Srinivas GarlapatiMHA (C)HPRO 5620

MANDATORY INFLUENZA

VACCINATION POLICY FOR HEALTH CARE

WORKERS: A BIOPSYCHOSOCIAL

VIEW

BIOPSYCHOSOCIAL MODEL

20,000 hospitalizations, 4,000 deaths Highly contagious Aff ects 10-20% of population each year, 20-30% of

children Aff ects populations disproportionately: elderly, very

young, immune-compromised, underlying illness, pregnant women etc

Immunization most eff ective protection but not as eff ective in those most at risk

(PHAC, 2014)

THE BURDEN OF FLU

Influenza causes by far the highest number of deaths among vaccine-preventable diseases.

Hospitalized patients are more vulnerable to influenza than members of the general population.

Transmission occurs before symptoms are obvious

THE BURDEN OF FLU

Health care workers and health care systems have an ethical and moral responsibility to protect vulnerable patients from transmissible diseases.

Vaccination of healthcare workers reduces the risk to patients - frequently implicated as the source of influenza in healthcare settings and patient mortality and morbidity goes down when HCWs are vaccinated.

Despite past eff orts to increase vaccination levels for health care workers, rates have stalled at less than 50 per cent.

VACCINATING HCW

Prevent transmission to patients who cannot mount immunity

Reduction of the risk of HCWs getting infected Creation of “herd immunity”Maintenance of a critical societal workforce during

disease outbreaks Set a good example concerning the importance of

vaccination for every person(Society for Healthcare Epidemiology of America, 2014)

THE NEED TO IMMUNIZE HEALTHCARE WORKERS (HCW)

Vaccine 9 minutes missed work 40% chance of sore arm

1 in 5000 chance of allergic reaction

1 in 1,000,000 risk of hospitalization (allergy/GBS)

1 in 50 million risk of death

No vaccine 135 minutes missed work 33% chance of acute resp

illness 2 in 100 chance of illness

needing antibiotics 1 in 100,000 risk of

hospitalization due to influenza

1 in 3 million risk of death

COMPARISON OF RISKS

PERCEIVED LIKELIHOOD

PERCEIVED SEVERITY

PERCEIVED SUSCEPTIBILITY

FLU CONTROL: NHS

Questionable effectiveness in elderly

Influenza disease burden and program impacts

Indirect effects of vaccinationCost and prevention effectivenessSafety/Effectiveness of repeated annual vaccination

UNIVERSAL INFLUENZA VACCINATION

INFORMATION GAPS

CDC (2011) : 70-90 % eff ective in healthy peopleCochrane Review 2010 : 60% (maybe)Osterholm review 2012 : 59% (maybe)

Moreover, Flu vaccines contain guess strains – may not be eff ective every season

HOW GOOD IS THE FLU VACCINE

IMPROVING HCW VACCINATION RATES

DIFFERENT APPROACHES TO INCREASE IMMUNIZATION OF HCW

MANDATORY FLU VACCINE POLICY : BRITISH COLUMBIA

http://www.cbc.ca/player/Radio/The+Current/ID/2413266848/

https://www.youtube.com/watch?v=8O8bP5grbvY

MANDATORY FLU VACCINATION : VIRGINIA MASON HEALTH CENTRE

WHY MANDATORY FLU VACCINES DO NOT AFFECT HCW SICK LEAVE

The number of flu shots have tripled in the last 15 years

The number of estimated deaths due to flu have also tripled in the last few years

A CONUNDRUM

Half of the vaccines given are flu shots

Flu vaccine sales >$4B and rising annually

FLU SHOTS ARE BIG BUSINESS

DO CONFLICTS-OF-INTEREST AFFECT PUBLIC HEALTH OFFICIALS COMMENTS IN THE MEDIA?

Influenza can be a serious diseaseThe court was satisfied that immunization of all HCWs

reduces transmission of disease to patientsMasking policyMasking has a patient safety purpose It has accommodative purpose for HCWs who refuse

flu shots

FINAL DECISION1. Mandatory flu shots for HCWs are not uncommon2. Getting vaccinated or masking format is not unique3. Policy survives Charter scrutiny (Section 1 and 7)

COURT’S DECISION ON BC’S MANDATORY

HCW FLU VACCINE POLICY

Psychological Values Beliefs Perceptions Altruism Egoism

IS MANDATORY FLU VACCINATION POLICY THE NORM ???

Social Health system Government Health promotion Judic iary Populat ion Pharma Industry

Biological Susceptibi l ity Risk Immune

response Personal choice