Should flu vaccine be mandatory for hospital staff?

Gary Finnegan

Gary Finnegan

June 11th, 2012

Gary Finnegan

‘Healthcare workers have a key role to play in preventing influenza, leading some hospitals to make vaccination a condition of employment.’

Should-flu-vaccine-be-mandatory-for-hospital-staffAs Dr Litjen Tan explained at the ESWI Flu Summit in Brussels, authorities want healthcare workers to have the flu vaccine for three reasons: to protect their patients; to protect hospital staff and their families; and to become role models for others.

Dr Tan, co-chair of US National Influenza Vaccine Summit and Director of Medicine and Public Health at the American Medical Association, said around 70% of hospital staff in the US receive the flu vaccine every year.

However, that is an average figure. Some hospitals have uptake rates of above 90% while others struggle to reach 50%. Everyone who works in a hospital – including janitors, porters, and kitchen and laundry staff – should be included in immunisation drives, he said.

“Healthcare personnel have the same superstitions and fears as the general public – they wonder whether the vaccine works, whether it’s safe and whether they really need it,” Dr Tan said.

No jab, no job

Dr Tan sits on the US National Vaccine Advisory Committee (NVAC) which published a bold new recommendation in February this year. The group suggests a series of measures to boost vaccine uptake in hospitals by making it easier for health workers to have the jab.

If that fails, the group suggests making vaccination mandatory. It recommends that if hospitals cannot convince 90% of their staff to have the flu vaccine it should “strongly consider” making it a condition of employment. No vaccine, no job.

Several hospitals have already implemented this policy. The Children’s Hospital in Philadelphia, for example, now has a flu vaccine uptake rate of 99.6%.

The proposal is a controversial one but the NVAC experts are confident that it is the best option.

“A lot of healthcare workers see it as a personal autonomy issue. We had those discussions but we looked at the science, we looked at the data and ultimately the recommendation still stood,” Dr Tan told Vaccines Today.

Role models

He said the arguments against insisting on vaccination are all valid but patient safety has to be a priority.

In addition, he said if doctors, nurses and others are to advise patients to protect themselves against influenza by having the seasonal flu vaccine then they need to set a good example.

“It’s very hard to hear a healthcare worker saying ‘You must get vaccinated’ if they have not been vaccinated themselves. We know that 85% of the time, when a doctor advises vaccination, patients listen and act. Pregnant women are five times more likely to be vaccinated if they receive recommendation from doctor,” Dr Tan said.

Transatlantic differences

Dr Caroline Brown of the WHO Regional Office for Europe said mandatory vaccination for health workers would be controversial.

“It would be very much on a country-by-country basis. Many countries will continue to encourage it for healthcare facilities. There are some countries in the region that have mandatory vaccination but whether this will become more widespread we cannot say,” she said.

Dr Vincenzo Costigliola, President of the European Medical Association (EMA), said mandatory vaccination would not go down well with doctors in Europe. “We think it’s better to recommend than to mandate. If you work with high-risk patients or are at high risk yourself then we strongly advise immunisation against influenza,” he said.

Prof Peter Openshaw of Imperial College London said a detailed look at vaccine uptake among doctors reveals a mixed picture. Psychiatrists have very low uptake, he said, with rates as low as 5%, but doctors who work with children have “reassuringly” higher rates.

Universal vaccination

Health authorities in the US have generally taken a firmer stance on influenza immunisation than their EU counterparts.

Vaccination against seasonal flu is now recommended in the US for all adults and for children aged older than six months. This followed a decade where new risk groups were added to the target populations until the US guidelines covered 85% of Americans.

“In 2009 we had about 18 target groups covering 85% of people – which includes people in high-risk groups and people who come into contact with those who are at risk. Our healthcare providers said ‘This is just too complicated.’ So when we stepped back and looked at it, we took the pragmatic step to say everyone over six months of age should be vaccinated,” Dr Tan said.

However, he stressed that this is a recommendation rather than a mandate, but added that experts believe vaccinating everyone is beneficial.

“No matter how you look at it vaccine is better in the arm than on the shelf.”