More hospitals require workers to get flu shots, but resistance persists

The general public may have wondered why it was worth announcing last week that Kaiser Permanente and 105,000 of its union employees had agreed that staff would either get a flu shot or wear surgical masks in patient-care areas during flu season.

But it's not a given that healthcare workers will get flu shots, even as providers and public health officials become increasingly vocal about encouraging patients to get them.

Kaiser's agreement with its unions reflects an “evolving norm,” according to Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, Aurora. The overall vaccination rate for healthcare workers has reached 77% and it surpassed 90% for hospitals. According to the Centers for Disease Control and Prevention, the average vaccination rate is just 44% at facilities where it's not required, promoted or offered on-site.

A growing number of hospitals and health systems require vaccinations for their employees, typically allowing those with religious objections to wear masks instead. Bronson Methodist Hospital in Kalamazoo, Mich., was one of the first to adopt the policy 10 years ago. Richard Van Enk, Bronson's director of infection prevention, says flu shots are now seen as an employee benefit and workers “would scream bloody murder” if the immunizations ended.

Still, resistance persists. Opponents argue that the evidence behind mandatory vaccination is not as solid as portrayed. They also note risks that include adverse reactions to the vaccine, and a tendency among immunized workers to become lax in other precautions, such as hand-washing.

Others argue it's a matter of civil liberties. Sakile Chenzira sued Cincinnati Children's Hospital in December 2011 when she lost her job after refusing to be vaccinated based on her religious beliefs as a vegan. Chenzira, a former customer service representative, said she lived a vegan lifestyle and opposed the consumption of animal products; flu vaccines are developed in eggs. (The case was settled for undisclosed terms.)

Many provider organizations have endorsed mandatory vaccinations, but nurses unions and associations have generally opposed them—often in court. The National Nurses United, while recommending members get vaccinated, has vigorously objected to policies that compel them, arguing that vaccinations should be an individual choice.

Amid measles outbreaks this past summer, however, the American Nurses Association updated its policy to call for all nurses to get immunized against all preventable diseases unless they can document religious or medical reasons for refusing them.

Wynia said it's incumbent upon healthcare employers to make it easy for their employees. “Healthcare workers don't want to put people at risk intentionally,” he said, “and not getting vaccinated is putting people at risk.”

Protein Sciences was granted FDA approval in 2013 for its FluBlok vaccine. FluBlok, which doesn't require eggs for production, takes less time to manufacture than more conventional means, but the vaccine has a shelf life of around six months.

The shorter production time is important, because the more time the manufacturer has to make a vaccine, the greater the number of doses will be able to be produced.

In the future, flu vaccine producers may be able to deliver a universal vaccine, administered once, that would target parts of the flu virus that don't mutate. But in an industry that sells individual pills for $1,000, a $2 shot is not exactly an incentive for innovation. In fact, some drugmakers are even getting out of the flu vaccine business. Novartis in August sold its flu vaccine arm to Australian biotherapy company CSL for $275 million.