The Controversy: Mandatory Flu Vaccines

[Julie Reyes]

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

[toomuchbaloney]

Spidey's mom, I appreciate your perspective about why you choose to vaccinate yourself and your family as well as the information you have provided. I am aware that formaldehyde is included in trace amounts and that mercury is included in the multi-dose formulation only. My employer uses the multi-dose formulation for staff and patients alike though I know I could easily go elsewhere and get a thimerasol-free version at minimal cost. I am not here to disagree with the information the FDA provides. What I would like to see is greater accountability when it comes to real adverse effects, disabilities and deaths that have occurred as a result of the flu vaccine and many others.

What sort of "accountability" are you wanting to see? Are you advocating for greater accountability on the part of the manufacturers? Are you aware of the Vaccine Injury Compensation plan and Trust Fund?

[Ankh]

What sort of "accountability" are you wanting to see? Are you advocating for greater accountability on the part of the manufacturers? Are you aware of the Vaccine Injury Compensation plan and Trust Fund?

I would love to see greater accountability from the pharmaceutical companies that make vaccines, from providers who administer them and from the FDA and CDC - the FDA for approving vaccines, medications, foods and food additives that are not safe and the CDC for making blanket recommendations. If an individual has a harmful reaction to a vaccine, and in the case of the influence vaccine many individuals, we should not brush this aside but take it into consideration the way that the vaccine components may be hurting or even killing people. However, these reactions are not always taken seriously when the data they can provide the public with (perhaps leading to safer vaccines) is critical. Knowing my holistic slant on things, I probably would still decline. However, this in itself would make me at least consider getting the vaccine.

[BostonFNP, APRN]

I would love to see greater accountability from the pharmaceutical companies that make vaccines, from providers who administer them and from the FDA and CDC - the FDA for approving vaccines, medications, foods and food additives that are not safe and the CDC for making blanket recommendations.

The FDA/CDC are government organizations and the government set-up the VICT so they are accountable. Providers are mandated/required to report all adverse effects. Manufactures are immune from most ADRs by design.

If an individual has a harmful reaction to a vaccine, and in the case of the influence vaccine many individuals, we should not brush this aside but take it into consideration the way that the vaccine components may be hurting or even killing people. However, these reactions are not always taken seriously when the data they can provide the public with (perhaps leading to safer vaccines) is critical. Knowing my holistic slant on things, I probably would still decline. However, this in itself would make me at least consider getting the vaccine.

What data have you seen that suggests vaccines are not safe, even adjuncts you listed above?

Vaccine reactions are taken very seriously, so seriously in fact, there is a whole program and court system in place to report, evaluate, and provide remediation for these rare ADRs.

[BostonFNP, APRN]

I will use the example of the flu vaccine offered by my employer - Fluzone. The ingredients I am most concerned with are the formaldehyde and thimerosal. Yes, I understand, the dose makes the poison. My opinion is that if something is a known toxin or carcinogen and can cause serious harm or death to people in a larger dose, should I be completely unconcerned with introducing a smaller dose to my system? People have different responses to this question which I respect but for me it's a no.

I agree that we need to be vigilent about what we put into our bodies, and with every medication/vaccine there is a risk. There is also risk of inaction and not vaccinating.

Formaldehyde is a necessary byproduct of metabolism and occurs naturally in every person at higher daily concentrations. The daily dietary intake is also higher.

Thimerosal is a mercury based compound that is easily processed at the dosage contained in vaccines. The concentration of the poorly processed form is actually much higher in most seafood, especially salmon. More importantly, there have been a myriad of long-term large studies that have demonstrated that it's safe at the dosage used.

[kanzi monkey]

