This year again the BC Ministry of Health has mandated that all healthcare providers must receive the influenza vaccine and if they choose not to, they must wear a mask for the duration of flu season whilst providing patient care. I applaud this decision and am frustrated by some of my colleagues who argue against science and common sense. Let’s examine some of the arguments.
Point 1: Flu kills. It doesn't tend to kill healthy people. I could care less if I personally get the flu but I care a lot if some nurse or doctor gives my elderly grandmother the flu and she becomes very sick (or worse). I care a lot if some family doctor, NP or public health nurse gives my two week old baby the flu during a home visit. Flu kills our young, our elderly and our sick. It really is that simple. And these are the people we have agreed to take care of.
Point 2: "I'll stay home from work if I get the flu". Great thinking….but you've already spread the virus before you even knew you had the flu. Most flus and colds work that way. You're spreading it before you have any symptoms. Why should I have to cover for your sickness at work? I took personal responsibility for my health and the health of my patients and co-workers to prevent getting sick but I'm supposed to cover for you because you didn't? Thanks. Why should your employer and taxpayers have to pay more because you didn’t take responsibility for your own health? Something seems pretty unfair about that.
Point 3: Mandated vaccines. We are already mandated to get a vaccine, it’s called Hepatitis B. When healthcare providers are accepted into their schools and training programs and when we're hired we are asked to prove we've had hepatitis B vaccine and also that our level of protection is adequate. So, we're already mandated to get a vaccination because of our chosen profession. This isn't new. Why is flu vaccine different? Why aren’t we crying “human rights” about Hepatitis B, Tetanus and MMR vaccines too?
Point 4: TB Skin testing. Read point 3...same thing for TB Skin testing. The fact is that healthcare providers have agreed to care for our most vulnerable populations and this includes a personal responsibility to do our best not to bring additional disease and infection to our patients.
Point 5: Shoddy science and “Big Pharma”. Healthcare providers who are citing out of date, scare tactic "research" just to support their points need to check their professional commitment to evidence based practices. I look to the science, the evidence and the experts. Conspiracy theorists abound and it’s difficult to sort through the rhetoric on both sides. Who should be making these vaccines instead of pharmaceutical companies? I would love nothing more than to have self-sacrificing scientists who are barely paid a living wage come up with amazing scientific breakthroughs. This isn’t happening in Canada. It’s a problem. But it doesn’t mean that the scientists who are working for pharmaceutical companies are all corrupt and out to kill and maim people. Our government has a vested interest in keeping the population healthy and out of emergency rooms.
Point 6: Only a few strains are covered. Sure, flu vaccine might only be 40% effective and only protect against two strains - but it's better than 0%. It's the best we have for now. We have a vaccine for hepatitis A and B but not for C so does that mean I won't take Hep A and B vaccines? If I took this logic into any other harm reduction strategy, my credibility could be called into question. This argument is like not wearing a bicycle helmet because it only protects my head - but I still might fall and break my arm.
Point 7: Safety. I've been involved in flu vaccine campaigns for more than 12 years now. I have yet to see a reaction more serious than redness at the injection site or a sore arm. But, because I also don't support anecdotal evidence as actual scientific evidence I look to the research. It supports my observation. Rare reactions (which can happen with any food or drug) do occur but at such super low rates you'd be more likely to win the lottery first.
Point 8: Getting the flu from the flu vaccine. Read up on first year immunology. Flu vaccine is an inactivated vaccine. It cannot infect you with the flu. It simply stimulates an immune response. Now, this being said, there are a lot of anecdotes about people getting the flu right after getting the vaccine. The fact is, you have a different strain or you were already infected before you got the shot. Just as you don't get hepatitis B from the hepatitis B vaccine, you don't get flu from flu vaccine...but wait, even if you did, I thought you said you didn't mind getting the flu?
Point 9: Human Rights and Bullying. Ok, so yes, you as a Canadian, have a right to your decision-making about your own healthcare. No problem with me. Your employer and patients also have a right to ask you to protect those around you and stay healthy in order to work. I wear gloves during procedures because it protects me and the patient. I change the gloves to protect the patients, not me. I don’t ever need to change gloves to protect myself…but I do, because I know it’s important to protect my patients. Don't like these policies? Feel free to go work somewhere else or chose a different career. Feel free to go work where the elderly, young and sick are happy to have the flu. Just let me know where you're going....because I'll be going the other way and taking my family with me.
Unfortunately, the logic and evidence is unlikely to change the minds of those people who are staunchly against flu vaccine. It makes me sad that they are closed to logical arguments and so entrenched in poor science, conspiracy theory and anecdotal evidence that they are willing to put the lives of their patients at risk. This winter, I'll be wearing my "Flu Sticker" on my employee badge with pride. It shows that I care about the people around me. It shows that I care about my health. It shows that I support evidence based practice. I will stand united in herd immunity to decrease the spread of the flu this year. It's part of my job, my career, my profession and my humanity.
Hannah Varto is a family nurse practitioner and an ARNBC Network Lead. She enjoys working as a part of interdisciplinary teams of health care providers. Her career focus has been primarily in the field of sexual and reproductive health, specific to women and adolescent populations. She has worked in a variety of settings including public health, youth clinics, walk-in clinics, telehealth, education, travel medicine, communicable disease and as a sexual assault nurse examiner. Hannah is on the board of directors for the McCreary Centre Society, a leading non-profit organization focusing on adolescent health research. Currently Hannah is leading the implementation of ARNBC’s first community of practice – the BC Contraceptive Management Community of Practice.