Should The Swine-Flu Vaccine Be Mandated For Health Care Workers?

Mandatory vaccination programs are seldom without controversy. Since the early 1900’s when public health workers went door-to-door inoculating people against smallpox and authorities blocked unvaccinated children from attending school, these widespread campaigns have been met with court challenges and public opposition. The underlying issue has always been that mandates threaten medical liberty—the freedom for individuals to choose which medical interventions they want and which they don’t want. But when it comes to vaccines and infectious disease, in the eyes of the law, protecting public health often trumps individual choice.

It was predictable then, that these same tensions would surface when New York State and some large hospital systems in other areas made H1N1 vaccines mandatory for health care workers. In New York, health care workers like nurses, aides, emergency room clerks, food service workers, etc. are all required to get both the seasonal and the swine flu vaccines by Nov. 30, or risk losing their jobs. The idea is that without being vaccinated, these workers pose a threat of infection to vulnerable patients, and also, in the event of a widespread outbreak, they are more likely to get sick and be unable to work when needed most.

Opposition to the mandate from health care workers is growing. Several groups of health care workers have launched “Stop the Shot” efforts, including a legal challenge to the licensing of the swine flu vaccine that was filed in federal court and contends that the vaccine was approved without appropriate safety and effectiveness testing. The workers (joined by the anti-vaccine groups Natural Solutions Foundation and the Foundation for Health Choice) have asked a judge to block the distribution of the vaccine and halt mandated flu shots in New York.

The mandate is also facing a legal challenge in NY state court where a lawsuit (which includes some of the same plaintiffs as the federal suit) has been filed against Richard Daines, the state health commissioner, in hopes of halting the required flu shots. Yesterday, a state judge denied a request for a temporary restraining order barring the state from mandating flu vaccines for health care workers, but left open the possibility of another hearing on the issue next week.

Health authorities have flirted with making seasonal flu shots mandatory for years—currently the shots are only required at a handful of hospital systems. But without mandates or—in many cases—effective voluntary efforts like offering free shots and having roving vaccination carts that make the process more convenient, studies show that barely 40% of health care workers nationwide get seasonal flu shots. Immunologists believe that this vaccination rate has to reach 90% before protection is really complete.

According to a 2004 report issued by the National Foundation for Infectious Diseases, widespread vaccination of health care workers reduces influenza rates in nursing home patients by 43% and mortality rates by 44%. It also cuts down on staff illness and the resulting problem of absenteeism. Not surprisingly, vaccination of health care workers saves money—both in costs of treating hospitalized patients and in lost work time.

This same report provides some insight into how many health care workers and patients were sickened in the Asian flu pandemic of 1957—a harbinger for this year’s bout with H1N1. At the Oklahoma City Veteran’s Hospital, for example, 39% of patients in the neurology ward were infected with the flu and all but one physician on the ward was sickened. At New York Hospital, some 62% of unvaccinated staff contracted influenza in 1957. The report contains many similar examples of hospital outbreaks from other years when flu was not considered pandemic but still exacted a heavy toll on patients and workers.

Dr. Thomas R. Frieden, the new CDC head and past Commissioner of the New York City Department of Health and Mental Hygiene said in August that “even though he expected a surge in swine flu deaths this winter and even though C.D.C. guidelines give health care workers first priority for the new vaccine, he would not push to make vaccinations mandatory.

‘This is just not the right flu season to take this on,’ said Dr. Frieden.

C.D.C. experts said there was just too much confusion this year, with the logistical difficulties of getting both seasonal and swine flu vaccinations to workers and the fact that the swine flu vaccine is still being tested, to risk a fight over the issue now.”

Clearly that view is not shared by everyone. Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania doesn’t mince words on how he feels about health care workers who refuse to get vaccinated:

“Enough already with the whining, moaning, demonstrating and protesting by health care workers. Doctors, nurses, respiratory therapists, nurses’ aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work.”

How does Caplan feel about the argument that mandated vaccination infringes on the rights of health care workers, on their “medical liberty?”

“Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?”

Caplan is clearly expressing the frustration that has surrounded the influenza vaccination issue for years. All the evidence points to real benefits in terms of protecting patients from illness and death when workers are vaccinated. Health care workers are already required to be vaccinated against measles, mumps, and polio and to undergo regular tuberculosis testing. Why the worry about flu vaccines?

Fears persist about the safety of influenza vaccines—even though there is no evidence that today’s shots cause illness or have any other side-effects beyond a “pinch” on delivery. Of course, fear and distrust of vaccines runs deep within our society and misinformation is rampant and spread irresponsibly by celebrities and some media outlets.

