Should flu shots be mandatory for health care workers?

A new study sounds a cautionary note for work that is being done to try to develop vaccines to protect against all subtypes of influenza. Fred Chartrand/CP

TORONTO — Dr. Michael Gardam rolls up his sleeve each winter and gets his dose of protection against the year’s strain of influenza.

The director of infection prevention and control at University Health Network says he always encourages Canadians to get the flu shot regardless of age or status of health.

He doesn’t think it should be forced upon health care workers, though. At least not until it’s improved.

“I am not anti-vaccination, I am clearly for vaccines — getting the flu shot is better than nothing,” Gardam says.

“Where I am drawing the line is saying: if this is the battle you want to fight, you have got to be careful because the vaccine is really not that good and you will open a lot of doors you don’t want to open,” he told Global News.

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In commentary published Monday in the Canadian Medical Association Journal, Gardam and his colleague Dr. Camille Lemieux argue that it may be too premature to enforce mandatory vaccination for health care workers.

Instead, officials should build on the existing vaccine before reviving the discussion on mandatory vaccination.

The commentary is adding to hot debate in the medical community on the controversial issue that has divided experts and associations across the country.

An imperfect vaccine

The editorial argues that the current vaccine has its shortcomings.

For starters, the vaccine is about 60 per cent effective in fighting influenza, Gardam says.

And that’s only if the shot matches the season’s circulating strain. Each year, strains of influenzas mutate and re-emerge. Scientists in the northern hemisphere keep a watchful eye over patterns in the southern hemisphere to make predictions on what may make its way over.

Three strains of influenza are included in the seasonal vaccine that’s doled out to the masses. Up to 20 per cent of the time, at least one of the guesses is wrong.

Its potency also wanes, Gardam notes. He points to this year’s nasty flu season: health care workers immunized in November, for example, had to prop up the vaccine’s efficacy with antiviral medication as its effects wore off.

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Read more: Flu season sweeps the nation as cases spike

“We have been overestimating how well our current flu shot works. We have been doing that so frequently and so often that we have actually convinced ourselves that it actually works pretty well,” Gardam says.

This attitude has led to some acceptance – almost complacency – in the current vaccine.

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Dr. Allison McGeer says those hesitant to enforce mandatory vaccination should consider the shot’s purpose, even if it isn’t perfect.

“There is nothing foolproof in prevention. The questions to consider are ‘does it protect health care workers? Does it save patients’ lives?’ The answer is yes to both,” she told Global News.

McGeer is director of infection control at Mount Sinai Hospital in Toronto. She’s one of the country’s leading flu experts. 

She says that hospitals and nursing homes need to begin discussion on mandatory flu vaccine.

Should flu shots be mandatory for health care workers? - image
AP Photo/Matt Rourke

Vaccination rates in Canada

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Right now, uptake of the flu vaccine sits at about 50 to 60 per cent for the country’s health care providers, Gardam says.

Research reports have suggested that voluntary campaigns encouraging health care workers to get the shot increase uptake by 22 to 52 per cent.

In some parts of the U.S. though, where mandatory vaccination is in place, rates of inoculation can reach 95 per cent or higher.

Among Ontario’s public, only 30 to 40 per cent of residents make the trip to a clinic to get their dose of protection. Gardam says this percentage is about the same across the country and that these patients are more or less the same – Canadians over the age of 65.

Pushback from frontline workers

Pushing for mandatory vaccination for doctors, nurses and health care professionals has been an uphill climb in Canada for decades.

Most recently last December, B.C. officials stepped down in their fight for a mandatory flu policy that would apply to its province of health care workers.

It would have forced employees looking after patients to get a flu shot or wear a mask — or face repercussions, such as the threat of losing their jobs.

There was backlash — nurses’ unions to national associations, argued that such a law would be breaching their privacy and control over their bodies.

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In 2002, an Ontario labour board sided with Hamilton, Ont. health care workers who argued that such a rule would invade their rights.

Meanwhile in London, Ont., hospitals forced doctors, staff and even visitors to get the shot or wear a mask if they were looking after patients.

Gardam says he suspects that pushing the vaccine would make room for more dissent when it comes to other enforced policies within the system.

He suggests waiting for a stronger, more comprehensive vaccine before pushing it onto health care workers.

Officials shouldn’t rely on mandatory inoculation as the sole plan in an attempt to stifle the spread of influenza in hotspots like hospitals and long-term care facilities, he says.

“If you are going to fight that fight, it has to be because you believe in the vaccine and you know you will win. Now is not the time to push that,” Gardam told Global News.

“And every time you try and fail, you weaken your position.”

Our strongest defense against influenza

Another editorial in the CMAJ, published last October, called for compulsory vaccination within the health care community because patients’ lives are in their hands.

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And if workers feel they’re losing their choice, they need to consider the best interests of their patients, Dr. Ken Flegel, the medical journal’s editor wrote in the piece.

“Patients should come first, and in similar situations they do already. For example, a surgeon infected with HIV or a hepatitis virus is not allowed to operate,” he wrote.

While most healthy Canadians beat the flu, there are vulnerable groups: pregnant women, children under five years old, seniors and residents in long-term care or nursing homes.

Anyone with underlying health problems, or chronic diseases, such as asthma, chronic bronchitis or cancer, for example, are at risk.

Nurses’ organizations take differing stances on the issue

Opinions are wide-ranging in the debate over mandatory vaccination.

The Canadian Nurses Association, which represents a nearly 150,000 registered nurses and a federation of 11 provincial nursing groups and colleges, says that it’s in favour of mandatory immunization.

The policy is “congruent” with the Code of Ethics for Registered Nurses in Canada, and acts in the public’s interest, its position statement says.

The Registered Nurses’ Association of Ontario says its stance on the issue is to focus on education and engagement to show health care workers why it’s important to get vaccinated.

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“I don’t think we’re doing it enough. We’re focusing so much on mandatory versus not that we’re missing the big picture,” Doris Grinspun, CEO of the RNAO, told Global News.

While organizations may resist mandatory vaccination, Grinspun says the RNAO wouldn’t fight it, but “we would explain why it’s the wrong approach.”

“This is not only about the vaccine. This about working with our health care professionals in a way that’s respectful and engages in a two-way street,” she said.

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