NVAC softens call for required flu shots
Employers may consider 'other exemptions'
A federal advisory panel endorsed an "employer requirement" for health care facilities that fail to vaccinate 90% of their health care workers against influenza but gave employers a wide berth to interpret what type of requirements they might set.
The move by the National Vaccine Advisory Committee (NVAC) was seen as a partial victory for unions representing health care workers and a step away from strong mandates and sanctions that lead to employee termination. The final recommendations advise that "in addition to medical exemptions, health care employers and facilities may consider other exemptions in their requirement policies."
"We were able to beat back language contained in the first draft report that told employers to adopt a full-blown flu shot mandate, to one that now asks employers to 'strongly consider' a flu shot requirement if they fail to achieve the Healthy People goal, currently at 90%, with voluntary efforts, while also adopting employee exemptions for medical and 'other reasons,'" says Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union (SEIU) in Washington, DC, and a member of the NVAC working group. "Whether this final language remains sufficiently vague to undermine employer efforts to push for more mandatory flu vaccination programs remains to be experienced."
Even while NVAC members debated the wording of recommendations, a growing number of hospitals adopted mandatory policies. The Immunization Action Coalition announced that it now has 157 facilities on its "honor roll" for imposing an influenza vaccine mandate.
Mandate inspires passionate appeals
The public comment to NVAC included emotional testimony for and against a mandate. Medical assistant Elizabeth Brown said she was terminated from the Washington (DC) Hospital Center for failing to get the flu vaccine.
"I just don't want the flu vaccine. That should be my personal choice," said Brown, who said she was devoted to her patients and has never had influenza. "You put me out of a job because of your decision to make the flu vaccine mandatory for people who choose not to have them."
Laura Scott, executive director of Families Fighting Flu, told of her 15-year-old son, Luke, who was in a coma because of complications related to influenza but ultimately survived. "No one can talk about the real consequences of skipping the flu vaccine better than our members," she said. "That's why we believe so strongly that it's completely unacceptable for health care providers ... to not protect themselves and their patients by getting vaccinated."
Borwegen asserted that the panel had not followed federal rules for advisory committees in drafting the final report. An attorney with the U.S. Department of Health and Human Services (HHS) determined that the subgroup was not subject to the Federal Advisory Committee Act.
Tiered approach is endorsed
Yet some wording was altered, even removing the target goal of 90% in acknowledgement that Healthy People 2020 goals could change. The panel endorsed a tiered approach, recommending a "comprehensive influenza infection prevention plan" including "education of health care personnel as a key component."
NVAC also recommends that:
Health care employers and facilities integrate influenza vaccination programs into their existing infection prevention programs or occupational health programs. NVAC also recommends that the Assistant Secretary of Health assure that this recommendation is implemented in HHS facilities and services (including the Public Health Service, HHS staff and Federally Qualified Health Centers) and strongly urges all health care employers and facilities to do the same.
The Assistant Secretary for Health encourage CDC and the Centers for Medicare and Medicaid Services (CMS) to continue efforts to standardize the methodology used to measure HCP influenza vaccination rates across settings
For those health care employers and facilities that have implemented Recommendations 1, 2 and 3 above and cannot achieve and maintain the Healthy People 2020 goal of influenza vaccination coverage of health care personnel in an efficient and timely manner, the NVAC recommends that health care employers and facilities strongly consider an employer requirement for influenza immunization. In addition to medical exemptions, health care employers and facilities may consider other exemptions in their requirement policies. NVAC also recommends that the Assistant Secretary for Health assure that this recommendation is implemented in HHS facilities and services (including the Public Health Service, HHS staff and Federally Qualified Health Centers) and urge all other health care employers and facilities to do the same.
Finally, NVAC agreed on the need for new and better influenza vaccines and vaccine technologies. On that recommendation for research and development of better vaccines, there was no dissent. The NVAC recommendations are directed to the Assistant Secretary for Health Howard Koh.
Ultimately, other factors may be a more important impetus for hospitals to adopt mandatory vaccination programs. Some states are now requiring public reporting of health care worker influenza immunization rates, notes William Schaffner, MD, chairman of the Department of Preventive Medicine at Vanderbilt University in Nashville, TN, and president of the National Foundation for Infectious Diseases. "Public reporting is going to change things," he says.
A federal advisory panel endorsed an "employer requirement" for health care facilities that fail to vaccinate 90% of their health care workers against influenza but gave employers a wide berth to interpret what type of requirements they might set.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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