Journal urges mandatory flu shots for health-care workers

The Canadian Medical Association Journal has added its voice to calls for mandatory flu shots for health-care workers. In an editorial published in this week’s issue, the journal said hospital workers ought to be vaccinated to safeguard frail, elderly patients whose immune systems are so weakened they don’t get much protection from a flu shot themselves.

The Canadian Medical Association Journal has added its voice to calls for mandatory flu shots for health-care workers.

In an editorial published in this week’s issue, the journal said hospital workers ought to be vaccinated to safeguard frail, elderly patients whose immune systems are so weakened they don’t get much protection from a flu shot themselves.

“We would like individual hospitals to think about taking the initiative,” said Dr. Ken Flegel, senior associate editor and a general internal medicine specialist at Montreal’s McGill University Health Centre.

Flegel acknowledged there will likely be pushback from health-care workers, the majority of whom do not get a flu shot.

“I don’t want anyone to make me do something I don’t believe in or I don’t agree to do to my body,” he said.

“I think that’s a sort of fundamental right. On the other hand, I think the hospital has to say ’That’s fine by us but don’t come near our patients because you’re a hazard to our patients.”’

In recent years there has been a growing movement towards requiring health-care workers to take a flu shot, especially in the United States. Earlier this year British Columbia became the first Canadian jurisdiction to require health-care workers to be vaccinated against the flu.

The B.C. policy applies to hospital workers, staff of long-term care homes and community-based health-care workers. It does not cover doctors in private practice.

Health-care workers who forgo a flu shot will have to wear a mask on the job from Dec. 1 to the end of March.

Dr. Perry Kendall, the province’s chief medical officer of health, said health-care worker vaccination rates — which were never high — have been dropping since 2007.

“If we really think it will make a difference, why do we keep on sitting on the fence and accepting declining levels? It either is important enough to really do it or it isn’t,” Kendall said.

Health-care unions, which had supported B.C.’s efforts to raise flu shot rates among members, were not happy about the new policy.

“They would rather it is a voluntary program and so would I, frankly. But that just hasn’t worked,” Kendall said.

The call to make flu shots mandatory comes at a time when serious questions are being asked about how effective flu vaccine actually is.

And some of the studies the journal editorial cites in making its case are among those that have been called into question.

It suggests, for instance, that flu vaccine is about 86 per cent effective at preventing flu when the strains in the shot are well matched to circulating viruses. But the study cited as the source of that information doesn’t actually make that claim. Flegel said he got the number from another study, which credited the study Flegel cited.

A recent comprehensive review of influenza vaccine written by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota said the scientific literature on flu vaccine is littered with mistakes — studies that misconstrue what previous research has found or which have design flaws.

The result has been an over-estimation of how much protection current flu vaccines can offer, the CIDRAP report said.

In the last couple of years many expert groups have quietly toned down their language on flu shots, lowering the efficacy estimates to 50 to 70 per cent from the 70 to 90 per cent that was previously claimed.

(It should be noted the studies that assess efficacy are typically done in healthy adults, the people whose immune systems are most likely to respond well to a flu shot. That means those efficacy estimates are a best-case scenario.)

Michael Osterholm, senior author of the CIDRAP flu vaccine report, said public health officials need to be careful not to over sell flu vaccine.

“I fully support the vaccination of health-care workers. But we must be held to a standard of science that we expect anyone who opposes vaccination to also be held to,” he said.

Flegel acknowledged that may be a problem. “We probably have been too enthusiastic about the protection rate available from the flu vaccine,” he said after learning of the problem in his citations.

But he said even if the vaccine offers only 50 per cent protection, minimizing the risk that health-care workers sick with the flu will pass it to their vulnerable patients makes sense.

The fact that the vaccine doesn’t work as well as people would like can actually be used as an argument for requiring health-care workers to get flu shots, said Dr. Kumanan Wilson, a Canada Research Chair in health policy at the Ottawa Hospital Research Institute.

Wilson, who researches vaccine acceptance issues, recently co-wrote an article exploring the issue of mandatory influenza vaccination for health-care workers in the publication Health Law Journal.

