the policy. It also includes volunteers, outside
contractors and visitors. There are no
distinctions made in the BC policy. Some
have suggested the policy would be less objectionable if it focused on protecting
the most vulnerable.
Notably,
a grievance arbitration ruling on this matter emphasized that employers are
legally obligated to accommodate health care workers who cannot comply with the
policy.
The mask option: “Very little information is available about
the effectiveness of face masks and respirators in controlling the spread of
pandemic influenza in community settings,” the U.S.
government flu web site notes.
Ontario:
Two major London, Ontario hospitals have recently announced that they
will enforce
the same policy
as B.C. Other hospitals may follow.
Doug
Sider, medical director of communicable diseases at Public Health Ontario, the
province’s health promotion agency, states “I suspect sooner
rather than later it’s not going to be up to an individual hospital. We are going to say ... ‘Here’s a standardized
set of approaches we’d like all hospitals to engage in.’”
The
Ontario government wants to see a dramatic increase in the number of health care
workers who get the flu shot, but opposes making vaccinations compulsory. “We don’t require health-care workers to be
immunized in this province, but we do have a three-year strategy to ...
strongly encourage health care workers to be immunized every year,” Dr. Arlene King,
chief medical officer of health for the province told reporters earlier this
year.
Ontario CUPE organized hospitals: Ontario hospitals and the Ontario Council of
Hospital Unions/CUPE have negotiated a protocol that recognizes the right of
workers to refuse vaccination, while also protecting the public. If government requires vaccination, workers
who do not receive the vaccination will be reassigned, or if that is not
possible, they will be placed on unpaid leave.
If the vaccine is
medically contra-indicated for the employee they will be reassigned, or if that
is not possible, the employee will be put on paid leave.
[1] Influenza vaccination for healthcare workers who work with the
elderly. Cochrane Database Syst Rev 2010;(2):CD005187 http://www.ncbi.nlm.nih.gov/pubmed/20166073
Comments
Post a Comment