The Controversy: Mandatory Flu Vaccines

Many hospitals are moving towards creating mandatory influenza vaccination policies as a condition of employment. Such mandates are causing surefire responses on both sides of the fence. What is the push behind the movement, and what is causing the pushback?

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The Controversy: Mandatory Flu Vaccines

First, let me just go over some of the symptoms of the flu, and then we will get down to business on the controversy surrounding the push to create mandatory flu vaccines for healthcare workers:

  • Sudden onset fever
  • Headache
  • Chills
  • Myalgia
  • Dry cough
  • Sore throat
  • Stuffy nose
  • Loss of appetite
  • Limb or joint pain
  • Difficulty sleeping
  • Diarrhea or upset stomach

I can't think of anyone who wants any of these symptoms, or to come down with the flu, can you?

Influenza vaccination research has clearly documented the benefits of receiving the flu vaccine (Google it - you will find a plethora of information...however, I will list some links at the end of this article for your information). However, even though there is sufficient evidence to prove the benefits of receiving the flu vaccine, vaccination rates among healthcare workers are pitifully low. In 2013, only 55% of nurses in the frontlines were vaccinated.

Organizations such as The Joint Commission, the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Physicians, Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the Centers for Medicare & Medicaid Services, the Centers for Disease Control, Healthy People 2020, etc., etc., have stated their position on recommending the flu vaccine for healthcare workers in order to decrease the risk of exposure and reduce deaths. Due to this recommendation, many healthcare facilities are now creating mandatory flu vaccine policies as a condition of employment.

Employers who create mandatory policies will have exemptions, of course. Exemptions are made for medical and religious exceptions. For places that do not have a mandatory flu vaccine, they may "strongly recommend" the vaccination and may have a declination form for employees to submit if they refuse the vaccine. Additionally, some employers will enforce refusers to wear a mask during flu season while they are at work in order to protect the patients and the employee.

What is the purpose behind the push toward flu vaccines?

Evidence has shown that there are more than 36,000 deaths in the US each year related to influenza, and more than 200,000 hospitalizations. Influenza is the 6th leading cause of death. Healthcare workers are the leading cause of influenza outbreaks in the healthcare system. up to 50% of people who are infected by the flu virus do not fill ill for several days and can spread the virus to people at risk of complications and death from the flu. Additionally, evidence shows vaccination decreases mortality by 40%, decreases the spread of nosocomial infections by 43%, and decreases absenteeism by 20-30%.

Additionally, there is the ethics to consider. As healthcare workers, we have all taken an oath to "do no harm". As a nurse caring for patients who are not in their most physically healthy state, do we take the vaccination in order to prevent spreading the flu to our vulnerable patients, in order to "do no harm"? We must consider this when we make our decision to take or refuse the vaccination.

What hospitals have created a mandatory flu vaccine policy?

I have the names of a few hospitals, and this is by no means a comprehensive list. This is based on a ListServe survey of hospitals and these are the responses received:

  • Children's Hospital of Philadelphia (Philadelphia, PA) - since 2009
  • Children's Mercy Hospitals and Clinics (Kansas City, MO)
  • Children's Colorado (Aurora, CO)
  • Children's Hospital of the King's Daughters (Norfolk, VA)
  • Children's Medical Center Dallas (Dallas, TX) - since 2012
  • Riley Children's (Indianapolis, IN) - since 2012
  • East Tennessee Children's (Knoxville, TX) - since 2013
  • Boston Children's (Boston, MA)
  • Sharp Mary Birch Hospital for Women and Newborns (San Diego, CA) - since 2013
  • Roger Williams Medical Center (Providence, RI)
  • Brookwood Medical Center (Birmingham, AL)
  • Johns Hopkins (all hospitals/clinics) (Baltimore, MD)
  • Driscoll Children's Hospital (Corpus Christi, TX)
  • Spohn Health System (Corpus Christi / San Antonio, TX)
  • All Connecticut Hospitals

What are some reasons that people refuse the flu vaccine?

