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Health workers must get flu shot or quit

Some health care workers say mandates requiring them to get flu shots violate their rights. But they don't have the right to infect and kill their patients, writes Art Caplan, Ph.D.
Image: Dr. Tanya Bailey and Marsha Behrens with H1N1 vaccines
Dr. Tanya Bailey receives one of the first doses of the H1N1 vaccine administered by nurse Marsha Behrens at Children's Memorial Hospital on Wednesday. The hospital is starting its inoculation program with health care workers before moving into the patient phase.Tannen Maury / EPA
/ Source: contributor

Enough already with the whining, moaning, demonstrating and protesting by health care workers. Doctors, nurses, respiratory therapists, nurses’ aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work.

The California Nurses Association and the National Nurses Organizing Committee have issued statements that individuals should be able to refuse the vaccine. The New York State Public Employees Federation said that “vaccination for influenza is not as effective in the control of disease as vaccination for diseases such as polio, measles and mumps.” Other health groups wanted to know why those who preferred to shun the shot could not simply wear masks.

Last week hundreds of people showed up in Albany, N.Y., at a rally to protest New York State’s plan to require all state workers to get both an annual flu shot and a swine flu vaccine. Most at the rally said their rights were being infringed.

Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?

Many hospitals in Illinois, Washington, Missouri, Georgia and Maryland are putting in place flu shot mandates. My own institution, the University of Pennsylvania Health System and its affiliated, top-ranked Children’s Hospital are leading the way in getting mandates moving. Why? The answer is simple: The vaccine will save lives.

Only half get vaccine
The annual rate of health care workers getting flu shots has been hovering around 50 percent at most institutions for years. The evidence for the toll this low vaccination rate takes on patients and staff has been mounting year after year.

If you can get close to 100 percent vaccination rates you can cut patient death rates from flu by 40 percent. Sick days among doctors and nurses drop by about the same amount. Eleven babies died of swine flu during the last week of September alone, according to the Centers for Disease Control and Prevention. With a potentially potent form of swine flu on the horizon, those kind of grim statistics have made hospital infection disease experts sound the alarm to implement mandates to boost vaccination rates.

Nothing works as well as vaccines to prevent getting the flu and transmitting it others. Masks may help, but still 20 percent of those who wear them get sick. There is no evidence that vitamins, special diets, fresh air or any other alternative ideas does anything to make flu viruses less nasty. And all we really have to fight swine flu are ventilators, some drugs that may or may not work and the new vaccine.

The medical establishment has been recommending that kids get flu shots forever. The state of New Jersey just put into practice a law requiring flu shots for young schoolchildren in day care and preschool. The U.S. Armed Forces has no time for anyone who will not get a flu shot. If you want to legally immigrate to this country you have to roll up your sleeve. Why should health care workers be treated any differently?

I understand that there are a few people who have medical reasons not to get a flu shot. Those people are and should be exempt. But that is not the issue driving opposition to mandates. When there is push back it is based on the notion that the individual’s rights are being trampled in the name of the common good.

Look, there are legitimate issues that ought to be debated whenever someone says you must do something to benefit others ranging from taxation to restrictions on driving under the influence. But health care workers' own code of ethics dictates that they put the interests of others — their patients — first.

Getting a flu shot is the least those who claim to be bound by professional ethics ought to do. It's time to man-up and protect those at risk in our hospitals and nursing homes, along with each other, and make getting a flu shot a part of the responsibility of being a healer.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.