Yes, thank you. Ok, I'll back up. It is confusing. Recently a 9 year old was left paralyzed and blind after a flu vaccine. Family believes flu shot left their daughter paralyzed, vision impaired | abc13.com One other informed us that one died from the flu in his area(and why the vaccine was needed). I asked, "Was the person who died from the flu vaccinated?" This wasn't known. One other asked me "Why would it matter?" I thought it mattered very much. How do you know the vaccine is working if people who ARE getting the flu were vaccinated themselves (as I was the last time I had the flu)?. I would think it's not made public by pro-vaxxers because it wouldn't be a good show for getting vaccinated after all. Also, it was not reported when I myself had the flu a few weeks after a flu vaccine, so I would think there are countless experiences like mine unreported. There would be a great question as to how "effective" the flu vaccine was. Perhaps more so negatively. The "science" and "math" are not accurate afterall. Just to add, :) I'm really not interested, (find it pretty amusing, sometimes gagging) to hear the dance around how "it wasn't the "flu" you had", "it might have been worse", lol and most other made up allegations. The flu shot is presented as the "utmost importance", and if you don't get it others will DIE. Nothing about some become blind and paralyzed from it, contract the flu anyway, or may die themselves. One nurse ended up in ER after being made to take the "mandated vaccine" I remember. Yet the push and the "science" that really makes no sense since it would impossible to know who comes in contact with any flu bug to begin with. Are they counted as a win for the vaccine? I went without the flu every year since NOT getting the vaccine. I credit that to organic foods and vitamins (and my "cold protocol":).

When you had the flu, how was it diagnosed?

(Apologies if this has been asked before, long thread, don't want to get caught up in any ill-activities against an already-dead horse...)

[JustMeRN]

I will use the example of the flu vaccine offered by my employer - Fluzone. The ingredients I am most concerned with are the formaldehyde and thimerosal. Yes, I understand, the dose makes the poison. My opinion is that if something is a known toxin or carcinogen and can cause serious harm or death to people in a larger dose, should I be completely unconcerned with introducing a smaller dose to my system? People have different responses to this question which I respect but for me it's a no.

The problem is the world around you is toxic to you. You will have constant toxic exposure every single day just by breathing. You sleep on a mattress doused in toxic chemicals. Your home, furniture, possessions off gas constantly. Your car poisens the air you breathe. Your house plants can kill you. A sting or bite from the right insect can kill you. Life isn't safe whether you are talking about man made things, or natural things. The key is understanding the balance and understanding the risk associated with things like vaccines. Even if a vaccine only reduces your chance of flu by 20% that can be significant. That means a 20% less chance of developing an illness that can lead to complications requiring further toxic treatments (antibiotics, inhalers, antivirals, Iv fluids).

Have ver you ever looked at the who's classification of toxic chemicals? So alcohol is considered a class 1 carcinogen (most toxic). Meat is a class 2 I believe. Are you vegan? Do you abstain from alcohol (including homeopathic remedies with alcohol as a base). Do you avoid all the things called carcinogens? Coffee? Caramel coloring? All processed foods? My point here is that it is impossible to avoid all things carcinogenic in modern life. You worry about the effect of minuscule amounts of carcinogenic compounds in vaccines, when you are likely innundated with larger doses of carcinogenic compounds when you eat a grilled chicken breast and have a glass of wine. The flu shot has become a bogey man. The perceived dangers are extremly inflated by those opposing flu shots. We live in a toxic world, and in my opinion your way of thinking is way off balance. You have given way more weight to toxins in a flu shot than is deserved.

[JustMeRN]

it is still a personal decision. But, like all decisions there are consequences. If you don't want to vaccinate your kids that's fine. But, they don't go to public school, that is the consequence. Your choice to choose pseudoscience does not trump all other parents choices to vaccinate for the health of their children. Your choice to ignore hundreds of studies on the safety and effectiveness of vaccines doesn't trump everyone else's choice to understand them. In short, your rights do not take presedence over anyone else's. The choice to not vaccinate has been time and again linked to disease outbreaks and puts at risk children in danger. When your rights endanger others there are consequences.

In relation to mandatory flu shots for health care workers, this one is even more straight forward. Vaccination, including yearly flu vaccine, is a condition of employment. No shots no job. Or in the case of flu vaccination for some facilities you don't get a shot you wear a mask. Period. Pretty black and white. Physical fitness requirements have been a component of many high risk jobs for a very long time. It's not discriminatory, it's not forced vaccination. It's a job requirement. If you can't meet the requirements of the job then you don't get the job. Period.

[JustMeRN]

kanzi, I knew from the flu symptoms, headache, body ache, fever, chills, totally drained (like being hit by a truck), etc. putting me in bed for 9 days. Actually, too sick to go to the doctor's office, that's how sick I could get. Fortunately vitamins help prevent it for me now, not having it since the last vaccine 10 years about. If I didn't know how well vitamins worked, I'd easily fall for the hype I suppose.

I'm sorry, but you have fallen for the hype. Your "vitamins" are hype backed by nothing. Again, your personal experience does not trump decades of research by qualified scientists. It just doesn't.

