Parents are used to mandatory vaccines for children entering school, but the idea of compulsory shots for adults is stirring up quite a controversy this fall.
For the first time, hospitals, university health systems, and even the state of New York, are requiring that health care workers get the flu vaccine -- and not all employees are happy about it.
Hundreds of people took to the New York state capitol Tuesday to protest the New York State Hospital Review and Planning Council's regulation making the annual influenza vaccination and the forthcoming H1N1 vaccine (Swine Flu) mandatory for state health care workers.
"It makes me feel very vulnerable," a nurse at the rally told ABC News affiliate WHAM in Rochester. "It makes me feel like I'm a guinea pig."
Currently, the voluntary vaccination rates for health care workers average around 50 percent.
"It drives vaccine advocates crazy," said Robert Field, a professor of law and public health at Drexel University.
"For a nurse and a health care worker, it's not just an issue of taking care of yourself -- you're in a position to do particular damage," Field said, referring to a handful of recent cases in which patients in a cardiac care unit died as a result of getting the flu from a nurse.
"In a healthcare institution, there's no magic number for herd immunity," Field added. "Just one person with an infectious case can spread the disease."
All health care workers who have contact with patients in New York are required to get both flu shots or face the possibility of losing their jobs. Only employees with medical issues are exempted, and the rule doesn't apply to those who work in nursing homes.
New York State Health Commissioner Dr. Richard F. Daines replied to the objections with an open letter, saying "on this (issue), the facts are very clear: the welfare of patients is, without any doubt, best served by the very high rates of staff immunity that can only be achieved with mandatory influenza vaccination -- not the 40-50 percent rates of staff immunization historically achieved with even the most vigorous of voluntary programs."
New York is the first state to require the shots, but the state government is following on the heels of renowned universities and the Hospital Corporation of America (HCA) -- one of the largest hospital management corporations in the country.
Should Hospitals Mandate the Flu Shot?
Anticipating an ongoing trend, the California Nurses Association and the National Nurses Organizing Committee (CNA/NNOC) issued a formal opposition Wednesday as "bargaining demands to hospital management and as guidance to regulators and legislators."
"What sort of gets lost in all of this in this rush to mandate these vaccines, is the employers right now aren't even doing the basics to protect the nurses and the patients," said Deborah Burger, a registered nurse and president of the California Nurses Association.
The, CNA/NNOC strongly recommended nurses get the vaccine, but said that they should have the right to refuse it for personal reasons. Burger and the CAN/NNOC charge that employers should institute isolation rooms for patients sick with the flu, allow more sick leave with compensation for nurses and buy the proper masks for patients sick with the H1N1 virus.
"It gives you a false sense of security that you're vaccinated against three viruses that cause the flu. There are hundreds of viruses that cause flu-like symptoms," Burger said. "The vaccine itself is anywhere from 60-90 percent effective."
However, the chief medical officer of HCA, Dr. Jonathan B. Perlin, said the company chose to mandate the flu vaccine because of compelling studies that showed it saved lives and kept health care workers well and at work. More than 120,000 HCA employees will be offered a free vaccine or can go get a free vaccine at CVS before the end of the month.
"The reason is really straightforward: a woman shouldn't come into a hospital to deliver a baby and leave with the flu," said Perlin.
"When you achieve that perfect level of vaccination, there is a 40 percent reduction in death from the flu among patients," he added. Perlin said having 100 percent vaccination can also reduce sick days among health care workers by 41 percent, citing statistics gleaned from several studies over the past 10 years.
More Hospitals Mandate Flu Shot for Workers
The HCA is not alone in their decision. Hospitals across the nation from the Virginia Mason Health System in Seattle, to the Loyola University Health System in Chicago, BJC health Care in Missouri, Emory in Atlanta, and the University of Pennsylvania and the University of Maryland have implemented flu vaccine mandates this year.
The penalties for employees who refuse vary from dismissal, to the requirement of wearing a surgical mask for the whole of flu season.
"Legally, in most states, employers do have that right… unless there's a specific exception in a contract," said Field. "You could also say that if you have chosen to work in the health care field, you have chosen to put yourself in a position where you can affect the lives and health of many others."
Opponents of the mandates also cite the rushed safety trials of the H1N1 vaccine as cause for concern, and that nurses and other health care workers should have a right to refuse the new vaccine for that reason.
In response to the New York state vaccine mandate, the New York State Public Employees Federation (PEF) released a statement stating "vaccination for influenza is not as effective in the control of disease as vaccination for diseases such as polio, measles, and mumps. The safety of the H1N1 vaccine has not been as thoroughly established."
Field acknowledged that the H1N1 vaccine was manufactured and tested quickly over the summer, but the rush didn't concern him.
"H1N1 has gone through a much faster testing process than others because the time frame is so much less so we don't have as much of a data trail to support it," said Field. "But what we've seen so far clearly demonstrates effectiveness."
Field also pointed out that seasonal flu vaccines have had a good track record since 1976, when a number of people reported symptoms of an autoimmune reaction called Guillain-Barré. The reaction attacks the person's nerves and can lead to paralysis.
"The fear with vaccines often relates back to the 1976 scare of Guillain-Barré syndrome," said Field. "But even though it was associated with the flu vaccine, it was extremely rare."