Refusal may be largely due to misconceptions related to the vaccine. Fears that the immune system will cause them to get the flu, beliefs that hygiene and better nutrition are more helpful than the vaccine, fear of needles, beliefs that the vaccine does not work, and fear of side effects. Others believe that they have a constitutional right to refuse the vaccine and that mandatory policies are violating these rights.

Common concerns and myths about the flu vaccination

(taken from the Los Angeles County Department of Public Health outline of flu vaccine talking points for managers)

The flu shot will give me the flu

The flu shot does not give people the flu. It uses inactivated ("dead") virus. People may still catch a cold or other virus that the vaccine is not designed match.

I don't believe the flu vaccine actually works

Studies have shown that flu vaccination prevents flu in 70% to 90% of healthy adults younger than 65 years old.

I had the vaccination last year

You need a new vaccine every year - the virus changes over time.

What about possible adverse reactions

Serious adverse reactions are very rare. They are explained on the CDC's Vaccine Information Statement, which is distributed when the vaccine is administered.

Local short-term reactions - such soreness at the vaccination site, slight fever, achy feeling - may occur but usually do not last long. Over the counter medicines are helpful. Even short-term reactions are much less bothersome than catching the flu and feeling very sick for days.

I'm not in a high-risk group

Your patients are at-risk, and possibly some friends and family members. You can be infected with the flu virus but not feel ill - and can still transmit flu to at-risk patients.

The flu vaccine made every year does not match the circulating flu strain

Inactivated influenza vaccine is effective in preventing transmission and reducing complications of the flu. In years when there is a close match between the vaccine and circulating virus strains, the vaccine prevents illness among approximately 70%--90% of healthy adults under 65 years of age. Vaccinating healthy adults also has been proven to lead to decreased work absenteeism and use of health-care resources, including use of antibiotics. Strong protection is also expected when the vaccine is not a close match with circulating strains, with 50%--77% effectiveness in these instances. In addition, effectiveness against influenza-related hospitalization for healthy adults from inactivated vaccine is estimated at 90%.

Knowledge is Power

All healthcare facilities will be facing the choice of creating a mandatory influenza vaccination in the near future, if they have not already. In order to make an informed decision on the topic, we must have information. Knowledge is power. Before you make a blanket statement on pros or cons, have the information you need, know the research, and make an educated decision.

Please respond to this article by answering the following questions:

  1. Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?
  2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?
  3. What concerns do you have about the flu vaccine?
  4. Do you know if anyone who has been released from their job because they did not get the flu vaccine?

References

American Association of Family Practitioners. (2011). AAFP supports mandatory flu vaccinations for healthcare personnel. Retrieved from: AAFP Supports Mandatory Flu Vaccinations for Health Care Personnel

ATrain. (2014). To accept or refuse the flu vaccine. Retrieved from: ZZZ_133_Influenza: Module 7

CDC. (2014). Vaccination: Who should do it, who should not and who should take precautions. Retrieved from: Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions | Seasonal Influenza (Flu) | CDC

Influenza Action Coalition. (2015). Influenza vaccination honor roll. Retrieved from: Honor Roll: Mandatory Influenza Vaccination Policies for Healthcare Personnel

Los Angeles County Department of Public Health. (2014). Talking points for managers. Retrieved from: http://tinyurl.com/p6nbg2u

National adult and influenza immunization summit. (2015). Vaccinating healthcare personnel. Retrieved from: Vaccinating Healthcare Personnel - National Adult and Influenza Immunization Summit

NursingTimes. (2014). Why do health workers decline flu vaccination? Retrieved from: http://www.nursingtimes.net/Journals/2014/11/28/y/k/x/031214-Why-do-health-workers-decline-flu-vaccination.pdf

TJC. (2012). R3 Report: Requirement, rationale, reference. Retrieved from: http://www.jointcommission.org/assets/1/18/R3_Report_Issue_3_5_18_12_final.pdf

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Julie Reyes

About Julie Reyes, DNP, RN

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Specializes in Emergency.

1. Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?

Yes.

2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

Yes. Big huge teaching hospital conglomerate corporation somewhere in NJ.

3. What concerns do you have about the flu vaccine?

That not everybody who should get it does.

