"We simply don't have good evidence that vaccination of healthcare personnel prevents influenza transmission to patients." -- Professor Nick Kelley, Center for Infectious Disease Research and Policy, Minnesota
When flu season starts, mandatory flu shots or wearing a mask will be required not only for hospital and care home staff in British Columbia, but visitors as well.
And that's just wrong.
Wrong on the science. Wrong on the approach to healthcare workers, including doctors and nurses. Wrong for the intrusion into people's personal choices about their own health. And wrong on the hundreds of millions of dollars spent by both governments and individuals on vaccinations that fail at least 41 per cent of the time, perhaps more.
But starting around December, neither visitors nor workers will have a choice -- you will take the shot or wear a mask if you are in a hospital or care home.
Visitors who refuse could be blocked from entering -- but workers could be fired, after an arbitrator rejected healthcare unions' objections last week.
"We're expanding our policy to visitors," B.C. provincial health officer Dr. Perry Kendall told media last week, saying everyone visiting hospitals or long-term care facilities should either have had a flu shot or wear a mask.
London, Ontario hospitals will enforce the same choice and others will likely follow, according to that province's health promotion agency.
But the science behind both flu shots and masks is simply nowhere near good enough to make such a draconian decisions on our rights.
Flawed flu studies
Start with the fact that most studies on flu shots are flawed, according to the Center for Infectious Disease Research and Policy at the University of Minnesota.
"Applying very strict criteria to filter out potential bias and confounding, a U.S. research team sifted more than 5,000 studies and found only 31 that they felt provided reliable evidence about the efficacy and effectiveness of flu vaccines. The findings were published online today by Lancet Infectious Diseases," it found.
One of Canada's most prominent infectious disease specialists agrees.
Dr. Michael Gardam argued in the Canadian Medical Association Journal that flu vaccine is only modestly effective and making shots mandatory could lose in court.
"Any sort of policy decision where you're going to make a vaccine mandatory is going to be an uphill battle, right? It's going to be a real fight. And so you have to decide if you're going to make that fight, is this vaccine worth it to make that fight? And I personally don't think it is," said Gardam, head of infection control at Toronto's University Health Network. Gardam himself is in favour of the vaccine and gets a flu shot.
Professor Nick Kelley, who is also pro-vaccine, points out that new analysis of past studies shows that the flu shot is no cure-all for healthcare workers.
"We really don't have a good grip on the epidemiology of influenza in the healthcare setting," Kelley said.
Kelley added that even if hospitals achieved 100 per cent vaccination rates for staff, there would still be a 41 per cent failure rate for the flu shot, leaving patients vulnerable to infection from sick workers.
Vaccination no fail-safe solution: US union
In B.C., the Health Sciences Association, the Hospital Employees Union and the BC Nurses Union all oppose mandatory flu shots for members, while still supporting voluntary immunization.
"Crucially, there is simply no evidence to support the assertion that vaccination of healthcare workers will prevent the transmission of influenza to patients," Lindsay Lyster, the HSA lawyer who argued the arbitration for the unions, told CBC Radio.
National Nurses United, the largest U.S. organization of nurses, also opposes mandatory flu shots.
"Nurses, joined by many physician organizations and researchers, reject the notion that vaccination is a fail-safe solution to prevent the spread of the flu virus," said co-president Karen Higgins. "We oppose forced vaccinations or the related mandate that those who decline the shots must wear masks or risk losing their jobs."
Higgins said the science simply doesn't support it.
"A 2005 National Institute of Allergy and Infectious Diseases study over 20 years found no correlation between increased vaccine use and a decrease in deaths," Higgins argued.
Professor Nick Kelly summed it up succinctly on Twitter last week: "Overstating the data on flu vaccines is shooting ourselves in the foot... reduces the need for innovation & confuses public."
Let sick workers stay home
National Nurses United promotes a better solution to preventing flu: make sure all workers can take sick time when they need it.
The organization cites a American Journal of Public Health study in 2011 that estimated that lack of sick time helped spread five million cases of illness during the 2009 swine flu outbreak in the U.S.
In the U.S., private healthcare companies would rather vaccinate than grant sick time or take additional preventive measures to reduce the spread of disease.
"Too many hospitals whose mantra is profits, not patient safety, favour forced vaccinations while cutting nursing or housekeeping staff, and denying paid sick leave," Higgins said.
The alternative to a flu shot -- wearing a mask at work in a hospital or during a visit -- is also of dubious medical value.
"Very little information is available about the effectiveness of face masks and respirators in controlling the spread of pandemic influenza in community settings," a U.S. government document reported.
For many healthcare workers, wearing a mask all day is irritating and gets in the way of developing an interactive relationship with their patients.
There are obvious occasions where a mask is required, as well as other protective gear and precautions.
But a blanket policy seems more designed to force workers to get a flu shot and punish those who refuse. It will also cause patients and co-workers to potentially shun those who wear masks while feeling falsely secure with workers who don't.
There are clear alternatives short of demanding healthcare workers be forced to have a flu shot or be fired. The famed Mayo Clinic's policy is that staff who don't want to take a flu shot must sign a statement that explains why. It has a 90 per cent vaccination rate.
Lastly, flu shots are an immense expense for both governments and individuals.
The cost of flu vaccines in Canada alone is likely more than $100 million, according to Dr. Danuta Skowronski of the B.C. Centre for Disease Control.
Those at particular risk, such as the elderly or those with chronic illnesses, can get a free flu shot, as can healthcare workers -- but for others it can cost between $20 to $30 per person. That adds up to a lot of revenue for drug companies.
Dubious scientific evidence, heavy-handed government intervention, high costs for low results, healthcare professionals' opposition and an intrusion on personal freedom all add up to one conclusion: "mandatory flu shots or else" is just plain wrong.