British Columbia has become the first province in Canada to impose a policy for a compulsory flu shot or mask for all its health-care workers.
Following the advice of B.C. health officer Dr. Perry Kendall, all health authority staff, doctors, volunteers, students, contractors and vendors who come into contact with patients will be required to follow the new rules meant to protect both patients and themselves.
Interior Health Authority medical health officer Dr. Rob Parker has been working on this issue for more than a decade, and says the policy is necessary.
"We brought in a revised policy back in 2000, where we said we 'expected' all health-care workers should get influenza immunization each year."
While making shots and masks mandatory was also considered back then, he says after talking to the provincial unions, it was decided not to go that route at the time.
"They thought an education campaign could be successful and we've been doing that for over a decade now."
Despite encouragement and offering the shots free, Parker says the good-will and education approach "didn't work."
Initially, the rate of wintertime flu shot compliance in IHA’s long-term care facilities went up to 60 per cent some years, but he notes it began to decline again, dipping below 50 per cent in 2011.
"For our acute care hospitals, it never got that high. It was just over 50 per cent, but now it's dropping back down to about 40 per cent."
B.C.'s health authorities looked southward to success rates in the United States where he says mandatory compliance is upwards of 90 per cent.
However, the B.C. Nurses' Union (BCNU) is expressing concerns about flu shots being made compulsory for its members without full consultation and consideration of alternatives.
BCNU executive councillor Margaret Dhillon says the union maintains the flu-vaccination program is most effective when it is based on education, not punishment.
"Health employers need to ensure that staffing levels, eliminating hallway care and improving cleanliness are also given the full attention of the employers and the government."
Parker says the mask is sufficient for most respiratory infections, but is more difficult to manage on the job.
Flu shots are a more effective measure for healthy adults, he adds.
"There's really no harm to it.... The rates of true allergy to influenza vaccine are very rare, in the order of one in 10,000."
Parker notes it is in the health-care workers' code of ethics, duty and obligation to ensure patients' safety comes first.
"In the vast majority who are not getting [the vaccine], they are making a choice, and I think the wrong choice."
Health-care workers with contagious infections can continue working unaware they are unwell since symptoms range from mild to full-blown illnesses, he adds.
"You'd find virus in the nasal secretions of somebody 24 hours before they started getting their first symptoms, and they're actually infectious."
Dhillon questions the health authorities’ statement that its other infection control measures include asking staff to stay home when ill.
"I’m not sure how the health authorities square that with their so-called 'attendance management' programs that threaten nurses with discipline when they stay home sick for more than the average number of sick days....”
Parker discounts reports health-care managers may pressure ill workers to continue duties, citing that most people don't want "someone with diarrhea" in the workplace, and most health-care workers won't knowingly go to work sick.
Following the province imposing these changes, Dhillon says the BCNU met with employer representatives and is "pleased" with a resulting agreement to consult with the union on a regular basis to address its concerns as the policy is implemented.
Parker adds previous influenza outbreaks have proven it is often the non-immunized nurses and aides who come down sick.
"That ability to provide adequate care over the winter is affected when large numbers of health-care workers don't get the influenza shot. I've seen that over and over, winter after winter."