By Karen Aney (The Cascade) – Email
Print Edition: September 19, 2012
British Columbia is now the first province in the country to mandate the influenza vaccination for all health care professionals.
The decision, introduced by Provincial Health Officer Dr. Perry Kendall, was announced on August 23. It states that any health care employee—a blanket term for anyone who comes in contact with patients, from janitors to surgeons—must either vaccinate against the influenza virus, or wear a mask at all times.
The move is an effort to reduce what the Public Health Agency of Canada (PHAC) reports is 2000 to 8000 deaths from influenza and its complications each year.
Dr. Kendall explained that “… influenza causes more deaths annually than all other vaccine-preventable diseases combined, and hospitalized patients are more vulnerable to complications from influenza than the general population.” No specific study was cited during this explanation.
British Columbia is the first province to make influenza vaccination mandatory, but there is some Canadian precedent, including North Bay General Hospital in Ontario. In an interview with the National Post, Kim Carter (the hospital’s infection control coordinator) stated that there have been no outbreaks of influenza in the hospital since the vaccinations were made mandatory – an unprecedented statistic within their facility.
In this case, grievances were filed against this mandate and unions argued that a compulsory vaccination violated their members’ rights. These grievances, however, were overturned by the labour-arbitration board and it was deemed that the compulsory vaccination was not a violation. This precedent suggests that although the BC Nurse’s union has already declared their intention to protest this change in BC, they may not be successful.
Vaccination rates in hospitals up until this point have been decreasing. Reports vary, but Fraser Health estimates that vaccination rates among health workers have fallen as low as 38 per cent. There are many potential reasons for this, despite the fact that vaccinations are free to all health workers and clinics are often set up on site for employees to be vaccinated while at work.
One possible reason is explained by Doug Manuel, who works with the Institute for Clinical Evaluative Sciences, and also as an associate professor in the Department of Public Health Sciences at the University of Toronto. He published a study entitled “Health Behaviour Associated with Influenza Vaccination among Healthcare Workers in Long-Term-Care Facilities.” Cited on the immunize.ca website, his study found that “Few people associated the vaccine with serious side effects, although 36 per cent of all staff believed that vaccination is moderately to extremely likely to cause the flu or flu-like illness.”
Sheila Edwards, of the BSN Program at UFV, teaches fourth-year students about public and community health. She stated that she is vaccinated every year and that she supports the mandate. She also explained that the belief that vaccinations can cause the flu is false.
“The viruses in the influenza vaccine have been killed,” Edwards explained.
“There is no live virus in the vaccine, so it cannot cause influenza. One, it takes about two weeks for the vaccine to work, so [if people experience symptoms] they could have been in contact with the flu and got it before the vaccine worked for them,” she said. “Second thing is, a lot of people confuse influenza with a cold or stomach flu – in actual fact, symptoms such as fever and body aches which go with influenza are not typical with a cold – also, adults don’t typically have nausea or vomiting with influenza like they would with stomach flu.”
The alternative that nurses have to vaccination is wearing a mask. Edwards was unsure if it would be possible to find an exact percentage of infections that masks will reduce, but she said it could certainly make a difference.
“The influenza virus is actually contagious 24 hours or more before you feel the first symptoms,” Edwards explained. “So that’s the thing, people are spreading it before they feel like they’re sick. That’s why having the vaccine, or having the mask all the time, is important.”
UFV professors will be speaking to nursing students at greater length about this new policy in the near future, after they’ve had a chance to make sure the policy won’t be changed.
As first-year nursing students begin working with patients in November, they will be required to follow this mandate, which takes effect when the flu season generally starts in October or November.
A recent study by the Provincial Infection Control Network found that nearly one third of hospital employees are not washing their hands with the mandated frequency. When asked if she felt that increased hand sanitation would affect infection control, Edwards stated that it would certainly help.
“It’s not just doing one thing, it’s doing multiple things,” she said. “It’s getting vaccinated and also washing your hands.”
A local nurse at a long-term care facility admitted he was “a little” frustrated that the vaccine is now mandatory, despite the fact he’s always gotten the vaccination. “The thing is, it’s still our bodies, and we know enough [as nurses] that we should get to decide what goes into them.”
One potential reason he suggested for the currently low rate of vaccination is that the vaccine protects against three or four strains per year, and there are more than 80 strands in total.
“… I can see why [healthcare workers] may not [get immunized],” he said, “because it’s a drop in the bucket in terms of protection.”
Edwards noted, however, that the strains are carefully chosen.
“The World Health Organization (WHO) scientists do global tracking for changes in the virus and predict which strains are most likely to circulate in a given year.”
Edwards recommended that all students be immunized, “… especially if they have a chronic illness, have a compromised immune system or are in regular contact with individuals who are at higher risk than themselves.”
For those wishing to get immunized, there are public health clinics where the vaccine is offered free of charge, including a church in Chilliwack where UFV student nurses lend their assistance. Those not eligible for the provincially-funded vaccine can pay a small fee to receive it at their local pharmacy or from their physician.
