Influenza has played a major role in the history of disease and medicine and has been a great population threat for decades. The flu is a single-stranded RNA virus with either antigen types A, B, or C. these antigens change every 10-40 years and hence it is difficult to have protective antibodies against new antigens. The World Health Organization (WHO) approximates that the global attack rate is at 20-30% for children and 5-10% of adults. Additionally, seasonal flu results in 3 to 5 million cases of illness and over 250,000 deaths annually (World Health Organization, 2014). In the US the estimates of influenza deaths over the past 40 years have been as high as 49,000 annually, with a huge number of deaths happening amongst the elderly.
According to The National Vaccine Advisory Committee (2012), more than 200,000 individuals are hospitalized for respiratory and heart conditions that are associated with seasonal influenza. Most healthy individuals are able to infect others with the virus from day one prior to the development of symptoms until one week after symptoms have resolved. With the continuous changing of the flu virus and the weakening of the immunity over time it is highly recommended that vaccination is on an annual basis. Vaccination is particularly crucial for people who are at high risk for serious complications related to flu sickness, their caregivers, family, and the healthcare personnel. Presently, the most used form of vaccination is an injection, which contains inactivated viruses that cannot cause the flu. The vaccine is considered to be effective and safe and it is advised that all people over the age of six months be vaccinated.
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Flu transmission results in increased absenteeism, interruptions in healthcare deliveries, longer patient stays in hospital, and inpatient deaths thus vaccinating healthcare workers against seasonal influenza is a simple and safe tool to reduce healthcare associate flu, absenteeism, and prevent patient deaths. Furthermore, studies show that these registered nurses are highly likely to be infected due to caring for patients. Vaccination for the healthcare workers is a specific focus of recommendation by the US, other public health agencies, and professional organizations. Despite known risks of the flu to vulnerable patients, vaccination coverage in the United States healthcare personnel remains near 50% (Ottenberg et al., 2011).
According to Healthy People 2020, the goal is to increase the percentage of healthcare staff who are vaccinated yearly against seasonal flu to 90% through consistency with the laws, policies, national programs, and regulations (Healthy People 2020, 2013) but over the past three decades voluntary programs have failed to achieve the acceptable vaccination rates. The low voluntary rates of vaccination in the healthcare department increase the risk of flu outbreaks in these settings. Without sufficient levels of vaccination, herd immunity is reduced in the hospital. Herd immunity is described as the practice of offering vaccination to a certain percentage of people, thus stopping immune-compromised individuals and other vulnerable patients from having influenza. Low rates of vaccination in the health care sector increases staff illness and absenteeism and flu-related deaths and sickness. In addition, this could lead to court cases when a patient dies from influenza and was transmitted from the nurse to them. Healthcare workers also need to be great role models to the community at large and by adhering to such mandates they show the public the importance of being vaccinated. Therefore vaccination directly protects healthcare personnel and indirectly protects their patients.
With the global outbreak of influenza, rising disquiet in governmental organizations and infectious disease institutions has led to them reflecting on enforcing vaccination amongst the healthcare workers. Even though the dominion of the healthcare staff must be put into consideration, the government has a responsibility to protect the public. At the moment as with any other organization, most employers view immunization as an individual choice of their workers and hence one may choose not to be vaccinated. Despite this fact, the concept of non-maleficence is very clear in this sector. It is an obligation to avoid causing any harm to patients. Patients have the expectation that their caregivers take reasonable precautions to prevent hospital-acquired diseases. And because of the risk, there is a need for mandatory vaccination as an initiative to safeguard the patient’s health. To improve the rates of vaccination certain measure have been taken like offering vaccination free of charge, providing on-site vaccinations, educational programs, mandatory signed declination forms, and yearly campaigns, have been used. Nonetheless, for the employees who choose not to be immunized, they have to take precautionary measures like wearing masks and keeping a safe distance from patients.
