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Island Health administered the first COVID-19 immunizations to health care workers in the Greater Victoria area, including Provincial Health Officer Dr. Bonnie Henry, left.Don Craig /Province of British Columbia

Bonnie Henry, B.C.’s Provincial Health Officer, has spent more than a decade trying to persuade those working in care homes and other front-line health workers to get the flu vaccine – a campaign that now must pivot to the effort to protect vulnerable seniors from the deadly COVID-19 virus.

British Columbia brought in a policy twenty years ago that allowed health care workers to be sent home without pay during an influenza outbreak if they refused to be vaccinated or to take anti-viral treatment. At the time, the majority of staff in long-term care facilities refused to get the flu shot, even though influenza is a serious risk to the residents they care for.

Dr. Henry, long before taking up her current post, was called as an expert witness to help defend the province’s position. She argued that health care workers have an ethical and professional responsibility to protect vulnerable patients from transmissible diseases.

“The whole idea of vaccine hesitancy is one that I spent a lot of time on the last number of years, because it is such a concern,” she said in a recent interview. “I strongly believe that as health care workers, we have that obligation to keep ourselves well, but also to protect those around us.”

The issue of vaccine acceptance is crucial now, as health care workers express reluctance to embrace the COVID-19 vaccine. Canadian health care unions are encouraging their members to be vaccinated, but maintain that workers should not be forced to do so as a condition of employment.

COVID-19 has proved to be especially lethal for seniors in care, but no jurisdiction in Canada is likely to make vaccination for care workers mandatory for fear of a Charter of Rights challenge. Just how far employers can go to push their workers to have the COVID-19 vaccination is unclear.

Since the vaccines began arriving in Canada in mid-December, public-health officials across the country have given priority access to those working in long-term care facilities, where the death toll among elderly residents has been horrendous. Last week, Dr. Henry’s office released data showing 43 active COVID-19 outbreaks in long-term care homes. The majority of B.C.’s pandemic deaths have been among this small population of the elderly in care facilities.

Dr. Henry expressed sympathy for those working in long-term care. In particular, she said, some may have reason to mistrust the institutions that have treated them poorly. The work force is dominated by women from racialized communities who have been “paid a pittance for the important work they do.” It is fair for them to ask questions and it was largely to allay their fears about the safety of the newly approved COVID-19 vaccines, she said, that she opted to get the Pfizer vaccine herself in late December.

But the lengthy conflict over the flu vaccine shows that there is no straightforward path to overcoming vaccine hesitancy. B.C. has tried both coercion and persuasion with health care workers for many years, and has still not consistently met its vaccination targets of 80 per cent.

British Columbia’s policy for health care workers over the flu vaccine has been challenged, exhaustively, by the province’s health care unions through grievances and arbitration.

Dr. Henry was working at the BC Centre for Disease Control when, in 2006, the BC Nurses’ Union (BCNU) went to arbitration to defend their members’ right to refuse the vaccine without penalty. The case was brought on behalf of a registered nurse who was excluded from work without pay during an outbreak at the long-term care facility where she worked. She cited concerns about the effect of the vaccine on her immune system.

All the residents in the care home where she worked were defined as “frail elderly” and at risk from influenza. Dr. Henry was called as an expert witness in communicable disease control, and described to the hearing the risk faced by those residents from influenza: Death is caused by drowning with fluid filling the lungs and causing failure to breathe. B.C.’s policy was upheld.

In 2012, another round of arbitration was brought, this time by the Health Sciences Association. The hearing ran for 14 days. The voluntary policies of the past weren’t working, the hearing was told, and vulnerable seniors were being put at risk by the people paid to care for them. Once again, Dr. Henry testified about the risk to seniors posed by unvaccinated care workers. B.C.’s policy was upheld.

But the BCNU had another major arbitration case set to start in 2020. Dr. Henry, after taking up the post in 2018 as Provincial Health Officer, faced the choice of devoting more resources to the fight, or trying a more collaborative approach. “Rather than spend the time and money and effort on going through all that again, I asked [the health employers’ bargaining association] whether we could look at how do we get people on board with this.”

On her order, the provincial policy was amended in December, 2019. Now, health care workers – who are one of the most common sources of flu transmission to patients in health care settings – are expected to do the right thing but will face no penalty if they refuse to immunize or mask up. In exchange, the BCNU agreed to campaign wholeheartedly in favour of vaccination.

That collaborative approach will be tested in the coming months as the province urges those working in long-term care to accept the COVID-19 vaccine. So far, she said, the reality of the pandemic has proved to be persuasive. “We’ve had very high uptake in both residents and staff. Some of our care homes where there have been outbreaks, the uptake is 100 per cent.”

Perhaps the experience of the pandemic will improve vaccination rates overall, she said. “I’m hoping that this whole traumatic year will help us rethink the important things that keep us well.”

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