Should Health Care Workers Be Required to Get Flu Vaccinations?

On the Scene Blog: Mandatory policies increase participation at some hospitals, but are controversial.

+ More

By Nathan Seppa, Science News

VANCOUVER, British Columbia—Nurses and other health care workers at Children's Hospital and Medical Center in Omaha, Neb.—many of whom had routinely skipped getting flu vaccinations—have changed their tune.

Over the past several years, the hospital has instituted some new policies. Staffers, for example, are now required to sign an explicit form if they decline vaccination, acknowledging the possibility that not getting immunized could spread the flu virus to children. But the real kicker came when workers who passed up the vaccination were required to wear surgical masks throughout the flu season, says physician Archana Chatterjee of Creighton University in Omaha. In recent years, the rate of employee vaccination has risen from about half to 97 percent. "Wearing a mask for eight hours is not easy," she says. "They realized what an onerous job that was."

That may sound like coercion, but Chatterjee prefers the term "mandate." In Vancouver, at the annual meeting of the Infectious Diseases Society of America (IDSA) that ran from October 21 to 24, people on both sides of the mandatory vaccination issue voiced some strong opinions.

No one denies that health care workers are in a unique position to stymie—or spread—flu and other diseases. "The [medical] literature is rife with healthcare workers' [involvement] in reported outbreaks," Chatterjee says.

Despite that reality, flu vaccination among all health care workers remains far from universal. The U.S. national rate has lingered at less than 50 percent for this group, according to an analysis of national survey data published April 2 in Mortality and Morbidity Weekly Report. The rate among nurses is slightly higher.

Some heavy hitters have joined the debate. The Society for Healthcare Epidemiology of America is calling for mandatory influenza vaccination of health care personnel—calling it a "professional and ethical responsibility," according to a position paper appearing in the October Infection Control and Hospital Epidemiology.

IDSA has endorsed the statement, calling flu vaccination of health care staffers a safety issue that should be a condition of employment in health care facilities. "I basically think we are responsible for the health of the people we take care of," says Richard Whitley, an infectious disease physician at the University of Alabama-Birmingham and outgoing IDSA president. If health care workers don't get vaccinated, he says, "We're not doing our jobs."

But mandating vaccination has turned out to be far from simple.

In 2009, the state of New York attempted to make flu vaccination mandatory for all its health care workers. That effort failed when vaccine ran short and unions sued. 

The Service Employees International Union, which represents about 1 million health care workers, encourages its members to get vaccinated against the flu but opposes mandates. "Health care is based on trust," says William Borwegen, SEIU director of occupational health and safety. "Patients have the right to refuse medical procedures and health care workers know this. It undermines the element of trust if you coerce them to do something they are basically willing to do voluntarily." He says in many institutions, programs to encourage voluntary vaccination have achieved more than 80 percent coverage.

Infectious disease experts dispute the reliability of the voluntary approach. In Seattle, infectious disease physician Robert Rakita and his colleagues at the Virginia Mason Medical Center instituted a mandatory flu vaccination program a few years ago for their nearly 5,000 employees. It was the first to write in mandatory flu vaccination as a "fitness-for-duty requirement," he says. In the first year of the program, the vaccination rate among employees rose to 97.6 percent after lingering below 50 percent in most preceding years using voluntary measures. Under the new program, people with medical or religious reasons for not getting vaccinated were required to wear a surgical mask, says Rakita, who is now at the University of Washington.