Hospitals facing resistance to health care worker flu vaccine mandate

A brief respite from all-things-H1N1 to mention a related topic in vaccine ethics and policy: the growing number of hospitals requiring employees to be vaccinated against seasonal influenza this fall and the resistance they are reportedly encountering.

As readers of this site know, public health and disease control experts have long been discouraged by the shockingly low rates of influenza vaccination among health care workers, despite the potential benefits to patients in reducing the likelihood of hospital-borne infections (not to mention the personal protection the vaccine provides). Strategies to boost vaccination rates among hospital staff -- educational campaigns, pleas to professional duty, monetary incentives like prize raffles -- have had only modest results.

Notably, health care workers who decline vaccination typically explain their decision by pointing to the same inaccuracies that vaccination proponents are continually trying to correct among the general public. (Included in this list: the possibility of getting the flu from the vaccine itself, something about one's personal constitution that means they "never get the flu," and unproven concerns about the vaccine's safety.)

In the past few years, a handful of hospitals and other health care facilities experimented with mandating seasonal flu vaccination as a condition of employment. This fall, the number of institutions implementing such a policy appears to have surged. Opponents of the requirements -- including many of the usual voices in the vaccine safety and policy debate joined here by labor organizations representing hospital workers -- are already lining up to voice their concerns, as stories in last week's Washington Post and New York Times report.

Left unclear in both of these stories is how H1N1 vaccination fits into programs that had been developed with the annual seasonal influenza vaccination in mind. The Post story implies that at least some of the hospitals mentioned are implementing requirements that include both types of flu vaccine, a difficult task given the uncertainties surrounding the timing of the H1N1 vaccine's arrival in large quantities.

That ambiguity underscores the confusion sure to surround the enforcement of health care worker seasonal flu vaccination mandates amid the tremendous attention surrounding H1N1 flu this fall. In fact, the nation's leading voice in public health, CDC director Thomas Frieden, suggested in the Times that waiting to introduce these mandates would have preferable. He says, "This is just not the right flu season to take this on."

It's hard to argue that vaccination of health care workers against flu doesn't protect patients, reduce hospital infections, and set a good example for the importance of annual vaccination. For health officials already confronting the overwhelming communication and logistical challenges related to H1N1 vaccination, introducing health care worker vaccine requirements (and responding to resistance and resulting media coverage) adds to the unprecedented challenges facing our public health infrastructure and leaders in the coming months.