The Public Health Agency of Canada has no plan to deal with front-line health-care workers who refuse to be vaccinated against swine flu, a scenario that some infectious-disease experts believe could accelerate the spread of the flu pandemic in the coming months.
The question of whether doctors and nurses should be forced to take flu vaccines has long been a contentious issue in the public-health community.
In 2002, the Ontario government withdrew legislation that made it mandatory for paramedics to get flu shots, after the paramedics' union launched a legal challenge under the Charter of Rights and Freedoms.
The Canadian Medical Association, which represents tens of thousands of doctors nationwide, will introduce a resolution at its annual meeting next month that encourages physicians to get the swine-flu vaccine, which is expected to be ready in the fall.
But the association will stop short of endorsing mandatory vaccinations, said CMA president Dr. Robert Ouellet.
"We think there should be informed consent," Ouellet said in an interview. "Everyone should have the right to refuse a vaccination if they think it's not right for them."
But some members of the medical community worry that such sensitivity toward the rights of health-care workers could undermine efforts to fight the flu pandemic.
It is believed that roughly half of all front-line health-care workers take the seasonal flu shot every year -- a higher rate of uptake than in the general public, but enough to leave an alarming gap in the pandemic battle, some experts say.
"Health care workers have been resistant to flu shots in general. That has been the problem," said Dr. Kumanan Wilson, a public-health policy specialist at the University of Ottawa.
"The general consensus is that if you vaccinate health-care workers, you improve morbidity and mortality to the patients. The number one vector to transmitting it to patients would be health-care workers who go from patient to patient."
He believes hospitals have the authority to send employees home without pay when they refuse to be vaccinated amid an outbreak. But others warn such actions could lead to more legal challenges.
The Ontario case, for example, arose after dozens of paramedics were suspended by their employers for refusing shots.
"It's a human-rights issue," said Linda Silas, president of the Canadian Federation of Nurses Unions. "It's like any medication or vaccination. You cannot impose it on workers, and you cannot impose it on a community."
The Public Health Agency of Canada has issued guidelines for front-line health-care workers when dealing with patients showing symptoms of the H1N1 virus. The guidelines advise nurses and doctors to take precautions against infection, such as wearing gloves and using respirators.
But a spokeswoman for the agency, Caroline Grondin, said PHAC has no "existing guidelines" on the administration of flu vaccine to health-care workers.
Once a swine-flu vaccine is ready, the agency is expected to recommend which "priority groups" should receive it first, and health-care workers will likely be near the top of the list.
Frontline health-care workers, including doctors, nurses and paramedics, were hit hard during the outbreak of severe acute respiratory syndrome (SARS) in 2003. According to some estimates, health-care workers accounted for more than one-third of suspected cases in severely affected countries.
Some of the reluctance against vaccination could stem from the mass-vaccination program instituted by the U.S. government in 1976, in response to a swine-flu outbreak. Several hundred people who were vaccinated developed a nervous disorder called Guillain-Barre syndrome, and 25 died.
But Dr. Gerald Evans, an infectious-disease expert at Queen's University, said there is still some debate about the links between the vaccine and the syndrome. "This is a different swine-flu strain," he noted.