Marc Siegel is an associate professor of medicine at the New York University Langone Medical Center.
From smallpox to polio to measles to hepatitis, modern history has shown us again and again that vaccines are one of the best medical tools we have to eradicate disease and to protect our most vulnerable populations. Yet the decision whether to make a particular vaccination mandatory or simply to recommend its use is not automatic. It depends on many factors, including the effectiveness of the vaccine versus the risk the disease presents.
I am a big advocate of the flu vaccine. I agree with the current recommendations of the Centers for Disease Control and Prevention that the vaccine we have is worth taking by everyone over the age of 6 months and completely safe. Even if the positive impact on illness severity is only 62 percent, as this year's in-season CDC study suggests, that's more than enough to warrant widespread use.
But recommending a vaccine strongly and mandating its use are two different things. There is simply no convincing evidence that forcing healthcare workers to be vaccinated under threat of losing their jobs cuts down on the risks of patients getting severely ill from, or dying from, the flu.
It makes more sense to mandate that workers with influenza-like symptoms not be allowed to come to work. And why not a mandate that unvaccinated workers not be allowed to care directly for flu patients? This would be a much more convincing and effective strategy.
In 2012, Colorado's Board of Health issued a mandate that health facilities in the state achieve a 90 percent vaccination rate for workers by 2015. In October, Rhode Island mandated the immunizations for all healthcare workers with direct patient contact. In Ohio, which also has a mandate that hospital employees be vaccinated, the healthcare company TriHealth has fired more than 150 workers for not complying with flu shots. Firings have also taken place in Florida and Pennsylvania.
It is one thing to insist on a flu shot as a condition for hire, quite another to terminate someone for not getting one. At-will states like New York, where private employees can terminate workers without cause, certainly have the legal right to do so. But is it ethical or medically justified? The answer is no.
According to the CDC, more than two thirds of U.S. healthcare workers and more than 85 percent of physicians have already had the flu vaccine. They hardly need a mandate.
Mandates should target vulnerable populations. The requirement for a measles vaccine correctly targets children. According to the World Health Organization, increased measles vaccinations resulted in a 74 percent drop in measles deaths between 2000 and 2010.
The evidence is not nearly as compelling for influenza, where the elderly represent 90 percent of flu-related deaths. But the reason that we don't mandate flu vaccines in nursing homes is because the evidence on effectiveness is conflicting. In fact, a 2005 National Institute of Allergy and Infectious Diseases study found no correlation between an increase in vaccine use over 20 years and a decrease in deaths.
I believe in the influenza vaccine, and one day, when newer versions are more effective at controlling or preventing the flu, I will support mandating it for certain populations. In the meantime, we need to work on keeping sick workers home, not firing those who are well.
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