The flu has been nasty this year, but not nearly as nasty as the battles being fought over this question: Should vaccination of health-care workers be mandatory?
A number of health workers have been sent home in recent weeks for refusing the flu shot. In British Columbia, the government backed away (at least temporarily) from legislation making the vaccine mandatory for all health workers after nurses waged a fierce public battle. In Ontario, the health minister, fearing a backlash, quietly refused to implement a call by Public Health Ontario to make flu shots a condition of employment for health workers. And across the country nurses have been pitted against nurses in public spats.
Let's be clear about one thing: It is perfectly reasonable to expect all health workers – from surgeons through hospital cleaners – to be vaccinated against influenza, to make it a condition of employment even.
It is no different than expecting them to wear gloves, dress in scrubs, wear masks (in some situations), wash their hands, and get hepatitis B vaccinations. These are all measures designed to protect patients from harm and, to a lesser extent, to protect employees themselves. Let's not forget that patients who are hospitalized or need community health-care services are, by definition, at higher risk of infection.
Ethically and legally, the safety of patients trumps the civil rights of workers.
Case closed.
That being said, introducing legislation to make influenza vaccination mandatory is a lazy and heavy-handed way of achieving a desirable public-health goal.
If you can't convince the vast majority of health workers to get a flu shot, then how can you expect the public to do so? In public health, communication and education are – and should be – much more effective tools than coercion.
In Canada, vaccination rates for health-care workers are abysmal, in the 40- to- 60-per-cent range. But the overall figures don't tell the whole story. In hospitals, there are wards where 100 per cent of workers get the flu shot, and others where virtually none do. Rates also vary a lot by profession. U.S. data show 88 per cent of pharmacists are vaccinated, followed by doctors at 84 per cent, and nurses at 82 per cent. Then rates drop sharply, below 50 per cent, among nursing aides and assistants. The data should remind us that fear of vaccines is sometimes (though not always) related to level of education.
So why were nurses in B.C. – a highly educated group – so fiercely opposed to the flu vaccine? Well, first of all, they were not opposed per se. While fighting the mandatory vaccine edict, the B.C. Nurses Union repeatedly told its members to get the shot.
This fight was really about respect. Nurses – and many other frontline health workers – have been kicked around a lot in recent years with measures like wage freezes or rollbacks, mandatory overtime, loss of bargaining rights and so on. They are frustrated and they are pushing back.
But refusing the flu shot is the wrong hill to die on.
The most unfortunate aspect is that when respected health workers like nurses refuse the flu vaccine, it sends the wrong message to the public and creates an opportunity for anti-vaxers and quacks to exploit the situation.
The fundamental issue is a fairly narrow legal one: Is making the flu shot a condition of employment something that has to be bargained for, or can it be imposed unilaterally as a measure to protect patients? It is already established practice that flu shots are mandatory during institutional flu outbreaks in hospitals and nursing homes; the question now is whether that rule is generalizable to the whole health system.
Yet this discussion got derailed by technical and emotional arguments about the efficacy of the flu shot. Canadian research shows this year's shot works about half the time. Ideally, we would like a better vaccine, but its efficacy is irrelevant to this debate; workers (and their unions) cannot pick and choose when health and safety measures apply. To take an everyday example, hospital cafeteria workers cannot refuse to wear a hair net if research shows hair falls into food only half the time. If anything, the 50-50 record of the flu shot makes it all the more essential that health workers get vaccinated, to reduce patients' exposure to the virus.
Much was also made of the right to opt out of the shot, for medical and religious reasons. Again, this issue is so trivial as to be largely irrelevant. Very few people have allergies to flu shots and very few religions discourage vaccination. Scientific ignorance and vague concerns do not justify exemptions.
Being a health-care worker is hard work, but it's also a privilege. With that privilege comes many responsibilities.
One of the primary responsibilities of carers and healers is creating a healthy environment for patients. Helping do so by getting an annual flu shot is not an unreasonable burden. If anything, it should be a point of pride.
André Picard