Policy Brief
Issue 1
February 27, 2015
Preventing the flu: Why healthcare workers
should be mandated to receive the flu vaccine
Seasonal influenza is the leading cause
of vaccine preventable diseases
associated with hospitalization (Chean,
Ferguson, & Stuart, 2014). The idea of
mandatory flu vaccines stems from the
healthcare worker’s (HCW) increased
risk of contracting the illness and then
further transferring it to coworkers and
patients. Complications to vaccination
include concerns about vaccine
effectiveness and safety, medical
contraindications, religious beliefs and
conscientious objection (Galankis,
Jansen, Lopalco, & Giesecke, 2013).
There are also issues regarding
inconvenience to obtain the vaccine and
the HCW’s underestimation of their own
susceptibility to contracting the flu
(Galankis, et al., 2013). However,
research continues to show that where
there are higher instances of vaccinated
HCWs, there are lower instances of flu
outbreaks. The flu is unpredictable in its
severity and the flu season can vary
widely (CDC, 2014). Therefore, it is
recommended that all HCWs receive the
flu vaccine to protect themselves and
their patients from the flu.
Why is this issue important?
The flu virus can be transmitted before
symptoms even develop (Galankis, et al.,
2013). This means that HCWs can
spread the virus without even knowing
they have it. This can easily lead to
outbreaks of nosocomial illnesses and
2015 Policy Brief:
Preventing the flu
potentially death (Galankis, et al., 2013).
HCW flu vaccination has been shown to
prevent the spread of the flu virus in
hospitalized patients (Galankis, et al.,
2013). Despite consistent
recommendations, dedicated efforts,
vaccine availability free of charge,
publicity, and education, voluntary
vaccination programs have had poor
results (Galankis, et al., 2013).
What’s the root cause?
First, we must look at the problem – a
low percentage of healthcare workers
vaccinated under voluntary policies,
leaving patients at risk for contracting
nosocomial infections. Then, we can
look at the underlying causes:
1. Many believe there is not enough
solid evidence in support of
vaccine effectiveness.
2. Enforcement of mandatory
policies may have long-term
effects on the employeremployee relationship.
3. Many also believe that the cost of
the vaccine is better spent on
other forms of education to
prevent the spread of infection.
4. Still others believe that
mandatory vaccination is a
violation of civil liberties,
creating a serious ethical
dilemma.
Emily Alpers, RN
Ferris State University
1
5. Others are also concerned of
vaccine side effects, though
serious side effects are extremely
rare.
How do we respond?
In refute, vaccination of HCWs has been
shown to decrease the spread of the flu
and in areas where a high percentage of
HCWs have declined vaccinations,
outbreaks of influenza have occurred
(Galankis, et al., 2013). In addition,
there is no documented evidence of
long-term negative effects on the
employer-employee relationship as a
result of mandatory flu vaccination. One
study noted that most HCWs believe that
mandatory flu vaccination is coercive,
but almost 90% agreed that mandating is
important for protecting patients and
staff and was part of their professional
ethical responsibility (Feemster, Presad,
Smith, Feudtner, Caplan, Offit, &
Coffin, 2011). Also, severe side effects
to the flu vaccine are extremely rare, and
those with health concerns can easily
receive a medical declination.
A change is needed!
The flu is a very real concern. Effects of
the flu can range from mild to severe
illness. Serious outcomes of contracting
the flu can result in hospitalization or
even death. According to the Centers for
Disease Control and Prevention (2014),
some people, such as people with certain
health conditions, older people, and
young children, are at high risk for these
serious flu complications.
The best way to prevent the flu is by
getting vaccinated each year, and
mandating the flu vaccine can help
2015 Policy Brief:
Preventing the flu
prevent the spread of the flu (CDC,
2014). However, for those opposed to
mandatory policies, “it is preferable for
higher uptake rates to be achieved
through consensus rather than coercion,
as coercive policies would bear the cost
of conflict and mistrust, devalue HCWs
and thus alienate important allies and
have long-term detrimental effects”
(Galankis, et al., 2013, para. 24).
However, these effects are not proven,
and the addition and implementation of
mandatory programs in the United
States, has yielded promising results.
These programs have increased coverage
rates of nearly 20% in the past few years
(Galankis, et al., 2013, para.13). Where
there is an increased percentage of
HCWs vaccinated against the flu, there
is a decreased percentage of outbreaks.
Therefore, to do nothing, means to
increase the likelihood of flu outbreaks
in the healthcare setting. This goes
against the HCWs responsibility to
beneficence and ensuring patient safety.
Ultimately, HCWs should have their
patient’s health as the top priority.
Mandatory vaccination helps to ensure
this professional virtue.
Recommendation
Action must be taken to protect patients.
The belief held by most healthcare
workers and organizations is that it is
morally justified for HCWs to be
voluntarily vaccinated, along with
adherence to all other preventive
measures for disease control (Galankis,
et al., 2013). Although voluntary
vaccination would be preferable, it is
recommended that if voluntary vaccine
uptake has failed to achieve the desired
results, then mandatory policies should
be implemented (Galankis, et al., 2013).
Emily Alpers, RN
Ferris State University
2
It is clear that the risk for the HCW is
negligible and that the patients’ welfare
is enhanced through mandatory
vaccination policies. As exemptions for
medical and religious reasons are always
offered under mandatory policies, there
should be no real detrimental effects on
the employer-employee relationship.
Deciding for exemption is a personal
choice, and one must weigh the potential
consequences for others. The HCW is
not only potentially protecting or
endangering themselves, but those they
come in contact with and care for. In
light of the HCWs call to professional
virtue and beneficence, it is
recommended that healthcare
organizations institute mandatory flu
vaccination policies to protect its
employees and any patients treated at the
facility. Without mandatory vaccination
policies, too many lives are risk for
contracting the flu.
Centers for Disease Control and Prevention (2014). Key facts about influenza (flu) and flu
vaccine. Retrieved from: http://www.cdc.gov/flu/keyfacts.htm
Centers for Disease Control and Prevention (2014). Seasonal influenza: flu basics.
Retrieved from: http://www.cdc.gov/flu/ about/disease/index.htm
Chean, R., Ferguson, J.K. & Stuart, R.L. (2014). Mandatory seasonal influenza
vaccination of health care workers: a way forward to improving influenza
vaccination rates. Healthcare Infection, 19, 42–44. http://dx.doi.org/
10.1071/HI13041
Galanakis E, Jansen A, Lopalco PL, Giesecke J. Ethics of mandatory vaccination for
healthcare workers. Euro Surveill. 2013; 18(45).
2015 Policy Brief:
Preventing the flu
Emily Alpers, RN
Ferris State University
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