December 05, 2006

Physician, Shoot Thyself

Caplan and David Curry write about the real reluctant holdouts on the flu shot: healthcare workers!
National Influenza Vaccination Week has kicked off the annual push for each of us to ``get our flu shots.'' This year, new ad campaigns in major newspapers and media outlets are reminding us, and there are more convenient options to get your vaccination than ever before. This year, we are told, the supply of vaccine is more than adequate. And the reasons to get a flu shot haven't changed. In fact, the Centers for Disease Control and Prevention's recommendations now say more people should get a shot than ever before.

But one important group has been particularly resistant to getting the shots. And it's a group, if the members remain unvaccinated, that is in a position to do a lot of harm to those least able to protect themselves. Who are these holdouts? Health care workers! Surprised? You should be.

It would seem logical that health care workers -- doctors, nurses, nurses aides, physical therapists and other care givers -- should be first in line to get their flu shots, particularly those who work around babies or those with weak immune systems such as patients with AIDS or cancer. Health care workers, by definition, work with those who may have come to the hospital because they are sick. This makes these patients, as well as others in extended care facilities and even those receiving home care, prime targets for the flu bug. But only about 40 percent of health care workers choose to get a flu shot each year.

How can this be?

Well, the operative word is ``choose.'' For the most part, flu vaccination among health care workers is entirely voluntary. The evidence is clear that unvaccinated doctors, nurses, dentists and health care workers increases the risk of flu infecting and sometimes killing patients. But we are reluctant to require that health care workers get flu shots. The value we place on voluntary acceptance of medical procedures -- including getting a vaccination -- wins out, even for those who are at the greatest risk of getting and spreading a deadly disease.

Hospitals and other health care facilities often conduct expensive and time-consuming annual awareness campaigns among their health care professionals and workers to improve flu-vaccination rates. These programs often include bringing vaccination carts to where the workers are during the workday. They don't even have to walk down the hall to get their shot. But breaking through that 40 percent vaccination rate has been tough.

Some states have legislation requiring annual influenza vaccination of health care workers, but provide an option for what is called ``informed declination.'' That means workers have an option to actually sign a form saying they decline to get the flu vaccine. Apparently, making flu vaccination a condition of employment is beyond the capability of even our largest and most sophisticated hospitals.

What to do? One thing is to ask those taking care of us if they have gotten their flu shot. The other is to push public-health departments and legislators to mandate flu shots for health care workers.

Suppose your elderly mom is in the hospital. Let's say her health condition makes her particularly vulnerable to the flu. The roughly 40 percent rate of flu vaccination for health care workers means that two in three of the people caring for her are not vaccinated. Do you have the right to ask that health care workers who interact with your parent get the flu vaccine? Why not? You should ask those providing health care: ``Did you get your flu shot this season?'' And don't forget the person who brings the food tray, changes the bedding or installs the cable TV. Asking may be embarrassing, but it will remind health care workers to do the right thing.

It is time to move public policy in the direction of mandatory flu vaccines for all appropriate health care employees. Choice is a key value for us all, but spreading infection among the sick is too high a price to pay for that choice. We should not have to wonder whether the person taking care of us, our newborn or our elderly parent has gotten a flu shot.

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