News Vaccinate or mask pays off

ealth care organizations in two provinces are starting to reap the Hbenefits of mandatory influenza vaccination policies, despite strong push- back from health workers, said experts at the Canadian Immunization Conference in Ottawa. Policies recently introduced in BC and New Brunswick that require health workers to get vaccinated or don a mask AndreyPopov/iStock/Thinkstock during flu season have deeply divided Health authorities in New Brunswick and British Columbia report early gains from staff of all stripes. Some argue such pol- condition-of-service policies that require icies are crucial for patient safety; oth- workers to get a flu shot or wear a mask. ers, an undue infringement of personal freedoms. There have been walkouts, worker vaccination, said Allison McGeer, terminations and grievances launched. director of infection control at Mount However, health authorities say early Sinai Hospital in Toronto. Efficacy in gains from the programs have been health adults is about 60%, she said, “but worth the struggle. Employee immuni- for all adults, getting vaccinated against zation rates are up; sick days are down; influenza is a safer, healthier choice than and in some cases, routine closures dur- not getting vaccinated.” ing flu season have stopped. Ironically, part of the problem is that “We used to have two or three units some randomized controlled trials over- that closed for periods because both the estimate the effectiveness of the inter- nurses and patients would get the flu — vention. European trials have shown that’s stopped for the last two years,” consistently higher mortality in patients said Marilyn Babineau, regional man- whose caregivers don’t receive the flu ager of employee health and wellness shot, with differences up to five percent- at Horizon Health Network in New age points. “I can remember seeing these Brunswick, at the Dec. 3 conference. results and thinking this is not possible,” The health authority introduced a said McGeer. “It’s unlikely the effect compulsory “vaccinate or mask” policy size is actually that big.” in 2012. It came on the heels of a disap- But why squabble over effect size pointing voluntary campaign in which when it’s clearly greater than zero? just 46% of Horizon workers got the flu Babineau was surprised to discover shot. Now vaccination rates are holding widespread misconceptions about vacci- steady near 70% and absenteeism has nation across all sectors of the health dropped an average of two hours per workforce. Early efforts to educate and employee. “Multiply that by 13 000 dispel these beliefs paid off. “A memo employees and it doesn’t take long to sent out by the nurses’ union [backing start saving some money,” said Babineau. the policy] was our biggest success of BC introduced similar requirements all,” she said. Recently, compliance with for health workers in 2012, with similar the policy is 100%. success, said Deputy Provincial Health The tide of opinion may also be Officer Dr. Bonnie Henry. In the first turning in BC. In October, Arbitrator year, immunization rates rose to 75%, Robert Diebold dismissed the griev- with a decrease in sick days,” she said. ance brought against the province by BC has faced some of the strongest the Health Sciences Association of opposition from health workers, includ- British Columbia, ruling that the vacci- ing a grievance brought against the gov- nation policy is a valid exercise of ernment by the Health Sciences Associ- management rights. “The union said ation of British Columbia, representing they would appeal but dropped this about 16 000 health care staff. At the after a few weeks,” said Henry. crux of these arguments are questions — Lauren Vogel, CMAJ about the effectiveness of the flu shot and the evidence supporting mandatory health CMAJ 2015. DOI:10.1503/cmaj.109-4959

CMAJ, January 6, 2015, 187(1) 19