Implications of mandatory flu vaccinations for health-care workers

Employers planning to implement mandatory influenza vaccination policies for health care workers need to understand the implications, according to an analysis published in CMAJ (Canadian Medical Association Journal).

Vaccination rates among health care workers are less than 50%, well below the level necessary for herd immunity. Evidence indicates that vaccination of health care workers can benefit patient health, leading to a move by many to consider mandatory influenza vaccination as a condition of employment or to require employees to wear a mask during influenza season. Many health care workers favour condition-of-service influenza vaccination policies.

However, in Canada, condition-of-service policies must comply with employment law, provincial human rights codes and the Canadian Charter of Rights and Freedoms. Condition-of-service policies that apply to unionized employees must be consistent with collective labour agreements, and vaccination policies should allow exemptions for religious beliefs and practices.

"With respect to the rights to liberty and security, vaccinate-or-mask policies have been found not to violate liberty or security rights, because the vaccine is not mandatory and masks are insufficiently invasive to violate these rights," states Dr. Allison McGeer, Mount Sinai Hospital, Toronto, Ontario, with coauthors.

Most legal cases around vaccination policies have weighed in favour of patient safety.

"Vaccinate-or-mask policies for influenza vaccination in health care organizations result in substantial increases in the vaccination rates among health care workers, are supported by most health care workers and, based on decisions to date, are likely to be found in compliance with Canadian law. …Physicians and employers should work together to find the best means to improve vaccination rates and protect both patients and providers from influenza," conclude the authors.