Flu season is approaching and that means getting immunized. But, a majority of Canadians do not roll up their sleeves. Surprisingly, that includes the health professionals. I think it's time we made flu shots compulsory for the people who care for you when you're sick.

Despite evidence that flu shots benefit both health care workers and their patients, vaccination rates among health care workers remain stubbornly low. This past summer, British Columbia announced plans to make it mandatory for health care workers who come into contact with patients during flu season to either get a flu shot or wear a mask. In that province, health-care worker immunization rates are lower than 50 per cent. In Ontario, fewer than 50 to 60 per cent of health care workers roll up their sleeves. The best voluntary programs seem to be able to achieve is a 70 per cent compliance rate Hospitals in the U.S. with mandatory flu shots have staff vaccination rates over 90 per cent and the rate remains high over time.

In B.C., Perry Kendall, the provincial health officer announced that provincial regulations will be put in place to make flu shots mandatory for health care workers. We're still waiting for those regulations to be released. And, last week, Public Health Ontario (PHO) an arms-length government agency that looks for ways to promote the health of Ontarians, released new guidelines calling for the flu shot to be made compulsory for all health care workers in the province. It wants flu shots to be a condition of employment at hospitals, at long-term care facilities, home care workers, and outpatient health care clinics.

Public Health Ontario says flu shots benefit health care workers through prevention of the flu and reduced worker absenteeism. That alone benefits both hospitals and the patients- both of which are affected when health care workers are off sick. The agency says that four randomized clinical trials have shown that vaccination of health care workers reduces the incidence of flu and overall mortality rates in residents of nursing homes. Two studies found that lower rates of flu shots among hospital employees are associated with higher rates of patients getting the flu while in hospital. That's as close to a smoking gun as you're going to get. Other studies have shown high rates in hospital of transmission of the flu from person to person in patients and health care workers alike.

At the same time, it's important not to oversell the benefits of flu shots. Just yesterday, Helen Branswell wrote an article for Canadian Press in which she quoted from a report by public health experts at the Center for Infectious Diseases Research and Policy at the University of Minnesota questioning the efficacy of current flu vaccines. That report called for more resources to be plowed into making more effective vaccines.

All that said, to me, there's more than enough evidence to support mandatory flu shots for health care workers.

British Columbia paved the way in August when its health officer announced it would become the first province to introduce mandatory flu shots for health care workers. The reaction has been tepid in Ontario. Ontario Health Minister Deb Mathews has said that it has no plans to introduce legislation making flu shots mandatory for health care workers. That may have more to do with current politics. 

The governing Liberals have a minority in the legislature and may be reluctant to turn flu shots into a big issue. The surprise resignation this week of Ontario Premier Dalton McGuinty makes it highly unlikely we'll see a similar move in Ontario anytime soon. By contrast, the province showed no such reluctance when it passed a law making paramedics roll up their sleeves; but that was when it had a majority government.  

The B.C. Nurses' Union isn't happy about mandatory flu shots - in part because it wasn't consulted prior to the move. The fact that physicians appear to be exempt from compulsory measures isn't sitting well with the nurses, nor should it, in my opinion. By contrast, a similar measure just announced in the state of Rhode Island did not exempt doctors.  However, the fact that B.C. is giving nurses the option of wearing a surgical mask instead of taking the flu shot seems to have placated the union.

Michael Hurley, president of the Ontario Council of Hospital Unions, told the Toronto Star that making flu shots a condition of employment is tantamount to slave labour. When the Ontario government passed legislation making flu shots mandatory for paramedics, the union representing them had a similar reaction. However, at the time, some of the concern among paramedics was that they and no other group of health care workers were singled out for mandatory flu shots.

Mandatory flu shots make sense for health care workers because they're in regular contact with sick patients who could be harmed (even killed) by getting the flu from health care workers. Since flu outbreaks are very likely to take off in schools, college dorms, military barracks and other places where people congregate, I can see the logic in encouraging workers in those places getting flu shots. It might make sense to legislate mandatory flu shots during serious outbreaks i.e. pandemics. But I think mandatory flu shots for seasonal flu for people who aren't in regular contact with patients is a tougher sell.

On my @NightshiftMD twitter account, I got some vigorous reaction from some health care workers who said flu shots should be a personal choice.  I don't think free choice is infinite.  When you go through airport security, you have to walk through a metal detector. Being a health care worker is a privilege with responsibilities that go with the territory. I see mandatory flu shots as something you do when voluntary measures don't work. I'm just sorry it's come to that.

If you'd like to listen, here's a link to my interview about mandatory flu shots with Dave White on the CBC Radio afternoon show in Whitehorse, Airplay.