Vaccinating the healthcare workers (HCW) serves numerous purposes: the first is to be able to lessen the risk that the HCW will be infected with the flu; the second is to prevent transmission of the virus to the patients, as well as those with a lower probability of vaccination response themselves; third is to form a herd immunity that protects the healthcare workers and their patients who are not in a position to be vaccinated or do not respond to the vaccination; the forth is to be role models on the importance of vaccination to the community at large; and lastly so as they can maintain a critical societal workforce during an outbreak. In addition, several types of research have shown that this is a cost-effective strategy and helps prevent patient morbidity and deaths. Regrettably, despite remarkable efforts to promote influenza vaccination in the healthcare sector by government agencies, professional societies, and regulatory groups, flu vaccination rates among HCW has remained unacceptably low.
The American Nurses Association (ANA) strongly encourages annual flu vaccination but does not support mandated policies. They believe that the rights of the nurses should be protected and unless mandatory policies are fair, nondiscriminatory and equitable they do not support them (Kung, 2014). Moreover, according to ANA, mandatory policies should only be implemented if the state government is to initiate them, if the vaccinations are available at convenient locations and time and are free, if the individual employees are not discriminated, if the policies are part of a comprehensive infection control program, and employers will be able to negotiate with their personnel unions to deal with any issue once a mandatory policy is put in place. Another limiting factor to mandatory vaccination is the possibility of legal challenges and potential employees’ infringement of their civil liberties. And despite obligatory vaccination may be very impactful to the society at large, it may not be worth the conflict and legal matters that may arise due to it.
Another reason for concern amongst the HCW is that the vaccination may have several side effects but research shows that the risk of this is relatively low. Moreover for the vaccination process to be accepted by most of the practitioners they should hold educational campaigns that address concerns like the ingredients and efficacy of the vaccines before and during the vaccination period. In some instances, there has been a shortage of the vaccinations and has led to discrimination in that other staffs get immunized and others do not. So it is vital that they make sure that the vaccines are in plenty before they start the process. Additionally, by hospital administration and management supporting this process through incentives they are likely to increase the rate of vaccination. Another concern is the one who is allergic to some of the vaccines; they want to be offered skin tests and vaccinations in an allergy laboratory free of charge. However, these suggestions may increase influenza vaccination rates to a point; the most effective intervention is the policy change. This will enable them to meet the Healthy People 2020’s goal which is to have 90% of all healthcare personnel vaccinated against the flu annually.
To conclude, the flu is a worldwide epidemic and has played a huge role in the history of medicine and disease over the past decades. In children, the attack rates have been recorded to 20-30% while in adults it is at 5-10%. There has been a controversial debate on whether registered nurses and other healthcare personnel should be mandated to vaccination or not. Flu illness in the healthcare sector has resulted to interruptions in healthcare deliveries, absenteeism, longer patient stays in hospitals and inpatient deaths because of infection from the healthcare staff. The HCW are also at a risk of being infected by the patients they are taking care of. Thus due to the low turnout in vaccination programs, various public health agencies, the government, and other professional organizations advocate for mandatory influenza vaccination. However, some organizations like The American Nurses Association are against mandatory vaccination saying that it infringes the rights of their nurses and this should only be implemented if the state government is in support of it. And also if the policies are fair, equitable and nondiscriminatory to all their employees. In my opinion, I believe that mandatory vaccination will be beneficial to all the employees as well as their patients.
References
Healthy People 2020 website. (2013). Immunization and Infectious Diseases. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases
Kung, Y. M. (2014). A quality improvement project to increase influenza vaccination in healthcare personnel at a university health center. Journal of the American Association of Nurse Practitioners , 26 (3), 148-154.
Ottenberg, A. L., Wu, J. T., Poland, G. A., Jacobson, R. M., Koenig, B. A., & Tilburt, J. C. (2011). Vaccinating health care workers against influenza: The ethical and legal rationale for a mandate [Commentary]. American Journal of Public Health , 101(2), 212-216.
The National Vaccine Advisory Committee (2012, February 8). Recommendations on strategies to achieve the healthy people 2020 annual influenza vaccine coverage goal for health care personnel. Retrieved from www.hhs.gov/nvpo/nvac/influenza_subgroup_final_report.pdf
World Health Organization. (2014). Influenza (Seasonal). Retrieved from http://www.who.int/mediacentre/factsheets/fs211/en/
