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Janice Vanderspek, a long-time nurse at BC Children’s Hospital who gets a flu shot ever year, said she has heard other nurses talk of risking discipline by refusing to comply with the vaccination edict.

The decision to hold off disciplining health-care workers who refuse to get a flu shot or wear a mask was made without consulting the province's chief public health officer, who announced the landmark policy in the first place.

Provincial Health Officer Perry Kendall said he learned of the softened approach only after it was approved late last week by a group consisting of deputy health minister Graham Whitmarsh and CEOs of the province's regional health authorities.

The Health Ministry opted to focus on education for the first year of the policy, rather than enforcement, notwithstanding that years of workplace campaigns had failed to persuade more than 50 per cent of health-care workers to be vaccinated.

An agreement was reached with B.C.'s three major health-care unions on Friday.

Asked why education efforts were expected to work this time, Dr. Kendall replied: "I wasn't at the front-line negotiations, so I don't know."

In the days leading up to the Dec. 1 deadline for health-care workers to be immunized or don a surgical mask while on duty, Dr. Kendall had strongly defended the edict, the first of its kind in Canada, which included possible punishment for those who did not comply.

In an interview on Wednesday, however, he rejected a suggestion that the unexpected turnaround left him with egg on his face.

"I don't think so. … Change is always a possibility, and one learns that early on," Dr. Kendall said. "The policy remains unchanged. The change was in how it would be implemented. … I don't think this is a retreat from Moscow."

He said he accepts the ministry's role in deciding how to implement the policy.

Public-health officials and all health organizations, including unions, recommend flu shots as the best way to prevent influenza outbreaks among patients and staff.

But the new policy produced an uproar among unionized health-care workers. Their unions filed grievances against the mandatory nature of the decree, arguing that immunization was an individual decision and evidence on the benefits of flu shots was weak.

Dr. Kendall said he was taken aback by the extent of the opposition. "I was thinking that the interest of the patient really did come first. When you become a health-care worker, I think you actually take on some obligation to your patients."

But he said there were ministry fears so many workers might have to be sent home for non-compliance that the quality of health care would be jeopardized. "There was some anxiety about that."

Despite the controversy and last-minute retreat on enforcement, Dr. Kendall remains adamant that a tough approach to get health-care workers vaccinated is the right way to go. "It's a valid policy. It's a supportable policy."

Ministry spokesman Ryan Jabs noted that Dr. Kendall was closely involved in developing the strategy, and only the discipline aspect has been altered. "This gives us much more time to continue to consult with labour groups and other stakeholders." Workers are still expected to be either immunized or wear a mask.

Fraser Health Authority spokesman Roy Thorpe-Dorward said those who refuse will be handed a pamphlet outlining reasons why they should be vaccinated.

Already, likely because of the earlier threat of discipline, flu shot rates among health-care workers are at record levels this year. At Fraser Health, more than 70 per cent of staff have now been immunized, nearly twice the level of previous years.

"This is a major step forward," said Michael Marchbank, president of the Health Employers Association of B.C. "More people are getting the flu shot. That is what's important."

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