It is an undeniable common consensus that the flu vaccine is the best way to prevent yourself from getting sick, and from spreading the flu to others. Plans to vaccinate hospital employees have met with mixed reactions. But none as extreme as the one that has played out amidst employees of Essentia Health, an upper-Midwest hospital chain.
On Wednesday, about 50 employees of Essentia Health did not go to work, and this was not just an early start to Thanksgiving for them. They were essentially fired for refusing to take part in Essentia’s drive to up their vaccination rate.
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According to Public Health experts, it is part of a growing trend for hospitals to require flu shots for workers. It is no surprise.
“It’s a patient safety issue,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University and a spokesman for the Infectious Diseases Society of America. “It’s a patient safety issue. It’s so that we do not give flu to our patients. Requiring that employees have the vaccine increases the rates, protects patients and causes no harm.”
Each year, influenza virus kills between 4,000 and 50,000 Americans, including children who were perfectly healthy before they caught flu. Health experts purport that hospital workers can easily pass on the flu virus to some of the most vulnerable people — the elderly who are frail, babies in incubators, and patients with severely compromised immune systems due to cancer treatment. It stands to reason that vaccinating employees protects patients and the employees’ co-workers.
Dr. Prabhu, the “Infectious Disease and Chief Patient Quality and Safety Officer at Essentia Health, added, “Patients are in the hospital because they are sick. That puts them at risk of a more severe outcome from influenza. People can die from influenza.
Just about everyone is advised to get a flu vaccine. The Centers for Disease Control and Prevention recommend annual flu vaccines for everyone from the age of 6 months unless there is a medical reason not to — for instance, an allergy to the vaccine.
But vaccination rates remain low, and even among healthcare workers, only around 65 percent of them get flu vaccines every year, the CDC says.
When employers have a policy in place that requires their employees to be vaccinated the CDC found that 85 percent of workers are vaccinated. Just 43 percent are vaccinated if there is no policy in place.
Several states, including California, require hospitals to make flu vaccines mandatory and to record and publish their vaccination rates. Maryland has a searchable database telling people a hospital’s vaccination rate.
Minnesota doesn’t require this but Essentia stated that it started the mandatory policy to protect its patients.
“Just like other people, we had a voluntary program encouraging our healthcare personnel to get vaccinated,” Prabhu said. “In 2012-2015 our vaccination rate among healthcare workers was about 70 percent. That’s not good enough. During the last flu season, we went to mandatory participation. Everyone who worked at Essentia had to say yes or no. That got vaccination rates to 82 percent — still not good enough.”
Now, it is a mandatory policy that Essentia employees must either be vaccinated or go through a process like school enrolment requirements: they must apply for a medical or religious/philosophical waiver. The requests are then reviewed by expert committees.
According to Prabhu, “You cannot get to a high immunization rate without some kind of mandatory flu vaccination program.”
Essentia spokeswoman, Maureen Talarico confirmed that this system implementation had increased the vaccination rate to 99.5 percent.
Employees of Essentia were given extra time to start the review process if they objected to getting a vaccine, but after an extra month, Monday, 20 November was given as the cut off for either getting a vaccine, or for starting the opt-out paperwork, as this was when they would be carrying out the vaccinations on the employees. Like many other hospital systems, Essentia offered multiple free vaccine clinics, had vaccine carts available to go to workers so they did not have to take the time to line up or seek out a flu shot and made sure every floor or unit had someone certified to administer vaccines.
They were informed that if they did not participate in the process, they would no longer be allowed to work at Essentia Health.
Out of nearly 14,000 employees, only about 50 took it to that point, Essentia said.
“Influenza is not the only vaccine that’s required for healthcare workers. Vaccinations against Hepatitis B, measles, mumps, rubella, diphtheria, tetanus, chickenpox and whooping cough vaccines are also required,” Prabhu said.
The Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the Pediatric Infectious Diseases Society and other groups all support mandatory immunization of healthcare workers — and all say there should be no opt-out except for medical reasons.
This is, in part, because people infected with influenza can pass it to others both before they have symptoms and after they feel better. In addition, people who think they just have the sniffles may, in fact, have flu and can spread it around without even knowing.
“Obviously, it is also about personal protection,” Schaffner said. “We want them to be protected because during a flu outbreak we need our healthcare personnel to be vertical rather than horizontal. We need them fit and able to care for all the people who need care,” Schaffner added.
Vanderbilt takes a more reconciliatory approach and doesn’t fire people who refuse vaccination, but makes them undergo counseling and they are compelled to wear a mask during flu season.
Schaffner went on to say that Vanderbilt made vaccination into a party they called “Flu-la-palooza”. “It’s a one-day event brilliantly organized to throughput as many people as quickly and easily and appropriately as possible,” he said. “This year we vaccinated almost 14,000 people.”
In fact, the medical center now holds a Guinness World Record for the event.
Schaffner said that this type of process had an added benefit: “It’s a training process such that if there is a pandemic and we have to vaccinate very large numbers of our people, our personnel, and our administrative people are beautifully trained,” Schaffner said.
The question remains: Why then would any health care worker refuse to get a flu vaccine?
Prabhu and Schaffner said that those health care workers who refused vaccines have the same arguments that non-medical people do —they’re afraid of side-effects, even though side-effects are not as serious as people believe they are; they think they don’t need the vaccine because they “never” get flu; or they worry it’s a waste of time because flu vaccines do not always provide perfect protection.”
“We all know it has limitations and we all recognize that it is the best that science has to offer us at this point,” Schaffner admitted.
Erring on the ‘rather-be-safe-than-sorry-side, he quotes an old saying about not letting the goal of perfection undermine doing good. “We can all do a lot of good with our pretty good vaccine,” he said.
In the meantime, some of Essentia’s employees have been left without work for what they would see as standing up for what they believe in?
Let us know your thought in the comments below.
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