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Srinivas GarlapatiMHA (C)HPRO 5620
MANDATORY INFLUENZA
VACCINATION POLICY FOR HEALTH CARE
WORKERS: A BIOPSYCHOSOCIAL
VIEW
BIOPSYCHOSOCIAL MODEL
20,000 hospitalizations, 4,000 deaths Highly contagious Aff ects 10-20% of population each year, 20-30% of
children Aff ects populations disproportionately: elderly, very
young, immune-compromised, underlying illness, pregnant women etc
Immunization most eff ective protection but not as eff ective in those most at risk
(PHAC, 2014)
THE BURDEN OF FLU
Influenza causes by far the highest number of deaths among vaccine-preventable diseases.
Hospitalized patients are more vulnerable to influenza than members of the general population.
Transmission occurs before symptoms are obvious
THE BURDEN OF FLU
Health care workers and health care systems have an ethical and moral responsibility to protect vulnerable patients from transmissible diseases.
Vaccination of healthcare workers reduces the risk to patients - frequently implicated as the source of influenza in healthcare settings and patient mortality and morbidity goes down when HCWs are vaccinated.
Despite past eff orts to increase vaccination levels for health care workers, rates have stalled at less than 50 per cent.
VACCINATING HCW
Prevent transmission to patients who cannot mount immunity
Reduction of the risk of HCWs getting infected Creation of “herd immunity”Maintenance of a critical societal workforce during
disease outbreaks Set a good example concerning the importance of
vaccination for every person(Society for Healthcare Epidemiology of America, 2014)
THE NEED TO IMMUNIZE HEALTHCARE WORKERS (HCW)
Vaccine 9 minutes missed work 40% chance of sore arm
1 in 5000 chance of allergic reaction
1 in 1,000,000 risk of hospitalization (allergy/GBS)
1 in 50 million risk of death
No vaccine 135 minutes missed work 33% chance of acute resp
illness 2 in 100 chance of illness
needing antibiotics 1 in 100,000 risk of
hospitalization due to influenza
1 in 3 million risk of death
COMPARISON OF RISKS
PERCEIVED LIKELIHOOD
PERCEIVED SEVERITY
PERCEIVED SUSCEPTIBILITY
FLU CONTROL: NHS
Questionable effectiveness in elderly
Influenza disease burden and program impacts
Indirect effects of vaccinationCost and prevention effectivenessSafety/Effectiveness of repeated annual vaccination
UNIVERSAL INFLUENZA VACCINATION
INFORMATION GAPS
CDC (2011) : 70-90 % eff ective in healthy peopleCochrane Review 2010 : 60% (maybe)Osterholm review 2012 : 59% (maybe)
Moreover, Flu vaccines contain guess strains – may not be eff ective every season
HOW GOOD IS THE FLU VACCINE
IMPROVING HCW VACCINATION RATES
DIFFERENT APPROACHES TO INCREASE IMMUNIZATION OF HCW
MANDATORY FLU VACCINE POLICY : BRITISH COLUMBIA
http://www.cbc.ca/player/Radio/The+Current/ID/2413266848/
https://www.youtube.com/watch?v=8O8bP5grbvY
MANDATORY FLU VACCINATION : VIRGINIA MASON HEALTH CENTRE
WHY MANDATORY FLU VACCINES DO NOT AFFECT HCW SICK LEAVE
The number of flu shots have tripled in the last 15 years
The number of estimated deaths due to flu have also tripled in the last few years
A CONUNDRUM
Half of the vaccines given are flu shots
Flu vaccine sales >$4B and rising annually
FLU SHOTS ARE BIG BUSINESS
DO CONFLICTS-OF-INTEREST AFFECT PUBLIC HEALTH OFFICIALS COMMENTS IN THE MEDIA?
Influenza can be a serious diseaseThe court was satisfied that immunization of all HCWs
reduces transmission of disease to patientsMasking policyMasking has a patient safety purpose It has accommodative purpose for HCWs who refuse
flu shots
FINAL DECISION1. Mandatory flu shots for HCWs are not uncommon2. Getting vaccinated or masking format is not unique3. Policy survives Charter scrutiny (Section 1 and 7)
COURT’S DECISION ON BC’S MANDATORY
HCW FLU VACCINE POLICY
Psychological Values Beliefs Perceptions Altruism Egoism
IS MANDATORY FLU VACCINATION POLICY THE NORM ???
Social Health system Government Health promotion Judic iary Populat ion Pharma Industry
Biological Susceptibi l ity Risk Immune
response Personal choice