245530 To mandate or not to mandate? Is that the Question?

Wednesday, November 2, 2011: 1:30 PM

Jo Anne Bennett, RN, PhD , Diit, New York City Department of Health & Mental Hygiene, New York, NY
Diane Downing, RN, PhD , School of Nursing and Health Studies, Georgetown University, Washington, DC
Jeanne A. Matthews, PhD, RN , Georgetown University School of Nursing and Health Studies and Arlington Public Health Division, Washington, DC
Derryl E. Block, PhD, MPH, RN , University of Wisconsin-Green Bay, Green Bay, WI
Nonceba Lubanga, RN, MPH , Office of Child and Family Health, NYC Administration for Children's Services, New York, NY
Judy Gibson , 1600 Clifton Road, NE, CDC/CCID/NCHSTP, Atlanta, GA
Ebbs and flows in attention to influenza vaccination over the last 2 decades have followed a familiar pattern, spiking when vaccine supplies are down or a rising number of cases (or complications) catches news headlines, and then evaporating. But influenza and its complications account for the greatest number of vaccine-preventable deaths worldwide -- even without a major epidemic. Concern about the implications of the high level of susceptibility among health workers has been mounting with increasing calls for making annual influenza vaccination a requirement for healthcare workers. A growing number of providers have implemented requirements, and multiple professional associations, including APHA, urge making requirements standard practice. Divergent responses by some healthcare workers capture headlines. In debating requirements, however, the essential question can get overlooked: How to raise vaccination coverage to the level needed for herd immunity in the healthcare setting i.e., > 90% vaccine uptake both within units and institution-wide? We suggest that the issues relevant to healthcare worker immunization against influenza are not so dichotomous. Moreover, dichotomizing can narrow thinking and limit problem-solving. While requiring health workers to be immunized can be a means to achieving the primary goal, which is to promote a safer environment in the healthcare setting, the question is: When are mandates needed and how should they be implemented? Reframing with a more holistic view considers how health worker susceptibility fits into evolving initiatives promoting patient safety, emergency preparedness, and healthy communities.

Learning Areas:
Administration, management, leadership
Ethics, professional and legal requirements
Protection of the public in relation to communicable diseases including prevention or control
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Analyze the rhetoric that can derail discussions about setting standards for influenza vaccination coverage in the healthcare workplace.

Keywords: Immunizations, Health Objectives

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I chaired the PHN Nursing Section workgroup that prepared APHA position statement on Requiring Annual Influenza Vaccination for Health Workers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.