Mandatory flu vaccinations: 5 points that frame the debate

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Karen Cheung-Larivee

 Karen Cheung-Larivee

With public health emergencies recently declared in Boston and New York state, the flu isn't just hitting patients this season. It's hurting hospital-clinician relations.

After the H1N1 outbreak in 2009, some hospitals moved up flu vaccination for healthcare workers from the nice-to-have list to mandatory policy. As you can imagine, that didn't go over well with employees.

In fact, 80 percent of healthcare workers say they oppose mandatory flu vaccination, according to a survey from the Association of American Physicians and Surgeons (AAPS), a group of physician advocates.

Now, with the flu arriving earlier--and with much more force--than expected, hospitals are getting even tougher about vaccinations. More than 400 U.S. hospitals required flu vaccinations for their employees, according to a CDC survey in 2011, the Associated Press reported. These policies require health workers that come into contact with patients to get vaccinated or wear masks--and, in some cases, can be fired if they refuse. Twenty-nine hospitals have already terminated unvaccinated employees, according to the AP.

Next to fair pay and staffing ratios, mandatory vaccination is one of the biggest hot-button issues among healthcare workers.

According to the AAPS survey, more than 150 of the surveyed physicians said they feel so strongly on the issue that they are willing to lose their medical staff privileges to avoid the vaccine.

The SEIU healthcare employees union in Rhode Island--a state with, arguably, the strictest flu vaccination regulations--fought back last month. The union went as far as to file suit against the state health department.

Although more employees are getting flu vaccines--about 83 percent of hospital workers in November--vaccination rates among healthcare workers still fall short of the 90 percent threshold that the Centers for Disease Control and Prevention wants to see of all healthcare workers by 2020.

Among those who are vaccinated, 88 percent are pharmacists, 84 percent are doctors, 82 percent are nurses, and fewer than half are nursing assistants and aides, according to the AP.

For many workers, though, flu vaccination isn't something they are willing to concede.

Why? Some people simply don't believe in the effectiveness of vaccines, while others say they don't like the idea of employers forcibly injecting them.

Although hospital management says it's about patient safety, hospital workers say it's about civil liberties.

Here are 5 things to consider when deciding whether or not to refine your policies on mandatory flu vaccinations.

1.Patient safety
According to a report released last month from the Center for Infectious Disease Research and Policy (CIDRP) at the University of Minnesota, the flu vaccine only provides modest protection for healthy young and middle-age adults, FierceHealthPayer reported last week. And an American Lung Association report released in 2010, couldn't find a sustained drop in flu-related deaths over the past decades, despite an increase in vaccination rates.

According to NPR and Kaiser Health News, flu vaccines are only 60 percent effective.

Even though many question the link between vaccination and flu rates among patients, medical groups are in favor of vaccinations for their members, including the American College of Physicians, American Association of Family Practitioners, National Patient Safety Foundation and National Foundation for Infectious Disease, the AP noted.

Art Caplan, medical ethics chief at New York University's Langone Medical Center, told the AP that healthcare workers have an obligation to protect patients.

"If you don't want to do it, you shouldn't work in that environment," Caplan said. "Patients should demand that their healthcare provider gets flu shots."

2.Joint Commission regulations
In July, The Joint Commission required all accredited hospitals and long-term care provider organizations have an annual flu vaccination program for staff. The updated requirement will be phased in for other providers during the next year.

But as national law firm Ober Kaler noted, there's a difference between offering and forcing.

3.Medical exemptions and religious exemptions
Medical allergies to flu vaccinations are rare, and religious exemptions aren't always cut and dried.

Sakile Chenzira, a vegan, sued Cincinnati Children's Hospital for religious discrimination when she refused to get vaccinated. An Ohio federal court recently refused to dismiss claims, saying the case will go forward because veganism is considered a "sincerely held belief," the Business Courier reported.

4.Employee rights and collective bargaining agreements
Similarly, in the great flu vaccine debate, one must consider individual rights.

Patients reserve the right to forgo vaccination, but as Carrie Calhoun, a fired nurse from Alexian Brothers Medical Center in Elk Grove Village, Ill., put it, nurses are patients too.

"Where does it say that I am no longer a patient if I'm a nurse?" she said in the AP article.

And there's the issue of union workers' rights. It's not about whether workers believe in vaccination, but the fact that they want their voices heard. Be sure to consider collective bargaining in union agreements.

In Virginia Mason Hospital v. Washington State Nurses Association the court found that the hospital unilaterally adopted a mandatory flu shot policy without bargaining with union representatives and, therefore, violated the collective bargaining agreement.

If applicable, a hospital should carefully review any collective bargaining agreement in place before implementing such a policy.

5.Consequences for those who refuse
If your institution does adopt a mandatory vaccination policy, carefully consider what the consequences will be if employees refuse. Will workers wear masks, and if so, it that for public health or to punish them? Will your hospital be willing to fire employees? What will the effects of their departure be on patient care and staff dynamics?

For some hospitals, mandatory flu vaccination is a no brainer, especially as more states report seeing more flu cases. But for the majority of hospitals, it's an issue that's much more complicated. - Karen (@KCheungLarivee / @FierceHealth)

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