What could be more innocuous than a simple flu shot, recommended every year by public health officials, nurses and doctors around the world?
Yet the move by B.C authorities to force more than 100,000 public health-care workers to be vaccinated against influenza, or wear a mask – the first province to do so – has provoked bitter controversy, as the Dec. 1 needle deadline nears.
The BC Nurses' Union has filed a union grievance against the policy, a well-known international health researcher has lashed out at public-health officers here as tyrants, and others have argued there is not enough scientific evidence to justify such a move.
"You can't ride on intuition with this stuff," said Alan Cassels, a drug-industry researcher at the University of Victoria. "The science should determine whether it's the right thing to do, and there is little evidence that [vaccination] prevents transmission from health workers to patients."
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.
"They feel it should be an individual choice," Ms. Vanderspek said. She added that she considered refusing her annual flu shot because she felt she was being coerced to have it.
Despite the backlash, public-health officers remain determined to press on with their landmark policy. They say they are motivated by years of having fewer than 50 per cent of the province's health-care workers opt to be vaccinated against influenza.
"At some point, you have to grab the nettle," provincial health officer Perry Kendall said Wednesday. "Either we believe it's worthwhile doing, or we don't, and we think we are doing the right thing."
Dr. Kendall agreed that many of the studies showing a benefit from having health-care workers immunized are not as rigorously scientific as they might be, but generally they do show a reduction in influenza-like illnesses in institutions with high vaccination rates.
"Perfect can be the enemy of the good," he said, noting that to discount the positive impact of flu shots would mean "99.999 per cent of public health officers, infection-control officials and infectious-disease specialists have got it wrong … I suppose it's possible… "
B.C. intends to evaluate the new policy over the next five years, using a $1-million grant from the Michael Smith Foundation.
Asked why the province didn't wait for more conclusive studies before pressing forward, Dr. Kendall replied: "We are at the pointed edge, which carries its risks and its pains. But every health jurisdiction across Canada recommends health vaccination as the right thing to do."
Health-care workers who refuse to be vaccinated or wear a mask while on duty will first be summoned to an informal meeting, said Vancouver Coastal Health Authority spokeswoman Anna Marie D'Angelo. Continued refusal would make an individual liable to discipline "up to and including termination," she said.
The Nurses' Union's opposition to the imposed vaccination policy has been buttressed by a report by the international, non-profit Cochrane Collaboration, which analyzed a number of studies on the impact of vaccinating health workers caring for the elderly and found "no credible evidence" that it reduced influenza complications among patients.
Despite its grievance, the BCNU continues to recommend its members receive a flu shot.