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Rogelio V. Solis/The Associated Press

Health-care professionals dedicate their lives to helping those who are sick. But if they refuse to get a flu shot, they are putting the very patients they are trying to protect at risk.

It might sound controversial, but according to an editorial published Monday in the Canadian Medical Association Journal, health care workers should be subject to mandatory flu immunization programs in order to prevent the spread to patients who could become seriously ill or die as a result.

The journal says that people working in health care settings have a responsibility to patients to get immunized.

"By failing to get the vaccine, [health-care professionals] are inadvertently contributing to the level of harm caused to patients in hospitals," said Ken Flegel, a senior associate editor at the journal who is also a physician and a professor of medicine at McGill University.

The issue of mandatory vaccinations in health care settings is highly contentious and divisive, with a debate that centres on the line between maintaining personal freedom and fighting to protect the greater good.

The editorial comes a few days after Health Canada announced it was halting distribution of flu vaccines produced by Novartis as a result of reports some batches contained clumps of particles. The majority of Canada's flu shots are produced by other companies and at this point, no adverse events have been reported in those who received the Novartis vaccine.

Compulsory flu shot programs have also been in the spotlight more than usual this year, as B.C. becomes the first province to require health care workers to get a yearly flu shot or, if they refuse, to wear a protective mask throughout the entire flu season.

Only 42 per cent of health care workers get the flu shot every year, according to the U.S. Centers for Disease Control and Prevention. The numbers vary each year, but Flegel noted that immunization rates in Canada are typically quite low, often with less than half of all workers getting vaccinated.

But several unions representing health care workers have opposed the move to compulsory flu shots as draconian, arguing it is unfair to workers and that flu immunization should remain voluntary.

"It's a pretty blunt instrument," said Mike Old, director of communications with the Hospital Employees' Union in B.C. Instead of a mandatory program, it would be much more effective to create better education policies aimed at health care workers and leaving the decision up to them, he said.

The CMAJ editorial, however, argues the issue isn't about choice. Sick and vulnerable hospital patients shouldn't be exposed to a virus that could make their condition worse or even kill them and health care institutions should use everything at their disposal, including mandatory vaccinations of workers, to prevent the spread, Flegel said.

"You are kind of taking away peoples' autonomy over their own bodies," he said. "On the other hand, they're inadvertently causing harm to our patients ... Some of that harm is death."

Up to 8,000 people die from the flu each year. While young, healthy people generally recover after infection with the flu within several days, people who have compromised immune systems, such as the sick and the elderly, can develop numerous complications as a result of the flu, such as pneumonia, which can lead to death. And while encouraging employees to stay home if they're sick could reduce the spread, people who are infected with the flu virus are contagious before they develop symptoms.

Vaccinating those vulnerable groups isn't enough to mitigate the risks of the flu, either. A growing number of studies, including a comprehensive report released earlier this month by researchers in Minnesota, showed that flu vaccines are less effective in certain groups, such as the elderly, because they often aren't able to produce an adequate immune response to ward off the virus.

That's why it's so important for health care workers to get the vaccine, according to the CMAJ. Even if some individuals refuse for religious or moral reasons, improving vaccination coverage rates would likely have a major effect on reducing the number of patients who suffer complications or die as a result of the flu, Flegel said.

A growing list of health authorities are endorsing a move to mandatory vaccinations. The American Academy of Pediatrics supports compulsory influenza immunization for health care workers. Public Health Ontario recently released guidelines that urges health care institutions across the province to implement mandatory flu vaccination programs for its workers.

Flegel said there might be more widespread support for those types of programs if a greater number of people understood the serious nature of the flu, particularly for sick, vulnerable people.

"I think we've got a bit complacent and comfortable with flu," he said. " It's not a joke."