- We require HCWs to be vaccinated for many diseases (such as mumps, measles and rhubella) and should do so for influenza as well.
- Immunization of HCWs can reduce the incidence and effects of influenza among patients.
- Failing to get vaccinated is unethical behaviour for HCWs.
From what I can tell, vaccination seems to prevent influenza some of time (overall, it is about 60% effective), including among HCWs. This finding seems pretty widely accepted; if you are interested, here is a study.
This is a significantly lower rate of effectiveness than MMR vaccinations (which are about 90% effective). Opponents of mandatory influenza vaccination note the much lower effectiveness of the influenza vaccine undermines the argument for mandatory flu shots.
The evidence on whether vaccinating HCWs affects patient outcomes (since HCWs are not the only source of patient infection) is mixed. Some research supports this position, particularly when looking at elderly patients in geriatric facilities (example and example). Yet, every study has limitations. A systematic review of the literature (which controls for the quality of studies) concludes:
Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. … This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs.This systematic review is not without controversy (it sets a high bar, for one). That said, it stands for the proposition that there is (as yet) no conclusive proof that vaccination programs reduce the incidence of influenza or its effects among older patients in long-term care facilities. I didn’t see any similar studies on effects among other patient groups or other kinds of helath-care facilities. Such studies may exist, I just didn’t find any in my search. Given this data, I think we can conclude the jury is out on the effectiveness of HCW vaccination on patients.
The final argument is essentially a moral one: if vaccination may reduce transmission to patients, then health care workers should be compelled to be vaccinated. As Simons puts it:
In a time of anti-vaccine hysteria, we need health-care workers to set an ethical example. We need them to demonstrate respect for science and for logic.Setting aside that HCWs are not responsible for refuting anti-vaccer non-sense (that would be journalists’ jobs…), as we’ve seen above, the science on the effectiveness of mandatory flu shots for HCWs is not settled. Rather than engage with this nuanced issue, Simons opts for an ad hominem attack on HCWs:
But it’s time to stop making excuses for health workers who just can’t be bothered, or who think they’re invincible, or who just have some vague prejudice against vaccines.As Jason Foster and I note in Chapter 5 of our new OHS textbook, the other side of this argument is that mandatory vaccinations interferes with the rights of HCWs to control their own health. Simons largely dismisses this concern, briefly noting “Forcing people to be vaccinated does sound coercive” and moving on to propose just that.
Health-care employers frequently advocate mandatory immunization. Presumably, they do so in pursuit of patient safety. Yet, this position is hard to square with the lack of evidence that vaccination affects patient outcomes. Some workers note that health-care employers have many motives for policies, including reducing sick leave claims.
Some employers (including the province of British Columbia) have attempted to manage this issue by giving workers a choice: get immunized or wear a mask when interacting with patients. This may be a more reasonable approach than the mandatory vaccinations that Simons advocates. An interesting question for those who like evidence-driven policy is what evidence of reduced rates of influenza has the BC experiment yielded?
-- Bob Barnetson