Mandatory Flu Shots Hit Resistance

By Rob Stein
Washington Post Staff Writer
Saturday, September 26, 2009

With the H1N1 pandemic spreading rapidly, hundreds of thousands of doctors, nurses, orderlies and other U.S. health-care workers for the first time are being required to get flu shots, drawing praise from many public-health authorities but condemnation from some employees, unions and other critics who object to mandatory vaccination.

One of the nation's most populous states, the country's largest hospital chain and the Washington area's biggest private health-care system are among those ordering influenza inoculation for health-care employees this year, along with a growing list of medical centers and clinics coast to coast.

The trend is being fueled by frustration at the stubbornly low proportion of health-care workers who get vaccinated each year despite years of coaxing, urging and incentives to do so voluntarily, combined with trepidation that the swine flu pandemic could overwhelm the health-care system, especially if many caregivers get sick, too.

Critics, however, say the decision to get vaccinated should remain individual, especially for the swine flu vaccine, which was rushed into production to try to blunt the pandemic's second wave.

"I don't want to be a guinea pig," said Orne Banks-Hopkins, 55, a clerical worker at Washington Hospital Center. "I don't think I should be forced to take something I don't want to take."

Some doctors and nurses in Britain have also expressed resistance to getting the swine flu vaccine. A survey of 1,500 British nurses conducted in August by the Nursing Times found that one-third would not get the vaccine because of safety concerns.

In the United States, the drive is fueling anti-government sentiment and rumors on the Internet and elsewhere that the vaccine may become compulsory for everyone.

"You start with health-care workers but then expand that umbrella to make it mandatory for everybody," said Lori Price of Citizens for Legitimate Government, a Bristol, Conn.-based group that opposes government expansion. "It's all part of an encroachment on our liberties."

While the federal government plans to buy enough swine flu vaccine for every American, it will remain strictly voluntary for the average citizen, according to federal, state and local officials.

"There continues to be information circulating that somehow this vaccination campaign is mandatory. It is not. It is voluntary," Health and Human Services Secretary Kathleen Sebelius said Thursday. "Our guidance is this is a voluntary vaccine."

William Schaffner, president-elect of the National Foundation for Infectious Diseases, said the move "is motivated solely by the dismal number of health-care workers who get vaccinated each year, which frankly is appalling."

Only about half of health-care workers get flu shots during a typical flu season, even though their patients tend to be more vulnerable to infection and potentially life-threatening complications. Concern is spiking this year because of the new swine flu virus, known as H1N1.

"We want to do everything we can so we don't lose people when there may be a peak in demand," said Jonathan B. Perlin, chief medical officer for the Hospital Corp. of America, known as HCA, in Nashville, which is requiring about 120,000 employees in 163 hospitals, 112 outpatient clinics and other facilities in 20 states get vaccinated.

New York this year became the first state to require all health-care workers with direct patient contact at hospitals, health centers, hospices and private homes to get flu shots -- both the seasonal flu vaccine, which is already available, and the swine flu vaccine, which will start to arrive next month.

"The rationale begins with the health-care ethic, which is: The patient's well-being comes ahead of the personal preferences of health-care workers," New York State Health Commissioner Richard F. Daines said.

Both vaccines are safe, and studies show that vaccinating health-care workers cuts their absenteeism, protects their co-workers and families, and prevents infections and complications among patients, proponents say.

"This is all about patient safety," said William L. Thomas, chief medical officer for MedStar Health of Columbia, Md.

MedStar is going further than New York and HCA at its facilities, which include Georgetown University Hospital, Washington Hospital Center and National Rehabilitation Hospital in the District; four hospitals in the Baltimore area; and 19 health-care-related companies with more than 100 locations throughout Maryland and Washington, including physicians' offices, hospices, rehabilitation centers and outpatient clinics.

MedStar is requiring vaccination of all 25,000 of its workers -- including nurses, orderlies, janitors and food-services employees -- as well as 5,000 affiliated doctors, every volunteer, and employees of suppliers who step inside any of its facilities, regardless of whether they routinely have direct patient contact.

While hospital administrators and several employees interviewed at MedStar facilities said most employees are eager to get vaccinated, some are angry.

"I'm scared," said Sandra Webb, 45, of the District, who has a clerical job at Washington Hospital Center and blames a flu shot she had several years ago for making her sick. "It's really freaking me out. I don't know what to do."

MedStar, the state of New York, HCA and other entities requiring vaccination are allowing exemptions for employees who have medical reasons for not getting vaccinated, such as egg allergies or risk factors for a rare complication known as Guilliame-Barre syndrome. MedStar and HCA and others also allow workers with religious objections to be exempted.

In New York, however, where the policy affects about 522,000 employees, no religious exemptions are allowed. Workers who refuse would be assigned to duties that do not involve patient contact, and they could face further disciplinary action.

"I have a problem with being mandated to put something in my body," said Sandra Morales, a labor and delivery nurse at Beth Israel Medical Center in New York City. HCA employees who do not get vaccinated will have to wear surgical masks during the flu season or be dismissed. MedStar workers who refuse would face disciplinary action, including possibly being fired.

"If somebody didn't want to wash their hands or scrub before going into surgery, you can imagine there wouldn't be a lot of tolerance for that," Thomas said, noting that MedStar was postponing a decision about requiring the H1N1 vaccine until more information was available about its availability. HCA is doing that too.

Similar mandates have been implemented by a few hospitals in previous years, including Virginia Mason Medical Center in Seattle. This year, the number is increasing sharply to also include Charleston Area Medical Center in West Virginia, Loyola University Hospital outside Chicago, Emory University Hospital in Atlanta, and University of Iowa Hospitals and Clinics in Iowa City. The University of Maryland Health System, which consists of 11 hospitals in Maryland, is making flu shots mandatory at three of its medical centers this year and asking employees at the other eight to either get shots or fill out a form explaining why they are declining.

But some question the decision.

"As a general rule, medicine should be a voluntary occupation," said George Annas, a Boston University bioethicist. "Once you start requiring doctors to get it, doctors are going to think it's reasonable to make patients get it. It starts you down that mandatory route, and I don't think we want to go there."

Some unions also object, saying mandatory vaccination diverts attention from other more effective infection-control methods, such as providing workers with state-of-the-art, well-fitting masks.

"These mandatory vaccination programs are really sucking the air out of the room to deal with infection control in a more comprehensive manner," said Bill Borwegen, occupational health and safety director of the Service Employees International Union. "This is the worst time to be demoralizing health-care workers: when we need them to be on the front line of this epidemic."

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