Should Flu Shots Be Mandatory?
Andrew Schulcz, SN
Background
Influenza (aka the flu) is a contagious
respiratory illness that infects the nose,
throat, and the lungs.
It can cause mild to severe illness, and at
times can lead to death, especially in the
very young and the very old. Complications
include pneumonia and worsening of
chronic medical conditions, such as CHF,
asthma, or diabetes.
Influenza is easily spread by tiny droplets
made when infected people cough, sneeze,
or talk, and can also through contaminated
surfaces.
Because it is a virus, it is easier to prevent
than to treat. The best way to prevent the flu
is to get an annual flu vaccine.
Nearly all healthcare organizations are
moving towards 100% mandatory annual
influenza vaccinations with only medical
exemptions allowed, but there is strong
opposition to this mandate. Does it truly
help protect our patients?
Methods
Does a mandatory influenza vaccination
requirement for healthcare workers work
better to decrease nosocomial influenza
infections when compared to a strictly
volunteer program?
Population: Healthcare Workers
Intervention: Mandatory Influenza Vaccination
Programs
Comparison: Voluntary Vaccination Programs
Outcome: Decrease in the spread of influenza
within the healthcare facility
Time: Annually
Results
According to the CDC, at least 80%
immunization coverage is required to
prevent influenza transmission in healthcare
facilities (Garcell)
Under voluntary policies, many facilities fail
to achieve this minimum level. The average
rates of immunization in hospitals reached
92%, but long-term care settings were 68%.
This is especially alarming considering the
increased susceptibility of the elderly long-
term residents.
100
Annual Percentage of Healthcare Workers Vaccinated, Sorted by Corporate Policy
80
60
40
20
0
201314 season
Mandatory vaccination requirement
On-site vaccination available >1 day
The evidence demonstrates that although
the overall rates of influenza immunization
are climbing, there are key areas in
healthcare that are lagging far behind.
Considering that you can spread the flu
virus for 24-48 before the onset of
symptoms, requiring unvaccinated
healthcare workers to wear masks when
working is inadequate to prevent spread
Jackson College
Clinical
Implications
Failing to prevent the spread of influenza is
a failure to follow the first rule of medicine
First, do no harm.
Voluntary vaccinations are readily available
and have been for many years, yet there
are clearly segments of the healthcare
population that still do not receive them.
Healthcare workers have been proven to be
a vector that can spread influenza,
especially in vulnerable populations (eg. the
very young and very old). At its core, this is
a failure of our duty to act in our patients
best interests.
As voluntary policies fail to show safe
and effective levels of compliance,
states should mandate influenza
vaccination for all healthcare workers.
201415 season 201516 season 201617 season
On-site vaccination available 1 day Other vaccination promotion No vaccination requirement or promotion
Src: Black, Yue 2017
There is evidence that hospital mandates
can lead to 98% compliance, and there is
no reason that states should not achieve
similar results. A states wish to prevent the
spread of communicable diseases clearly
constitutes a compelling interest (Najera)
Conclusions
Mandatory vaccinations are more effective.
In being proactive and taking steps to prevent
the spread of harmful diseases, we are proving
to the public that we are seriously committed to
preserving their health as well. In failing to
support mandatory influenza vaccinations for all
health care providers, we are actively
undermining the foundations of public health.
If a health care worker cannot trust
something supported by evidence as
extensive as that supporting the safety
of vaccines, how can they trust the rest
of the medical care they are ostensibly
providing? (Najera)
Bibliography
Black C., Yue X., et al. Influenza Vaccination Coverage Among Health Care Personnel United States, 201617 Influenza
Season. MMWR Morbidity Mortality Weekly Report 2017; 66: 10091015.
Chiu, S., Black, C., et al. (2016) Working with influenza-like illness: Presenteeism among US health care personnel during the
2014-2015 influenza season. American Journal of Infection Control, 45(11), 1254-1258
Garcell, H. G., Arias, A. V., Garca, E. G., Jimnez, R. R., & Alfonso, R. N. (2015). A Successful Strategy for Improving the
Influenza Immunization Rates of Health Care Workers without a Mandatory Policy. International Journal Of
Occupational & Environmental Medicine, 6(3), 184-186
Hayward, A. C. (2017). Influenza Vaccination of Healthcare Workers Is an Important Approach for Reducing Transmission of
Influenza from Staff to Vulnerable Patients. PLoS ONE, 12(1), e0169023.
Najera, R. F., & Reiss, D. R. (2016, Annual). First do no harm: protecting patients through immunizing health care workers.
Health Matrix, 26, 363+.
Nuttall, D. (2003). The influence of health professionals on the uptake of the influenza immunization. British Journal Of
Community Nursing, 8(9), 391-396.
Rodal, R., Ries, N. M., & Wilson, K. (2009, Annual). Influenza vaccination for health care workers: towards a workable and
effective standard. Health Law Journal, 17, 297+.
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