Will feds recommend mandatory flu vaccine?
NVAC takes steps to consider mandates
Federal health authorities are taking the first tentative steps toward considering a recommendation on mandatory influenza immunization of health care workers.
Assistant Secretary of Health Howard Koh asked the National Vaccine Advisory Committee (NVAC), an advisory panel of public health experts, to look into the issue. Current federal vaccine guidelines don't address vaccination mandates. Such requirements, even for school children, are typically set at the state or local level.
"I think he's interested in a range of issues related to influenza," says Guthrie Birkhead, MD, MPH, deputy commissioner for public health in the New York State Department of Health and NVAC chairman, noting that Koh also asked the NVAC to review racial and ethnic disparities in influenza immunization and the impact of the recent recommendation for universal influenza vaccination.
"Health care worker [influenza immunization] is being discussed a lot more recently, nationally in professional circles and in the press," says Birkhead.
NVAC was scheduled to discuss how it might address mandatory influenza vaccination at its September meeting. "It's really the introduction of that concept to NVAC as to whether it's something they would consider," explains Bruce Gellin, MD, director of the National Vaccine Program Office in Washington, DC.
Infection prevention professional groups have not been as tentative. The Society for Healthcare Epidemiology of America (SHEA) called for flu vaccination to be a condition of employment for health care workers.
Such policies have been adopted by a growing number of hospitals and health systems. In a survey of about 1,500 health care workers conducted by the Rand Corp. for the Centers for Disease Control and Prevention, about one in 10 said they work for employers who require flu vaccination. (In some cases, employees who do not receive the vaccine must wear a mask when caring for patients but are not terminated.)
Among health care workers who reported employer mandates, 97% said they received the seasonal and H1N1 vaccines. If there was no mandate, 71% received the seasonal vaccine and 50% reported receiving the H1N1 vaccine.
"As a strategy to improve immunization of health care workers, it's clearly effective," says Tom Talbot, MD, MPH, assistant professor of medicine and preventive medicine at the Vanderbilt University School of Medicine and Chief Hospital Epidemiologist at Vanderbilt University Medical Center in Nashville, TN. "I think we'll see increasingly more professional groups moving toward a strong position on vaccination."
Unnecessarily punitive?
Mandates certainly do lead health care workers to get their vaccine. But critics say the tactic is unnecessarily punitive. Unions have successfully overturned mandates in some hospitals or health systems because they were not implemented through the collective bargaining process.
The American College of Occupational and Environmental Medicine (ACOEM) also has opposed mandatory influenza vaccination of health care workers, particularly since the effectiveness of the vaccine varies significantly as the prevailing strains change from year to year. "Current evidence regarding the benefit of influenza vaccination in health care workers as a tool to protect patients is inadequate to override the worker's autonomy to refuse vaccination," ACOEM said in its position statement.
To Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU), the recent push for mandatory vaccination policies represents skewed priorities. The Centers for Disease Control and Prevention recently proposed revised guidelines that recommend the use of face masks rather than N95 respirators for health care workers caring for patients with H1N1 influenza.
"The imbalance of protection is really startling," he says. "We won't give a health care worker a 50-cent, fitted N95 respirator when they go into a room with a coughing patient with suspected or confirmed H1N1."
Yet the CDC has stated that the H1N1 vaccine was just 62% effective, he notes. "If the vaccine was effective, we could maybe make the argument that this [mandatory policy] made sense," he says. "To fire people for not getting a vaccine that's not all that effective, it's just massive overreach."
Talbot acknowledges that vaccination is just one strategy to prevent influenza transmission in hospitals. For example, hand hygiene is another important measure, he says.
But he and other infection preventionists assert that vaccination is a matter of patient safety. "There aren't many vaccines that are 100 percent [effective]," he says. "Even a 62% reduction in risk is significant."
Federal health authorities are taking the first tentative steps toward considering a recommendation on mandatory influenza immunization of health care workers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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