[quiltynurse56, LPN, LVN]

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, I have received the flu vaccine every year for the last 27 or so years. In the 70's I had a bad reaction to one so hadn't up to that time. My children's asthma/allergy doctor would not let me leave until I had one so as to protect my respiratory compromised children from it. Due to my own allergies, it was a good idea anyway.

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

We do not have mandatory vaccine policy, but it is strongly recommended. I work in LTC in one of the plains states.

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

Nothing

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

Nope

[Spidey's mom, ADN, BSN, RN]

AV'ers are against all vaccines for basically the same reasons so came across this blog that also has that great Jimmy Kimmel video with the PSA from physicians. Thought I'd share "5 Reasons To Not Vaccinate Your Kids".

5 Reasons To NOT Vaccinate Your Kids - Totally The Bomb.com

[Ankh]

The problem is the world around you is toxic to you. You will have constant toxic exposure every single day just by breathing. You sleep on a mattress doused in toxic chemicals. Your home, furniture, possessions off gas constantly. Your car poisens the air you breathe. Your house plants can kill you. A sting or bite from the right insect can kill you. Life isn't safe whether you are talking about man made things, or natural things. The key is understanding the balance and understanding the risk associated with things like vaccines. Even if a vaccine only reduces your chance of flu by 20% that can be significant. That means a 20% less chance of developing an illness that can lead to complications requiring further toxic treatments (antibiotics, inhalers, antivirals, Iv fluids).

Have ver you ever looked at the who's classification of toxic chemicals? So alcohol is considered a class 1 carcinogen (most toxic). Meat is a class 2 I believe. Are you vegan? Do you abstain from alcohol (including homeopathic remedies with alcohol as a base). Do you avoid all the things called carcinogens? Coffee? Caramel coloring? All processed foods? My point here is that it is impossible to avoid all things carcinogenic in modern life. You worry about the effect of minuscule amounts of carcinogenic compounds in vaccines, when you are likely innundated with larger doses of carcinogenic compounds when you eat a grilled chicken breast and have a glass of wine. The flu shot has become a bogey man. The perceived dangers are extremly inflated by those opposing flu shots. We live in a toxic world, and in my opinion your way of thinking is way off balance. You have given way more weight to toxins in a flu shot than is deserved.

Agreed, there are many environmental and food-based toxins surrounding us. To clarify, I haven't drank a sip of alcohol in 7 years and very little before then and yes, I am vegan and also do not drink coffee. I am certain that toxins enter my system when I breathe and engage in other typical ADLs. That being said, why would I want to add to my baseline exposure? As I said before, I respect individuals who choose to vaccinate and reduce their chances of getting the flu and/or other illnesses. My right to avoid additional exposure to toxins should also be respected. Risk-benefit analysis doesn't only take place on the groupthink level but on the individual. We all have family histories, illnesses and knowledge of self that cannot be accounted for when the CDC makes their recommendations. My body wisdom is not an invalid source of information. rusti1 brings up a great example of an RN ending up in the ED d/t a vaccine he or she attempted to declined but was pressured into getting. That RN's body wisdom should have been respected and taken into consideration to avoid that horrible outcome.

[Ankh]

The FDA/CDC are government organizations and the government set-up the VICT so they are accountable. Providers are mandated/required to report all adverse effects. Manufactures are immune from most ADRs by design.

What data have you seen that suggests vaccines are not safe, even adjuncts you listed above?

Vaccine reactions are taken very seriously, so seriously in fact, there is a whole program and court system in place to report, evaluate, and provide remediation for these rare ADRs.

I have to respectfully disagree with your comment that vaccine AE's are taken seriously by our FDA and federal government via VAERS and other forums. Yes, reporting systems are in place for vaccine AE's just like other medications, foods and FDA regulated substances. When it comes time to actually pursue legal action d/t harmful or fatal effects of vaccines, there are many barriers to this process. Claims are easily and frequently dismissed since causation is rarely acknowledged. At times claims are successfully made and individuals or families are compensated. But does that ever make up for a permanent disability or fatality? What I would like to see acknowledged are the thousands upon thousands of reported serious adverse effects people have experienced (and one can only imagine how many unreported) due to receiving vaccines we are told are safe? How can a concoction that has caused so many problems where billions of dollars have been awarded to compensate victims of vaccine injury be described as "safe"? A great start would be to use more accurate language to describe the risks and benefits of vaccines.