Why Your Nurse Didn't Have to Take a Flu Shot

The British Columbia government knew that mandatory influenza vaccination for health-care workers was doomed before it began.

The government announced Aug. 8, 2012, that B.C. would become the first Canadian province where all health-care workers would be required to get flu shots or wear masks during flu season. On Nov. 30, 2012, deputy health minister Graham Whitmarsh postponed the program after an uproar from health-care unions against the measure, opting for an education-and-awareness campaign instead of discipline.

An Aug. 1, 2012, briefing note for then-health minister Mike de Jong said less than half of health-care workers get immunized every year.

"The influenza vaccine is safe and effective -- when used in conjunction with other infection control practices, such as hand washing and remaining home when sick -- it is extremely effective at preventing illness. Those who are unable to be vaccinated, or who choose not to, will be required to wear a face mask to prevent transmission," said the document, obtained via Freedom of Information (see below).

"A mandatory vaccination policy that ends employment rights for non-compliance with a vaccination requirement would be unacceptable in B.C. However, a vaccine or wear-a-mask policy achieves high rates without requiring staff get vaccinated and with less implementation costs."

Discipline was vaguely threatened in a question-and-answer sheet about the program, which emphasized the ethical responsibility of health-care workers to protect their patients. It also said incentives, such as iPad and Caribbean vacation giveaways, failed to push the immunization rate above 50 per cent. It also conceded the vaccine is not 100 per cent effective in keeping away the flu.

"Even in years of vaccine mismatch, evaluation shows that protection is better than 40 per cent, significantly better than no protection at all."

Risks said to be minimal

The documents said the Society for Healthcare Epidemiology of America supported mandatory shots. The documents also downplayed the risks of flu shots. It said the neurological disorder Guillain-Barre syndrome affects only one-in-a-million recipients. An extended section on thimerosal said the mercury-based preservative had been used for decades in U.S. multi-dose vials to prevent germs, bacteria and fungi.

"The amount of mercury in vaccines is very small, less than one-tenth of the mercury in a tin of albacore tuna, available in grocery stores." Thimerosal was "only associated with minor local injection site reactions like redness and swelling at the injection site."

The documents also denied a link between thimerosal-containing vaccines and autism. "Numerous studies have found no association between thimerosal exposure and autism." The communications rollout began Aug. 1, 2012, when Health Employers' Association of B.C. CEO Michael Marchbank met with B.C. Nurses' Union, Hospital Employees' Union and B.C. Government and Service Employees' Union representatives to explain the policy. A formal letter outlining the policy was sent Aug. 7, 2012. A day later, memos to executives and staff were sent, followed by a Health Ministry news release.

The rollout document said the flu vaccine campaign was to kick-off the week of Oct. 8 and, by the traditional start of flu season during the first week of December, "all staff should now be vaccinated or wearing masks."

Whitmarsh was involved in an Aug. 3 briefing for de Jong. Dr. Perry Kendall, the provincial health officer, was on holiday from July 20 to Aug. 10, 2012, but met with Whitmarsh on Aug. 13 and was involved in a flu control policy conference call on Aug. 14.

But was it all just hype?

Kendall claimed studies in The Lancet, British Medical Journal, Canadian Medical Association Journal and Society for Healthcare Epidemiology supported mandatory immunization of health-care workers, but Dr. Tom Jefferson of the Cochrane Collaboration said reviews found several recent studies to be at a high risk of bias.

Effectiveness disputed

"We conclude that there is no evidence that only vaccinating health-care workers prevents laboratory-proven influenza, pneumonia and death from pneumonia in elderly residents in long-term care facilities," said a review by Jefferson on the Cochrane website. "Other interventions such as hand washing, masks, early detection of influenza with nasal swabs, anti-virals, quarantine, restricting visitors and asking health-care workers with an influenza-like illness not to attend work might protect individuals over 60 in long-term care facilities and high-quality randomised controlled trials testing combinations of these interventions are needed."

The Feb. 14 B.C. Influenza Surveillance Bulletin issued by the B.C. Centre for Disease Control was headlined Influenza Activity in B.C. Declining After Peak.

"The proportion of medical visits with an influenza diagnosis continued to decrease, with most regions at or approaching seasonal norms, though some variation exists," said the update. "Less than a third of the respiratory specimens tested at the B.C. Public Health Microbiology and Reference Laboratory were positive for influenza, predominantly A/H3N2."

Outbreaks at long-term care facilities continued to decline, but the proportion of consultations for flu-like illnesses at B.C. Children's Hospital emergency room "remained somewhat elevated."