NVAC approves recommendations on health worker flu vaccination

Feb 8, 2012 (CIDRAP News) – An advisory group to the US Department of Health and Human Services (HHS) today approved a set of voluntary measures designed to boost flu vaccination in healthcare workers.

The five-part recommendation, designed to offer hospitals and other health facilities strategies for reaching the Healthy People 2020 goal that 90% of healthcare workers be vaccinated against influenza, was adopted by the National Vaccine Advisory Committee (NVAC), a group of outside experts who advise the HHS on vaccine policy issues.

An NVAC subgroup had worked on a draft proposal of the plan since November 2010. The recommendations present a tiered approach to increasing worker vaccination levels and stop just short of urging mandatory vaccination if the national goal isn't achieved with the first three steps.

The full committee was slated to vote on the measure yesterday but tabled the issue until today to consider a fresh round of public comments. Today it addressed questions about whether the subgroup's deliberations in the final months of its work excluded healthcare employees' views and violated rules that govern federal advisory committees.

The NVAC's recommendations urge US hospitals to establish comprehensive infection control programs that include education on how to prevent flu transmission and integrate flu vaccination programs into existing flu prevention and occupational health programs. The recommendations also press federal health officials to continue efforts to standardize methods on how to measure healthcare worker flu vaccination rates.

If those three steps don't push the healthcare worker vaccination levels to the national goal, NVAC suggests that healthcare employers strongly consider mandatory flu vaccination policies. A fifth recommendation calls for new and better flu vaccines.

The mandatory vaccination policy suggestion spurred strong reactions from employee groups who oppose such mandates, have concerns about the safety and efficacy of flu vaccines, and believe hospitals might interpret the NVAC recommendations as a license to institute mandatory vaccination policies.

Anna Jacobs, an HHS attorney, told NVAC members that their use of the working group was consistent with the Federal Advisory Committee Act and that subcommittees are not subject to the act, because they don't report directly to a federal official.

Christine Nevin-Woods, DO, MPH, who cochaired the subgroup, reviewed the group's work timeline over the past 5 months, which included in-person meetings, e-mail discussions, online voting and feedback, and drafts circulated to committee members. Nevin-Woods is public health director of the Pueblo City-County Health Department in Colorado.

NVAC members tweaked the wording of some of the steps before their final vote. For example, they added wording to the first step in the strategy—comprehensive flu infection control programs—that education of healthcare workers is a key component.

Also, based on concerns from some observers that the 90% level in Healthy People 2020 goals is more aspirational than realistic, the group struck out the specific numerical level in case officials decide to revise the target at a later date.

For the mandatory flu vaccination requirement step, they changed the wording to reflect that healthcare employers can consider other exemptions in their requirement policies beyond medical and religious ones.

NVAC members voted on each of the five steps. A few members voted no or abstained on some of the votes, but each item passed with a majority.

Walter Orenstein, MD, NVAC's chairman and associate director of the Emory Vaccine Center in Atlanta, thanked the working group and said the topic was one of the more contentious issues that the committee has addressed. "It was a fair hearing of opposing views and is a step forward," he said.

The newly revised and passed recommendations will be forwarded to HHS Assistant Secretary Howard Koh, MD, MPH.

See also:

Feb 7 CIDRAP News story "Federal advisors propose steps to boost health worker flu vaccination"

NVAC healthcare personnel influenza vaccination subgroup Web page

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