If data is all the rage, why is it missing from the mandatory flu shot debate?

Google's flu trends map shows "high" and "intense" flu activity across the U.S.

Google’s flu trends map (Jan. 23) shows “high” and “intense” flu activity across the U.S.

Here’s what we think we know about the influenza vaccine: it’s about 60 percent effective, and anyone working with patients should get it.

But as more controversy unfolds around the mandatory vaccination policies being put in place by some hospitals, and the job losses that follow, there seems to be some important information missing.

Let’s look first at what’s out there. The Centers for Disease Control tracks trends in flu vaccinations among healthcare professionals, and its most recent survey from November is actually pretty interesting.


Most notably, it supports the notion that more healthcare workers are getting vaccinated. Up until the 2009-2010 flu season, fewer than half of all healthcare professionals got vaccinated, according to the CDC. Today, that number is estimated around 63 percent. And it’s even higher in hospitals, with the most recent data suggesting that at least four out of five hospital workers get a flu shot.

That’s probably partially due to the push from hospitals to get employees vaccinated. Fifteen percent of healthcare workers surveyed said they got the vaccine because their employers required it. And, vaccination rates tend to be lower among hospitals that don’t require it. The Cleveland Clinic, for example, encourages the vaccine but doesn’t require it. Last year, only 54 percent of its employees were vaccinated, according to a public database maintained by the Ohio Department of Health.

So, vaccination rates among healthcare workers are generally rising, yet we’re in the middle of a flu epidemic. There are undoubtedly many factors at play in an epidemic, but in this context, I’m most curious about whether vaccination among health facilities is actually associated with lower rates of infection inside or outside of the hospital.

The research I was able to round up on this front wasn’t very convincing. One 1999 study that looked at immunization and respiratory infections among healthcare workers found that those who were vaccinated demonstrated only less absenteeism than those who weren’t; their rates of respiratory infections were not significantly different.

Another study tracked how vaccination rates among staff members at numerous UK nursing homes were correlated with influenza-like illnesses among patients over two flu seasons. During one season, reports of influenza-like illnesses and hospital admissions for such illnesses were significantly lower among residents at homes with more vaccinated workers, but during the second year no significant differences were found. A 2006 study in Canada concluded that vaccination of staff in eldercare facilities affected flu-like illnesses only when patients were vaccinated, too.

Robust data on how healthcare worker vaccinations affect the spread of infection just isn’t there. Hospitals track and report information on certain hospital-acquired infections like catheter-associated urinary tract infections and central-line blood stream infections, but they don’t do so for influenza. Tracking that kind of data may be too costly, laborious and complicated to be worthwhile. But, if more hospitals are going to require employees to get vaccinated or lose their jobs, and especially if it’s going to be mandated at the state level, shouldn’t it be done on a more solid foundation?

Another point to consider is that the long-term effects of repeated influenza vaccinates, from both a safety and effectiveness standpoint, have not been extensively studied.

Some argue that it’s the ethical responsibility of healthcare workers to get vaccinated, both to protect patients and be the leaders in “herd immunization.” The thing is, though, when the CDC asked healthcare workers who got vaccinated why they did so, under 10 percent said they did it to protect patients. Almost half said they did it to protect themselves. Similarly, an online survey of Association of American Physicians and Surgeons members found that nearly 80 percent thought the flu vaccine should be a personal choice.

So long as the flu vaccine is seen as a personal decision, and not one based on sound evidence that it will protect patients and do a greater good, the issue of whether people should be fired for refusing them is probably going to play out in legal battles, the same way many other clashes between personal choice and policy historically have.

“We think this issue of employers mandating flu vaccinations may have to play out in the courts,” said Adam Sachs, spokesman for the American Nurses Association. “It’s not just a healthcare issue, it’s an employment issue. There may be more to come.”

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