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Mandatory flu vaccinations for health care workers

Last updated on June 13th, 2012 at 05:06 pm

Nosocomial infections, or hospital acquired infections, are a significant issue in hospital environments and has become a serious public health issue. These infections include everything from drug resistant bacteria to several viruses, including the flu.  They have serious repercussions in a hospital environment–everything from employee absenteeism to higher mortality rates of patients.  For example, influenza, which has a reputation of being innocuous, can be dangerous to infants, the elderly and immune compromised patients.  Further, a flu outbreak can leave a hospital short-staffed with sick nurses, techs and physicians, making it more difficult to deal with the outbreak itself.

This week, the George Washington University School of Public Health and Health Services has issued a comprehensive report that analyzed state regulations on flu vaccines in the health care environment.  Their findings about levels of flu vaccinations were surprising (at least to me) since HCW’s are in contact with so many ill patients, especially during the winter flu season.

❝Between 2004 and 2008, the average annual influenza vaccine uptake among HCWs has remained approximately 40% in the United States. A 2007 survey of 991 Infectious Disease Consultants indicated that approximately 7% of facilities achieved HCW annual influenza vaccination rates higher than 80%.❞

Of course, 40% vaccination rates is well below the number to create a herd immunity in the hospital; consequently, the rate of influenza infection in HCW’s is very high:

❝Influenza outbreaks in health care settings, attributed to the unvaccinated workforce, have been well described and documented. During an average season, 23% of HCWs are infected with the influenza virus, show mild symptoms, and continue to work despite being infectious.❞

As you might expect, the anti-vaccination lunatics are up in arms about this.  Their first arguments are the civil rights of the HCW’s; however, long precedents in law favor the public health over individual.

Beginning with the landmark U.S. Supreme Court decision in Jacobson v Massachusetts, courts have ruled that states have the authority to exercise their 10th Amendment “police powers” to require immunizations and that the threat posed by transmissible disease trump individual autonomy to refuse health care. Courts continue to rely on Jacobson, because vaccine-preventable diseases threaten the public and the means to prevent transmission have “a real and substantial relation to the protection of the public health and the public safety.”

Several cases that have weighed religious freedoms against public health and safety recognize that the freedom to practice religious beliefs without government interference is a core principle of U.S. society. Nonetheless, the Constitution’s “free exercise clause” does not permit this freedom to supersede important public interests. Indeed, courts have supported the Constitution which does not require states to include religious exemptions in school entry vaccination requirements.

Also relevant are prior rulings related to the meaning of the Contract Clause. Although the Constitution protects the right of individuals to enter into agreements with others without government interference, courts have ruled that states may also limit and regulate contracts in the interest of the public’s welfare, and essentially placing protection of the public against individual economic interests.

Finally, competent individuals have the right to refuse medical treatment. However, courts have ruled that patient autonomy may be restricted when government can demonstrate that the interests of the public exceed the extent of individual intrusion.

Because voluntary flu vaccination programs have had poor results, his report is recommending that states require mandatory flu vaccinations for the health care workers as a condition of their employment, with a goal of 80% of HCW’s vaccinated by 2020 (seems too long for my taste).  In states or in healthcare facilities where the vaccination is a requirement for employment, the rate of vaccination went up to 99% with a concomitant drop in flu outbreaks.

A hospital should be a location where there are increased odds that you’ll get better.  Health care workers have an ethical and moral obligation to keep their patients safer, and getting a simple, 5 second vaccination should be an easy choice.  I was once responsible for a rather large sales force, who called on physicians offices.  I required (by force of will only) that they get flu vaccines, that we provided for free.  I heard every excuse that is listed in the anti-vaccination how-to book.  I thought it was just our sales force.  Then I just talked to healthcare works on why they didn’t (yes, this is anecdotal) get vaccinated.  It was amazing, creative and nonsense.

Of course, mandatory flu vaccines are just an excuse for pharmaceutical companies and the government to start another pandemic.  Another interesting consequence of these laws:  are chiropractors, naturopaths, homeopaths and other junk medicine pushers included as health care workers?  I do love good irony.

Michael Simpson
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