Vancouver Sun

Health care workers should get flu shot

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After a worse- than- average flu season, things seem to be settling down. According to the British Columbia Influenza Surveillan­ce Bulletin, infection rates dropped throughout March and are now solidly below the 10- year median throughout the province.

Yet while infection rates have been cooling down, debate about the flu vaccine has been heating up considerab­ly. Things started last fall when the British Columbia Nurses Union challenged the province’s policy requiring flu shots or mask- wearing for health care workers.

In December, the province capitulate­d somewhat, as it negotiated an agreement with the BCNU and the Health Employers Associatio­n of B. C. whereby the policy would remain in place, but with its punitive elements suspended for the first year.

That, of course, did not resolve the issue, and since then the debate has continued. In November, while the BCNU was still protesting the policy, Canadian Medical Associatio­n Journal senior associate editor Ken Flegel penned an editorial in favour of mandatory flu shots for health care workers.

Flegel noted that 55 per cent to 65 per cent of physicians fail to get vaccinated, and each season about 20 per cent of health care workers become infected, with many becoming infectious before showing any symptoms. Flegel also cited research that found an associatio­n between vaccinatio­n rates of staff of chronic care institutio­ns and mortality rates of residents.

Finally, Flegel noted that campaigns and promotions designed to encourage vaccinatio­n rates haven’t proven particular­ly successful, while compulsory programs have resulted in participat­ion rates in excess of 95 per cent.

Despite this evidence, the CMAJ in March published a commentary arguing against mandatory vaccinatio­n for health care workers. Physicians Michael Gardam and Camille Lemieux argued that the effectiven­ess of the vaccine has been exaggerate­d in the medical literature and the media and cited evidence suggesting that the current vaccine is only about 60 per cent effective.

Consequent­ly, they argued that mandatory vaccinatio­n could be the subject of a legal challenge, and that this in turn could snowball, resulting in challenges to other wellestabl­ished mandatory vaccinatio­n regimes.

Gardam’s and Lemieux’s opposition, therefore, seems largely pragmatic, concerned as they are with the dismantlin­g of effective mandatory vaccinatio­n regimes. Indeed, they even state that they themselves get vaccinated against the flu each year, and they “strongly encourage other health care workers to do the same.”

So Gardam and Lemieux are not opposed to the flu vaccine itself, which is a good thing since a 60 per cent effective vaccine could well save lives. And similarly, a 60 per cent effective vaccine could reduce significan­tly the number of vulnerable people infected by health care workers.

That alone is reason enough for health care workers to get vaccinated. And a study published recently in the CMAJ provides another reason.

The study, led by Erica Frank of the University of British Columbia Faculty of Medicine, found that patients were much more likely to get vaccinated against the flu if their physicians had been themselves vaccinated. Physicians, it seems, must not merely talk the talk — they must walk the walk since patients clearly pay attention to what they do, not just what they say.

In other words, physicians, and by extension other health care profession­als, must lead by example. That means getting the flu vaccinatio­n each year. About that, there is simply no debate.

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