How to Sidestep Hospital Flu Shot Mandates

Should vaccinations against influenza be mandatory for healthcare workers?

A debate is currently raging about whether the decision to get a flu shot should be made by a nurse, or by his or her employer. In Massachusetts, one in five employees at acute care hospitals declined to be vaccinated last fall.

Last week, the National Vaccine Advisory Committee (NVAC) recommended that hospitals, physician practices, and other healthcare organizations "strongly consider" imposing a flu shot mandate among employees if they fail to achieve 90% voluntary immunization.

Organizations such as the American Hospital Association and American Academy of Family Physicians support mandatory flu vaccines for healthcare workers, with exceptions in the case of health or religious opposition. But nurses have provided some of the most vocal opposition to such mandates; just read some of the individual comments and the summary of public comments about the issue.

Although the nurses' union National Nurses United "maintains the position that every RN should be vaccinated against the flu," it opposes vaccine mandates, saying that such programs "engender distrust and resistance among employees; offer a disincentive to providing vaccination education to employees, and raise ethical and legal questions about the personal employment rights of employees."

The union also argues that "issues such as vaccination supply and efficacy make it such that the vaccine cannot be relied upon to exclusively provide adequate protection from the flu virus."

In its written policy provided to HealthLeaders Media, the American Nurses Association "urges all registered nurses to get vaccinated every year to protect themselves, their families, and the patients they serve."  However, it "does not support mandatory influenza vaccination requirements for healthcare workers unless they adhere to certain guidelines to ensure they are fair, equitable and nondiscriminatory."

The ANA believes a mandate should be implemented only if:

• The mandatory policy comes from the highest level of legal authority, ideally state government
• Suitable exemptions, such as for those allergic to components of the vaccine, are included
• Discriminating against or disciplining nurses who choose not to participate is prohibited
• The policy is part of a comprehensive infection control program that includes personal protective equipment, such as N95 respirators, to increase safety
• Vaccinations are free and provided at convenient times and locations to foster compliance
• The employer negotiates with worker union representatives to resolve any differences when the policy is implemented at a health care facility

But voluntary measures don't seem to work as well. According to the CDC, "during the 2010-2011 influenza season, coverage for influenza vaccination among healthcare workers was estimated at 63.5%." However, "coverage was 98.1% among healthcare workers who had an employer requirement for vaccination."

I personally feel very conflicted about this issue. On one hand, I totally understand nurses' resistance to vaccine mandates as a condition of employment. Something seems very wrong with being forced to inject something into your body.

But I'm also the mom of a little girl who had surgery twice before she was five months old. It was late autumn, and the hospital was heavily restricting visitors because of a local flu outbreak. Only immediate family—and absolutely no kids—could visit my daughter after her surgery.

Our pediatrician vehemently insisted that I, my husband, our parents, and any other adult who came into contact with her be vaccinated against the flu. I personally harangued my relatives—who had no health or religious reasons for not getting the vaccine—until they complied. Not only was I worried about her surgical complications, I was worried that my unvaccinated infant would be exposed to a flu outbreak.

I knew that the flu vaccine would not be 100% effective, but I still felt better about having that extra level of protection. A heavy padlock might not keep a determined intruder out of your home for long, but locking the door is safer than leaving it open.

At the end of the day, no one should be forced to get a flu vaccine as a condition of employment; there are too many legal and ethical problems with doing so. However, mandates with provisions and conditions such as those outlined by the ANA seem warranted.

In the meantime, healthcare groups that oppose a mandate, but support vaccinations should take much stronger action to achieve higher voluntary vaccination rates.