Mandating The Flu Vaccine in Hospitals

A decade ago, the Virginia Mason Medical Center in Seattle became the first hospital in the U.S. to require all of its health care workers to receive a flu vaccine. Since then a growing number of health care facilities, childcare centers and state health departments are implementing similar mandates for workers and health care professionals. (1)

But resistance to this movement is also growing, with opponents calling for a continuation of the long-held practice of instituting only voluntary policies for flu vaccines. As a result, public health professionals are increasingly finding themselves involved in this debate. Is it appropriate to mandate flu vaccines at hospitals, health care facilities, long-term care facilities, school-based clinics, care centers and other sites where people are at greater health risk and within close contact with each other? Or is this a violation of health workers’ civil liberties?

University programs that train healthcare professionals, including Creighton University’s online Master of Public Health degree, are increasingly considering this issue and similar ones that balance safety and privacy. The Creighton program offers service-oriented concentrations including Public Health Services Administration, which aims to provide leadership and management skills to promote public health and service the public.

Nearly Two In Three Vaccinated

During the 2014-2015 flu vaccination period, the Centers for Disease Control and Prevention (CDC) found that only 64.3% of health care personnel were vaccinated. Meanwhile, influenza, or more familiarly known as the flu, results in approximately 200,000 hospitalizations and 24,000 deaths each year, according to an American Medical News report. 

The percentage of health care personnel who received flu vaccinations during the 2014-2015 period varied widely depending on the organization’s influenza vaccination policy, according to a CDC report: 

  • 85.8% were vaccinated for the flu if mandated
  • 68.4% were vaccinated if it was recommended
  • 43.4% were vaccinated if there was no recommendation or policy

Some organizations with mandatory flu vaccination policies have terminated health care workers for failure to comply, and others have required them to wear surgical masks during the flu season while at work, according to various reports. (2)

Health care organizations calling for mandated flu vaccines for health care professionals and workers include the American Academy of Family Physicians, American Academy of Pediatrics and the Infectious Diseases Society of America, which are among the more than 500 organizations that have mandated influenza policies at their respective health care settings, according to the Immunization Action Coalition's honor roll. (3)

The U.S. Supreme Court also weighed in on the constitutionality of mandated vaccinations in 1905. In Jacobson v. Massachusetts, the high court, in ruling on the state’s actions in a smallpox epidemic, found compulsory vaccination to be acceptable for the benefit of the public, according to an American Medical News report. 

Mandated flu vaccines for health workers can protect patients who are immunosuppressed, or have a reduction in the efficacy of the immune system, and are thus not able to be immunized. Those would include babies younger than six months old, those suffering from immune diseases, some elderly or some cancer patients, said Arthur Caplan, founding director of the division of medical ethics at NYU Langone Medical Center, in a informational video. (4)

Caplan noted that all doctors, nurses and health care workers know they are supposed to put the patients’ interests ahead of their own and to take measures to do no harm.

Mandatory flu vaccines vs. personal rights

Despite the wide number of organizations that support mandatory influenza vaccinations, a number of health care professionals and unions are against such requirements. 

The American Medical Association, the Association of American Physicians and Surgeons and Service Employees International Union are among the organizations and unions opposed to mandatory flu vaccinations, according to a report. (5)

Drs. Michael Gardam, Camille Lemieux and Susy Hota, in an opinion article published in the Toronto Star, wrote that influenza vaccinations are about 60% effective in flu protection, and in some years they are “far less effective.” The doctors note that “too many caveats” exist in the gray issue area of mandatory influenza vaccinations and punitive requirements, such as requiring those who are not vaccinated to wear surgical masks all day while at work if not vaccinated, to “justify taking away an individual’s autonomy.” (6)

The doctors, however, said they support the use of influenza vaccinations but not mandatory policies.

While some may argue there is no middle ground between proponents of mandatory influenza vaccinations and those who oppose them, others point to the potential for compromise. (7)

Some mandatory influenza vaccination policies, for example, come with exceptions for workers who decline due to religious or cultural reasons. Perhaps exploring new creative alternative measures for those who opt out of mandatory vaccination policies -- such as assigning these workers to patients who are not immunosuppressed or otherwise vulnerable -- may be worth pursuing while maintaining a balance with patient safety and health.

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1. First state flu shot mandate at center of legal battle
2. Influenza Vaccination Information for Health Care Workers
3. Influenza Vaccination Honor Roll
4. The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers
5. You Won’t Believe Which Big-Name Groups are Opposed to Flu Vaccine Mandates
6. The case against mandatory flu vaccination for health care workers
7. Mandatory vaccinations: No middle ground