And, in fact, there are a fair number of Americans who, like the disgruntled health care workers, feel equally wary of the H1N1 vaccine. Some of them, like Bill Maher, are famous and reach a wide audience. On a recent show, Maher debated the merits of the vaccine with Senator Bill Frist—who ended up looking like the reasonable one on a health care issue while Maher sank to the level of anti-vaccine zealot in his opposition to the flu shot. Maher starts off the interview with Frist by asking:

"Conservatives always say about health care, especially, you know, are you going to let the government run health care? They screw everything up. So why would you let them be the ones to stick a disease into your arm?"

At one point Maher—who said he would never get the swine flu vaccine “or any vaccine,”—says he believes that pregnant women (considered by the Center for Disease Control to be high-priority for the shots because they have a higher risk of serious illness and death from H1N1) shouldn’t get H1N1 vaccinations. He provided no scientific basis for his statement and later, sent out a message to his 60,000 Twitter followers that those who decide to get the swine flu shot are “idiots.”

A significant portion of Americans seem to agree—or at least feel confident that H1N1’s return this season in a milder form is not a serious enough threat to their health or to that of their children. In fact, a recent AP poll  found that 38% of parents said they would be unlikely to give permission for their kids to be vaccinated at school. A Consumers Report survey found that only about half of all Americans say they are planning to get the swine flu vaccine, and many of those are senior citizens, the ones least likely to actually get the disease.

The swine flu experience is, in the end, the latest example of how Americans react to public health crises. Last April when reports of serious infection and thousands of deaths from a new flu virus were at the forefront of the news, fear of an epidemic reached a high level. Daily reports from the CDC tracked the virus and schools closed in infected areas for a week at a time. People wore masks on the subways and sales of antibacterial gels sky-rocketed. The hope was that the government would come up with a safe, effective vaccine as soon as possible that would protect us from the next wave of virus in the autumn.

As it turns out, that effort was mostly successful: In June, Congress appropriated $7.65 billion for agencies to use to respond to the H1N1 pandemic, and much of that has already been spent or committed to public health programs. Some $2 billion went to vaccine makers like MedImmune, Novartis, Sanofi-Aventis  and GlaxoSmithKline who geared up to produce adequate supplies of “Flu-Mist” and shots. Then came the good news that adults and children over 10 only needed one vaccine to have protection.

This week the first deliveries of vaccine were reaching state health authorities. They are being sent supplies free of charge to distribute to doctors, school nurses and elsewhere. The CDC has a goal of providing 195-250 million doses of the vaccine—enough to protect those at highest risk (asthmatics, pregnant women, children, parents of children under 6 months of age, and those who are medically fragile) and then some.

Will vaccination efforts ultimately be successful? So far, doctors and health care facilities are being inundated with requests for shots from worried parents and elderly folks (who are actually at lowest risk for this particular variety of influenza) so the problem is too much demand for limited supply. But what about when that initial demand is gone? Will the government be stuck with a lot of extra vaccine as this year’s swine flu—at least in the short term—proves to be a mild version?

I think it would be shortsighted to be complacent about swine flu. According to the CDC, so far this season 147 children have died from Type A influenza—the type associated with swine flu; 19 died last week alone. The virus has now been confirmed in 39 states and tens of thousands have been sickened. People with asthma, diabetes, heart disease, and those who are obese—along with pregnant women, young children and other groups—are at greater risk of serious illness and death. The vaccine will soon be available; it’s safe, cheap and very effective. Where’s the downside?

For health care workers and many others who being urged to get the shot, the real issue is once again, the “greater good.” Massive immunization campaigns are ultimately less about individual risk and more about “herd immunity;” reducing the pool of virus in a population to such low levels that those at greatest risk of serious illness or death are protected. With this particular shot, the benefits of mandated vaccination greatly outweigh any risks to health care workers—and the population as a whole.

Comments

[turtle]

If anyone gets a swine flu vaccine shot then they deserve what will happen to their health and liberties. The average American is clueless.

http://articles.mercola.com/sites/articles/archive/2009/10/17/Washington-Health-Department-Suspends-Mercury-Restrictions-for-Swine-Flu-Vaccine.aspx

[Ricky]

We don't need government manufactured epedemic to scare us to get the Obama agenda done. There should be no government swine flu vaccine. If it was profitable, the free market would sell it. It's being pushed on us by Obama when he hasn't even prove he's legally President. WHERE IS THE BIRTH CERTIFICATE? Vote Republican in 2010 as if your life depended on it! It probably does!

[generic valtrex]

this vaccine is only another joke. there's no way to escape the flu