“The fact that the vaccine is not so good actually necessitates a high percentage of health-care workers getting the vaccine in order to create some level of herd immunity,” Wilson said in an interview.

“So as long as it has some effectiveness, a reasonable level of effectiveness, you could use that as an argument ’This is why we have to mandate everybody get it.”’

Still, Wilson said requiring workers to take a flu shot isn’t something hospitals or governments should do lightly. “Because people will perceive it as a major infringement on their liberty. It’s actually putting a needle into someone. So you really need to be careful how you proceed with this.”

Wilson said mandatory flu shot programs should include commitments from the authorities making the policy that they’ll review emerging scientific data on the safety and efficacy of flu vaccine on an ongoing basis.

As well, he said, authorities should commit to studying whether the program is actually working. They should also monitor for any vaccine-induced side-effects and commit to compensate any health-care worker who sustains a health injury that can be linked back to the flu shot.

“If you do bring it in, you have to do it respectfully and showing that you understand the concerns of health-care workers,” said Wilson, who noted that he supports the idea of vaccinating health-care workers against influenza.

“If you don’t do that, then it comes across, I think, as a bit heavy handed.”

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Innisfail mayoral candidate Glen Carritt posted an election sign last month that raised hackles among some. Town council is looking at tightening up its regulations so that election signs cannot be planted more than 45 days before the Oct. 18 election. Photo from Glen Carritt’s Facebook page
Innisfail beefs up election sign regulations

Bylaw prompted by complaints signs for October municipal election already going up

The SuperHEROS program was born in 2018 and will arrive in Central Alberta in the fall, giving kids with physical and cognitive challenges a chance to participate in a modified hockey program. (Photo courtesy of HEROS Hockey)
SuperHEROS hockey program to arrive in Central Alberta this fall

Program provides hockey opportunities for kids with physical and cognitive challenges

Red Deer Regional Health Foundation receives $40K in donations

Donations from Canadian Pacific and Durham family of Red Deer

NDP MP Heather McPherson pictured in Edmonton on Friday, March 6, 2020. Alberta’s legislature may have been silenced but its partisan warfare has relocated to the House of Commons as MPs hold an emergency debate tonight on the province’s soaring COVID-19 cases. THE CANADIAN PRESS/Jason Franson
Kenney under fire during Commons emergency debate on Alberta’s COVID-19 crisis

Edmonton New Democrat MP says Kenney ignored the evidence of science

Victoria Police help BC conservation officers carry a cougar which was tranquilized in the backyard of an apartment building in the community of James Bay in Victoria, B.C., Monday, October 5, 2015. THE CANADIAN PRESS/Chad Hipolito
Cougar believed to be responsible for B.C. attack killed: conservation service

AGASSIZ, B.C. — The British Columbia Conservation Officer Service says it believes… Continue reading

People line up outside an immunization clinic to get their Oxford-AstraZeneca COVID-19 vaccine in Edmonton, Tuesday, April 20, 2021. THE CANADIAN PRESS/Jason Franson
Hospital investigating whether woman who died after AstraZeneca shot was turned away

EDMONTON — Officials with an Edmonton hospital say they’re investigating what happened… Continue reading

A sign is seen at a walk-in COVID-19 in Montreal on Wednesday, April 21, 2021. THE CANADIAN PRESS/Paul Chiasson
NACI chair says advice not meant to give AstraZeneca recipients vaccine remorse

OTTAWA — The chair of the National Advisory Committee on Immunization says… Continue reading

Minister of Employment, Workforce Development and Disability Inclusion Carla Qualtrough holds a press conference on Parliament Hill in Ottawa on Thursday, Sept. 24, 2020. THE CANADIAN PRESS/Sean Kilpatrick
Liberals pressed to ease access to EI parental leave to help unemployed moms

OTTAWA — The federal government is being asked to give new and… Continue reading

An oil worker holds raw sand bitumen near Fort McMurray, Alta., on July 9, 2008. THE CANADIAN PRESS/Jeff McIntosh
Alberta eases security payment burden for oilsands companies

EDMONTON — Alberta is changing how it calculates the payments oilsands mines… Continue reading

Most Read