A vaccine is the most effective form of prevention. In the case of influenza, a vaccine can cut your risk of developing the disease by up to 90 percent, depending on a variety of factors, including the effectiveness of the vaccine that year. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care professionals get vaccinated annually against influenza.
Mandatory vaccination is a controversial strategy that pits health care professional and personal autonomy against patient/public safety and employee relations. Administrators planning to implement mandatory influenza vaccination policies for health care professionals must understand the implications involved in these policies.
To Prepare for This Discussion:
Review the peer-reviewed, professional journal articles and news article in this week’s Learning Resources, describing a dispute involving a health care facility’s mandatory vaccination or mask for seasonal flu. Select one of these articles for the Discussion, or find one of your own in a peer-reviewed journal or on the Internet. This dispute may involve an individual health care provider or facility.
By Day 3
Posta cohesive response to the following:
Format your post as if you are advising the CEO of the health care provider or facility identified in the journal/news article you read, and discuss the following implications:
Analyze the situation in light of health care service delivery.
Analyze the situation in light of patient and public safety.
Explain the conflict(s) that may arise as a result of this policy.
Explain any ethical issues raised by this policy.
Finally, explain your conclusion/position regarding mandatory seasonal flu vaccination or mask for health care professionals.
This is the article you will be writing on plus additional research
Mandatory influenza vaccination of healthcare workers:
is it necessary or sufficient to protect patients?
Allen C. Cheng1,2,3 FRACP, MPH, PhD Leon J. Worth1 MBBS, FRACP, PhD
1 Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Vic. 3004, Australia.
2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
3 Corresponding author. Email: [email protected]
Abstract. In response to recent calls for mandatory influenza vaccination policies, we argue that these policies are
neither necessary nor sufficient to protect patients from healthcare-associated respiratory viral infection.
Additional keywords: mandatory policies, vaccine effectiveness.
Received 15 June 2014, accepted 2 July 2014, published online 24 July 2014
We note Chean and colleagues’ editorial suggesting
mandatory vaccination to protect patients from influenza.1We
strongly support influenza vaccination of staff to protect
themselves and patients from influenza. However, we suggest
that mandatory influenza vaccination is neither necessary nor
sufficient to protect patients from healthcare-associated
respiratory virus infections.
The influenza vaccine is clearly not sufficiently protective
to justify mandatory vaccination. Although it is commonly
quoted that the vaccine provides 70–90% protection, more
recent clinical trials employing the specific outcome of
confirmed influenza (by nucleic acid detection) have
estimated vaccine effectiveness to be ~59%,2 with efficacy as
low as 16% in some non-pandemic seasons.3 Enforcement of
the wearing of masks is impractical, and redeployment,
particularly for specialised clinical staff, may present
considerable logistical problems.
Although other vaccine-preventable diseases (VPDs) may
be less common, mandatory vaccination might be considered
first nationally for infections where vaccines are highly
effective, such as measles. However, Chean et al. cite NSW
data suggesting that a policy of mandatory vaccination or
reporting of immune status for VPDs (not including influenza)
resulted in only 50% of staff being compliant and a small
number of staff being terminated or redeployed.4 This raises
questions about the implementation and enforcement of the
policy for non-compliant staff, 2 years after release. Despite
recommendations, mandatory programs for VPDs have not
been enforced for healthcare workers within Australia,
and implementation remains a challenge. A recent study of
Victorian healthcare workers highlighted the requirement
for dedicated resourcing of vaccination programs to
satisfactorily implement strategies in accordance with
NHMRC guidelines for VPDs other than influenza.5
A principle of public health is that the least restrictive
policies should be used to achieve the desired outcome. We
dispute the assertion by Chean et al. that a goal of 75% of
staff being vaccinated would not be possible without
mandatory vaccination policies. At Alfred Health in June
2014, almost 90% of staff with patient contact had been
approached, with vaccine coverage close to 80% for the
2014 season. This was achieved using a social marketing
campaign supported by the hospital executive together with
reporting to managers listing staff not yet approached for
vaccination. These figures are similar to those reported in
2013 by the Royal Melbourne Hospital (pers. comm.) and the
Peter Macallum Cancer Centre,6 both achieved without
enforcement of mandatory policies.
We believe that the goal is to protect patients from
healthcare-associated infections with respiratory viruses, not
just influenza, as poor outcomes have been reported in patients
with non-influenza respiratory viral infections. To achieve
this, ‘horizontal’ interventions, such as reducing the
proportion of healthcare workers attending work while unwell
with respiratory illnesses (‘presenteeism’), are likely to be
more effective.7 This approach is readily accommodated by
promoting existing policies and would be expected to reduce
transmission of non-influenza respiratory viruses. It would
also be effective in seasons where there may be a significant
mismatch between circulating and vaccine strains, and for
vaccine failures.
Finally, there is little evidence that nosocomial influenza
poses a significant burden of illness to justify mandatory
vaccination. Although case finding may be incomplete, we
Journal compilation Australasian College for Infection Prevention and Control 2014 www.publish.csiro.au/journals/hi