4. Do you know if anyone who has been released from their job because they did not get the flu vaccine?

No.

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Specializes in Complex pedi to LTC/SA & now a manager.

1. Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?

Yes, if I have coverage. Can't afford out of pocket. New employer offers vouchers to remove that barrier

2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

Yes. Private duty with medically complex & fragile pediatric patients.

3. What concerns do you have about the flu vaccine?

"That not everybody who should get it does." Same here. Plus the wealth of misinformation claiming pharma makes big bucks and hides adverse effects, worse when promoted by licensed nurses.

4. Do you know if anyone who has been released from their job because they did not get the flu vaccine?

Yes. One nurse was not because of a verifiable rare medical contraindication but was released from the complex respiratory patients and reassigned to the more stable, less at risk basic cars children. The nurse's risk outweighed the benefit but the risk of the nurse carrying & transmitting influenza to the most fragile children (some too sick for vaccinations) was too great.

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1. Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?

Yes.

2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

Yes. Big huge teaching hospital conglomerate corporation somewhere in NJ.

3. What concerns do you have about the flu vaccine?

That not everybody who should get it does.

4. Do you know if anyone who has been released from their job because they did not get the flu vaccine?

No.

I have several friends who are afraid to get the vaccine because they truly believe the vaccine itself made them sick in years past. This is the main excuse I hear from people.

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Specializes in Cardiology, Cardiothoracic Surgical.

  1. Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)? Yes, it's always free from employers, and I have many other hills I am better off dying on besides this one.
  2. Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? Yes, I'll be returning to a Level 1 trauma center in a month, also, my per diem position in homecare requires it especially around respiratory patients.
  3. What concerns do you have about the flu vaccine? I'm concerned about the mutation rates of the different strains and adequate coverage of strains for the next year. However, partially effective flu vaccine is better than no vaccine.
  4. Do you know if anyone who has been released from their job because they did not get the flu vaccine? Not personally, as fortunately most of my coworkers are sane, rational people that support vaccinations for themselves and their children. You know, SCIENCE, and public health, 'n at.

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Flu vaccination has been mandatory for years at my place of employment. I don't even work in a patient care area. My employer does NOT want to lose my man hours while I am ill with a preventable disease, or want to pay for the cost of the treatment.

Far as I'm concerned, they (ha-ha ) call the shots on this one.

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My big-famous-academic-medical-center employer has had a number of meaningful incentives in place to encourage employees to get vaccinated for a number of years, and announced earlier this year that, starting this year, vaccination is going to be mandatory (I have no problem with that, or with taking the vaccination).

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1)__ Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?

I do. :yes:

2)__ Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

Yes. Small rural hospital; in home hospice nurse. School district.

3)__ What concerns do you have about the flu vaccine?

Not a darn thing! :up:

4)__ Do you know if anyone who has been released from their job because they did not get the flu vaccine?

Not yet.

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1)__ Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?

No-the flu vaccine is only effective if it is a match for that year- the only times I had flu like symptoms was the first year I received the vaccine, and last year when I did not. I took Tamiflu last year and was better in two days.

2)__ Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work?

Yes, Kaiser was my most recent employer

3)__ What concerns do you have about the flu vaccine?

It adds to the scope creep of vaccines, that you do not know which strains are being included in that years vaccine= not informed consent.

4)__ Do you know if anyone who has been released from their job because they did not get the flu vaccine?

No, just supposed to wear a mask

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1 -- YES, annually.

2 -- NO, not mandatory.

3 --NONE whatsoever

4 -- NO--but they are required to mask for about 6 months out of the year, and it's enforced.

...and I'm quite sure the forums will be FULL of threads voicing complaints about how unfair it is to require the vaccination....and the rebuttal of those who voice how unfair it is to expose others when it is preventable.

Let the flu season begin!

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Specializes in Tele, ICU, Staff Development.

Love this article, like all of Julie's articles!

I take the flu shot, my employer requires a waiver from employees who refuse the immunization.

My ethical beliefs in this case are "for the greater good" and my feelings of social responsibility.

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if it did any good, i might not be so against it. i do it to work, and soon that will be moot, and i will never do it again.

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