TORONTO – With flu season just a few weeks away and concerns about the spread of Enterovirus D68 – should Ontario health care workers be forced to get the flu shot?
The policy is called the mask rule, whereby health care workers are being asked to either get their flu shot or wear a mask whenever they interact with patients, throughout the flu season.
This is something that we’ve seen in several Canadian jurisdictions lately, including British Columbia, and in 2013, eight Ontario hospitals followed suit. And we’re seeing many more hospitals in Ontario considering it this year.
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And the data we have is encouraging: the health care worker vaccination rate went from about 55 per cent to above 70 per cent at both London Hospitals that enacted the rule.
But there has been a lot of controversy – the Registered Nurses’ Association of Ontario supports this, but the Ontario Nurses’ Association opposes it and has filed grievances.
The logic behind the policy is because health care workers are the ones taking care of patients with the flu, we have a higher chance of contracting it.
And we know that people start shedding the virus and become infectious 24 to 48 hours before they develop symptoms, so even the best meaning health care worker can spread the flu before they know they have it. And health care workers are in contact with the kinds of patient populations that are most vulnerable to severe flu and severe consequences of the flu.
Health care workers are the ones with the training and expertise to care for flu victims, so they have an obligation to minimize our chances of being infected so that they’re available to take care of patients if there’s a severe outbreak.
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And finally, every year we struggle with low influenza vaccination rates in the public and the choices that health care workers make send a powerful message to a public which can either hurt or help vaccination rates. It helps if health care workers practice what they preach.
But there are objections: mainly we have heard from unions representing health care workers. One argument is that there isn’t enough scientific evidence that mandatory immunization actually saves patients’ lives.
We do know that patient vaccination reduces the hospitalizations from flu and death from flu, especially in certain patient groups. We also have well documented outbreaks that have been spread from health care workers to patients, and have resulted in deaths, particularly in nursing homes and other long-term facilities.
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Also it’s clear these policies increase vaccination rates, as they have in London, Ontario. The last piece of the puzzle is demonstrating that these policies actually decrease patient infections and death, and there have been a few studies that have looked at this, and although they’re controversial, when they’re reviewed as a whole, they do suggest reduced deaths from influenza in institutions with these policies.
But the trickier argument is that mandatory flu shots represent an infringement on people’s basic human rights. To address that, Canadian policies have offered an alternative in the form of asking health care workers who refuse the shot to wear a mask, but unions have argued that this stigmatizes health care workers who either don’t want to or can’t get the flu shot.
And so the question is really one for the public. With respect to where do we draw the line between the need to protect the public and the need to preserve an individual’s rights. For example, we don’t allow people to text and drive, in order to protect others, we don’t let people smoke in public, also to protect others.
My personal opinion is that being a health care worker is a privilege and not a right, and for me, I can accept the loss of certain autonomy that comes with that privilege.
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