Mandatory Flu Vaccination Policies Gaining Ground


By Jennifer Larson, contributor

When a prospective employer informs you that you must get an influenza vaccination as a condition of your employment, what’s your response?

Increasingly, it may be to roll up your sleeve, as more and more health systems begin to implement mandatory flu vaccination policies for all their employees, including contract or temporary staff. One major reason that hospitals want health care professionals to get vaccinated: their patients are often very sick and, due to illness or age, may be more vulnerable to the flu and its potentially devastating complications.

“Their safety is more dependent on our actions than anything that they themselves can do,” said Amy Berhman, MD, medical director for occupational medicine services at the Hospital of the University of Pennsylvania, who recently argued in favor of mandatory flu vaccinations for health care workers in the British Medical Journal. The University of Pennsylvania Health System implemented a mandatory policy in 2009.

Henry Ford Health System infectious disease physician Allison Weinmann, MD, said she would encourage travel nurses to go ahead and get a flu vaccination prior to a new assignment. “More and more places are going to make you get it,” she predicted. “Patient safety should be everybody’s priority, and it is a very low-risk vaccine.”

The rate of health care professionals getting vaccinated is already higher than the rate among the rest of the population.

According to performance measurement data for acute-care hospital-based health care professionals (HCPs) from the Centers for Disease Control and Prevention (CDC), hospitals reported that 82 percent of their hospital-based HCPs were vaccinated during the 2013–2014 flu season. Meanwhile, just slightly more than 46 percent of the U.S. population over the age of 6 months was vaccinated during the 2013–2014 flu season, despite the CDC’s recommendation that all adults receive an annual flu vaccine.

The CDC reports that 92.2 percent of physicians and 90.5 percent of nurses--up from 85 percent the previous year--received flu vaccines last year.  However, the rates are lower among employees of long-term care facilities, at around 63 percent.

CDC director Tom Frieden, MD, MPH, noted during a recent press conference that the high rate of vaccination among hospital employees can be attributed to employer vaccination requirements and to free vaccinations provided on-site.

"It's good medical policy to vaccinate your workers," said Frieden, "not only for their protection, but also for the protection of the often medically-fragile patients they serve."

This Year’s Influenza Vaccine

According to the CDC, this season’s flu vaccine protects against the viruses that research suggests are the mostly likely to circulate during the 2014–2015 flu season:
• A/California/7/2009 (H1N1) pdm09-like virus;
• A/Texas/50/2012 (H3N2) virus;
• B/Massachusetts/2/2012-like virus; and
• B/Brisbane/60/2008-like virus.

Behrman agreed that employers need to make it easy for health care workers, particularly those who work nights or weekends, to get vaccinated.

“I think the mandates may be the most obvious and well-published way to make a jump in your compliance rate, but that should always be in the context of making the vaccine available in a way that does not inconvenience workers,” she said.

Henry Ford Health System in Michigan achieved a 99 percent employee influenza vaccination rate when it implemented a mandatory vaccination policy two years ago. The system started with a less intense policy that strongly encouraged employees to vaccinated and required employees who didn’t get vaccinated to wear masks.

But finally, the system decided to make vaccination mandatory for all employees and tightened up its opt-out provision to only allow employees to decline for a religious or medical reason with a declination form signed by the physician or religious leader.

“The majority of our 23,000 employees went along with it,” said Weinmann, who analyzed the data for a study recently presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy. “It’s the right thing to do for patients.”

And while a few employees objected to the policy, there were very few who followed through on their decision to not adhere to the mandate. Weinmann and her team at Henry Ford made it a priority to speak to the employees with concerns and provide education to them about the vaccine and the reasons the system decided to make it mandatory. The system also made the vaccines available for free in multiple locations at a variety of times. After people got accustomed to the policy, there were fewer complaints or concerns the second year.

One common concern that Weinmann, Berhman and others hear from people, including health care professionals, is the vaccine’s effectiveness. Why get the vaccine if it’s only 60-65 percent effective in protecting someone against contracting the flu?

“It’s not 100 percent, but it’s still the best thing that we have,” said Weinman. “It’s still the best weapon in our arsenal.”

“It’s an objection that you have to acknowledge,” Berhman said. “On the other hand, 60 percent risk reduction for a minor inconvenience and a very low cost sounds like a pretty good tradeoff to me.”

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