Mandating influenza vaccine in the hospital
The debate over whether or not to mandate influenza vaccine for health care workers was a popular topic this past year at the Infectious Diseases Society of America’s annual conference. Many, if not most, hospitals have some form of mandatory or opt-out influenza vaccination program for their employees. These programs take various forms. Some mandate that all employees with direct patient contact must be vaccinated, some mandate all employees must be vaccinated unless they sign a formal declination stating their objection to receiving the vaccine, some require unvaccinated employees to wear masks in patient care areas during the influenza season (roughly October through March each year). However, until I saw Dr. Offit’s discussion of CHOP’s policy, I had never heard of a true vaccine mandate for all hospital employees (i.e.–if you are not vaccinated you lose your job).
Generally, I am against punitive public health policies. Directives that punish people for non-compliance generate a sense of antagonism and generally are less effective than their rewards-based counterparts. Unfortunately, I am unaware of any hospital influenza vaccination policies that reward hospital employees for getting vaccinated or any investigations into the effectiveness of such policies. I think this is an area with potential for creative policy making from infectious diseases specialists and health care administrators.
At the same time, why isn’t mandatory influenza vaccination the norm at hospitals across the country? Tuberculosis is such a public health threat that health care workers are required to be tested annually (although some variation exists among hospitals even on this). Influenza poses an equal threat (many may argue a greater threat given its prevalence and variable virulence), yet the debate over mandatory vaccination rages on.
Personally, I am somewhat torn on the issue. From an infectious diseases and public health standpoint, I think mandatory influenza vaccination should be the norm. This provides the maximum amount of protection for vulnerable patients. From a policy standpoint, I think they may be a better way, something that is more effective at maximizing the vaccination rate while respecting personal autonomy. For now, mandatory vaccination seems like the most prudent choice for protecting out patients.
[The American Journal of Public Health just published an article addressing this very issue. Unfortunately, it’s gated, so nobody will know what it says.]