Mandatory Flu Vaccination Case Study

Mandatory flu vaccination for health care providers (HCP) and students has been a controversial issue that create a needed discussion about the rights and boundaries of individuals who choose careers in these fields. It is argued that nurses have a duty to protect their patients and throughout nursing history nurses have championed for the prevention of communicable diseases through the use of vaccinations to their patients and communities. Admittedly it is true that nurses are in environments with vulnerable individuals who are at a higher risk of developing flu related complications and therefore risk of transferring these organisms to their patients. Nevertheless I disagree with the implementation of mandatory vaccination of nurses and

nursing students, I believe each individual should have a right to provide consent regarding their body. Other issues include the safety of the vaccine, medical contraindications and the effectiveness of the flu vaccine.
The ethical issue of autonomy of HCP is placed against their ethical principles of beneficence and non-maleficence of their patients.

Is it justifiable to claim that community protection outweighs the liberties and rights of the HCP? Mandatory vaccines violate autonomy and “no one should be forced to take medications, in particular controversial and potentially harmful as vaccines” (Galanakis, Jansen, Lopalco, & Giesecke, p. 4-5, 2013). Consent to vaccination can intersect other rights such as medical, religious and cultural liberties. This creates an ethical dilemma where nurses are asked to choose between their beliefs and careers. Galanakis et al., (2103) warns that the principle of beneficence does not mean protecting patients by harming HCP (p. 5). Nurses should not be forced to harm themselves in order to protect patients, an example of this harm is when the flu vaccine strains do not match with the circulating strains and nurses may “suffer unjustified harm at no benefit to patients” (Galanakis et al., p. 5, 2013). There is also no definitive evidence to claim that non-vaccinated HCWs harm patients. The health care field must promote justice for all, and this also includes creating voluntary vaccination policies for HCP. Mandatory flu vaccination can also be viewed as coercion which can lead to distrust in the employee – employer relationship and also see a decrease in students who choose nursing as a

career.
The safety of the flu vaccine is also a concern. Proponents of mandatory vaccination claim that risk of a flu shot causing serious harm or death to be extremely small (Centers for Disease Control and Prevention (CDC), p. 1, 2015). On the other hand, the risk still exists, there are individuals who experience severe allergic reactions and others who suffer side effects such as soreness, swelling, fever and aches after receiving the vaccine. Will mandatory vaccination policies come with clear defined acceptable medical and religious exemptions? What type of compensation will nurses have available should they suffer any harm from the vaccine?
The effectiveness of the vaccine is another reason why I disagree with the mandatory policy.

Gardam and Lemieux (2013) state that the effectiveness of the current influenza vaccine has been exaggerated in the medical literature and media. The seasonal flu shot protects against the three or four influenza viruses that researchers indicate will be most common during the upcoming season (CDC, p.1, 2015). The US Centers for Disease Control and Prevention found that 2013’s vaccine was “only 55% effective against laboratory-confirmed influenza A and 70% effective against influenza B” (Gardam & Lemieux, 2013). Health care providers receiving the flu vaccination does not guarantee that patients may not be affected by different strains. Additionally HCP are not the only individuals who may expose patients to these pathogens, visiting family, and community members can also play a

part.
In their review of research studies Abramson (2012) found that there is no evidence that vaccinating HCP prevents influenza in patients. Despite its short comings the influenza vaccine is currently the best defence against influenza, and that receiving the vaccine is better than not. Nevertheless there must be compelling evidence of community benefit before personal freedoms are stripped from HCP. Heinrich-Morrison et al. developed and implemented a successful voluntary campaign to improve influenza vaccine intake of Australian HCP. This campaign included the use of “social marketing, improving availability of vaccination, staff incentives and feedback to managers”. This is an example that with proper planning and education, hospitals can create non mandatory programs that potentially increase vaccine participation. A rising question includes do nurses influence the community’s viewpoint regarding influenza vaccination?
Centers for Disease Control and Prevention. (2015). Seasonal Flu Shot, Questions and Answers. Retrieved from http://www.cdc.gov/flu/about/qa/flushot.htm
Gardam, M., & Lemieux, C. (2013). Mandatory influenza vaccination? First we need a better vaccine. CMAJ: Canadian Medical Association Journal, 185(8), 639-640. doi:10.1503/cmaj.122074
Abramson, Zvi Howard. (2012) What, in Fact, Is the Evidence That Vaccinating Healthcare Workers against Seasonal Influenza Protects Their Patients? A Critical Review. International Journal of Family Medicine, 2012(1), 1-6. doi:10.1155/2012/205464
Galanakis, E., Jansen, A., Lopalco, P. L., & Giesecke, J. (2013). Ethics of mandatory vaccination for healthcare workers. Euro Surveill, 18(45). DOI: http://dx.doi.org/10.2807/1560-7917.ES2013.18.45.20627