IDSA urges requiring flu shots for healthcare workers

Jan 25, 2007 (CIDRAP News) – Influenza shots should be mandatory for healthcare workers, and public health officials should think of seasonal flu as a dress rehearsal for pandemic flu, the Infectious Diseases Society of America (IDSA) said today as it unveiled a 12-point plan to strengthen the nation's preparedness.

The IDSA's recommendations, aimed at Congress and the Bush administration, laud the government for the $6 billion allocated so far to pandemic preparedness and the December 2006 passage of the Pandemic and All-Hazards Preparedness Act. "But most of the work remains ahead of us, and we need to keep attention focused on what needs to be done," said Andrew Pavia, MD, chair of the IDSA National and Global Public Health Committee, at a teleconference today.

"Our recommendations are guideposts to complement the work of the Department of Health and Human Services," (HHS) he said.

Investments in pandemic influenza planning can help public health officials better manage seasonal flu, said Kathleen M. Neuzil, MD, chair of IDSA's Pandemic Influenza Task Force, at the teleconference. Stabilizing vaccine production and distribution for seasonal influenza will lay the groundwork for an effective response when a pandemic strain emerges, she said.

Though the US government has allocated more than $6 billion to pandemic planning, most of the money is one-time emergency funding that falls short of what's needed to support long-term national, state, and local efforts, the IDSA said in its report.

Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention, voiced similar sentiments yesterday in testimony before a US Senate subcommittee hearing on pandemic preparedness, according to a Reuters report today. She said public health had been neglected for decades before the increases of the past few years.

Pushing flu shots for healthcare workers
The strongest language in the IDSA's proposals was aimed at boosting seasonal flu immunization rates among healthcare workers. The current rate for this group is about 40%, the ISDA report says.

"This is a strong call to go from a voluntary system to one that has more teeth," Neuzil said. The IDSA recommends that healthcare workers be required to receive flu shots unless they decline, in writing, for religious or philosophical reasons or because of a medical contraindication.

Pavia said some hospitals are already starting to mandate flu shots, and the Joint Commission on Accreditation of Healthcare Organizations has proposed mandatory flu vaccination as a quality indicator for hospitals. The federal government could also force greater participation by linking mandatory healthcare worker vaccination to Medicare or Medicaid reimbursement.

Some groups oppose mandatory vaccination for healthcare workers. In 2005, the American College of Occupational and Environmental Medicine (ACOEM) issued a consensus statement encouraging healthcare employees to be vaccinated but opposing a requirement. The ACOEM said that having employees decline the vaccine in writing has not been shown to improve overall vaccination rates.

In 2004, Virginia Mason Medical Center in Seattle became the first hospital in the nation to make vaccination a "fitness for duty" requirement for its employees.

Kim Davis, communications director at Virginia Mason, told CIDRAP News that for the 2005-06 flu season the hospital's immunization rate for staff topped 98%, with the remainder of staff using masks.

However, the Washington State Nurses Association (WSNA) opposed the plan. "We don't believe a mandate is the best method for compliance," Anne Tan Piazza, spokesperson for the WSNA, told the Spokane Spokesman Review. "We think you get the best results through education."

Bioethicists Arthur Caplan and David Curry supported mandatory vaccination for healthcare workers in a recent editorial in the San Jose Mercury News. "Choice is a key value for us all, but spreading infection among the sick is too high a price to pay for that choice," wrote Caplan and Curry, who are members of the Vaccine Ethics Project in the Center for Bioethics at the University of Pennsylvania. "We should not have to wonder whether the person taking care of us, our newborn, or our elderly parent has gotten a flu shot."

More Preparedness Goals
Several of the IDSA's other recommendations are aimed at supporting the development of new vaccines and improving the supply and selection of antiviral medications. The United States should serve as a catalyst for a well-financed international effort to quickly develop pandemic influenza vaccines, the report says. The IDSA envisions the effort, which it suggests calling "the Pandemic Influenza Vaccine Master Program," as a large public-private partnership on the scale of the Apollo space project.

The IDSA supports using incentives for the pharmaceutical industry to develop flu vaccines and treatment, such as tax credits, enhanced intellectual property rights, and streamlined regulatory approval. The group emphasizes that antibiotic innovations should also be a focus of pandemic flu planning, because patients who have severe influenza often develop lethal secondary bacterial infections.

Planning for mass casualty events and updating plans for distributing vaccines and antivirals are other major themes of the IDSA's recommendations.

Among suggestions for protecting the healthcare workforce during a pandemic, the IDSA proposes that Congress establish a compensation fund to help those who are injured by a pandemic influenza vaccine given during an emergency, as well as liability protection for healthcare workers following altered standards of care, consistent with local and national recommendations, during a public health emergency.

Other recommendations include developing and testing community mitigation measures, improving flu surveillance, and strengthening leadership and communication.

"We're better prepared now than we have been, but we have a very long way to go," said Pavia in an IDSA press release on the report. "We can't take our eye off the ball now."

See also:

IDSA statement: "Pandemic and Seasonal Influenza: Principles for US Action"

Julie Gerberding's prepared Senate testimony
http://www.cdc.gov/news/2007/01/gerberding-testimony-avian.htm

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