Should flu shots be mandatory for all healthcare workers?

Steve Mertl
National Affairs Contributor
Daily Brew

It seems like an obvious thing to do: Healthcare workers in places like hospitals and care homes all should have influenza vaccinations to minimize any chance they'll infect their vulnerable patients.

Doctors and nurses should see the logic of that but in reality immunization rates among healthcare professionals are surprisingly low, and some are refusing the needle even under threat of suspension.

The latest instance comes in Alberta, where a nurse at an extended-care facility in Medicine Hat was sent home without pay for refusing a flu shot, the National Post reports.

Diana Lockie worries she could have an adverse reaction to the vaccination that could trigger an attack of trigeminal neuralgia, a highly painful chronic neurological condition she suffers from.

Lockie said she was one of more than a dozen workers sent him this week for refusing to be vaccinated. Several workers at an extended-care home in suburban Edmonton were also kept off work for the week, the Post reported.

[ Related: Canadian study suggests flu vaccine halves risk of infection this year ]

Influenza kills thousands of Canadians every year and experts say this is one of the most active flu seasons in recent years.

But according to the Canadian Healthcare Influenza Immunization Network, immunization rates in healthcare organizations range from 40 to 60 per cent, well below World Health Organization guidelines that recommend 90 per cent of healthcare workers be vaccinated.

There is a push among healthcare administrators to require mandatory vaccination as a condition of employment. In Canada we don't force people to undergo treatment they don't want. Should healthcare workers be treated any differently?

Institutions should be discussing it, Dr. Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital, told CTV News earlier this month.

“There’s now very solid evidence that when you vaccinate health care workers there is less death in the patients they take of,” McGeer said.

“This is clearly a patient safety issue… the vulnerable patients in our hospitals are at risk of getting influenza and dying of influenza and we have an obligation to protect them. The question is how we do that best.”

The Post noted that Public Health Ontario and the Canadian Nurses Association are among groups supporting mandatory vaccination.

The B.C. government announced last year it would become the first province to make getting the flu shot compulsory for healthcare workers but backed off temporarily after getting push-back from the B.C. Nurses Union, among others.

"BCNU has consistently advocated the value of an annual flu shot for all nurses, but believes this should remain a personal, voluntary choice and that nurses should retain the right to exercise their professional judgment," the union said last month.

"BCNU recognizes that the employer has a right to develop policy on flu shots, but opposes making compulsory vaccination or mask-wearing a condition of employment."

According to a CBC News report last May, a survey found B.C. had the highest overall vaccination rate in Canada, with 52 per cent of residents getting the shot, with the result that only 10 per cent of British Columbians caught the flu in 2011-12. Quebec was worst, with a vaccination rate of 27 per cent and one in four Quebeckers becoming ill.

The clear benefits of vaccination ought to propel the discussion about immunization for healthcare workers. The Post noted existing institutions give employes a choice if flu breaks out: Get a flu shot, take the anti-viral drug Tamiflu, do alternative work away from patients or be sent home without pay.

“In the setting of an outbreak, it’s very clear that unvaccinated people get sick and transmit,” McGeer said. “You’re making a decision that is counter to the advice of just about every public-health official in the world.”

[ Related: 7 ways to reduce the risk of catching the flu ]

But what about people like Lockie who calls the policy "unfair?"

Her pain specialist, Dr. Gaylord Wardell, told the Post there's no conclusive evidence a flu shot could trigger an attack of trigeminal neuralgia, so painful it's been dubbed the "suicide disease." But even the remote chance it could should be enough to make an exception for patients like her, he said.

Perhaps the answer would be to allow healthcare workers to opt out for medical reasons if they get a written endorsement from their physician.