When the Supreme Court was debating the legal foundation of the Affordable Care Act in the United States, Justice Antonin Scalia challenged the Obama administration claim that the controversial individual mandate provision was Constitutionally legitimate, even under the broad 'Commerce' clause.

"Could you define the market -- everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli," Scalia said. 

And that was always the worry; if taxpayers pay for your health care, can they tell you what to eat? Obese people cost more in health care than thin people, after all. Can they tell you not to smoke. Can they tell you that you have to get a vaccine or get an abortion?

Health care workers are in the business of making sick people better and they are also increasingly government-controlled, so an ongoing debate is whether or not health care workers should have mandatory flu vaccines. Do they have a choice when it comes to their bodies? 

For mandatory vaccination of health care workers

Influenza vaccines are estimated to prevent thousands of hospital admissions and millions of illnesses annually (PLoS One 2013;8:e66312) - but that is the problem with estimates; they are trying to measure what did not happen, which means virtually every advocacy group can claim an implicit benefit in banning or endorsing their cause.  But, fuzzy numbers aside, we know flu vaccines help people and that they have the greatest protective effect in healthy non-elderly adults, precisely the demographic of most health care workers, argues Amy J. Behrman, the medical director of Occupational Medicine Services at the Hospital of the University of Pennsylvania.  

Thus, vaccinating hospital staff can improve patient safety and that of health care workers. Mandatory staff vaccination help protect patients who are at the highest risk for influenza complications and most likely to be in a hospital setting: elderly people, infants, patients with heart and lung disease, and patients with compromised immune systems.

The rights of individuals and choice is supplanted by "First do no harm."

Health care workers can do it by choice or by mandate, the same way rules require them to scrub up before surgery.

Against mandatory vaccination of health care workers

Will Offley of Vancouver General Hospital argues that vaccinating health care workers doesn't reduce the transmission of influenza to patients and cites a recent Cochrane review of five studies (Cochrane Database Syst Review 2013;7:CD005187) which found no evidence that vaccinating health care workers prevents influenza or its complications in individuals in long term care, and thus there is no evidence to mandate compulsory vaccination, he states. The ability of influenza vaccines to prevent influenza varies considerably, he says, citing a 9-year study from California where it protected a reported high of 93% to a low of 4.6%. In 2012, vaccine effectiveness against the dominant A(H3N2) influenza was 47% in the US and 45% in Canada (MMWR2013;62:119-23).

Worse, Offley
says, compulsion strips health care workers of a basic right guaranteed to every other patient— the right to informed consent.  

Health care workers, according to him, should protect patients from influenza by isolating people with symptoms of respiratory infection, improving infection control, covering coughs, washing hands, and staying home when sick. For him, influenza vaccination should remain a personal decision until there is more persuasive evidence.

Citation: Should influenza vaccination be mandatory for healthcare workers? BMJ 2013;347:f6705