An unseemly fracas has broken out over the wisdom of mandatory flu shots for health-care workers. On the pages of several Canadian publications recently, dueling experts have praised the policy as essential and damned it as unwarranted.
The issue has emerged because a growing number of jurisdictions, B.C. among them, now insist that front-line health workers get flu shots. (B.C. allows employees to wear masks as an alternative).
Earlier this fall, the Canadian Medical Association Journal came out in support of the policy. The journal quoted studies that show fewer deaths among residents of long-term care institutions when staff are vaccinated.
But that immediately prompted a counterblast from several research scientists, who claimed flu shots don't provide enough protection to justify imposing them.
Then two weeks ago, Dr. Perry Kendall, B.C.'s provincial health officer, told the Vancouver Sun that vaccination is indeed effective. He gave a success rate of 60 per cent.
That produced a strongly worded response from an expert in respiratory infections, who called Kendall's view "ideologically driven," and put the effectiveness rate far lower.
What makes the debate so extraordinary is that flu shots have been a staple of the public health arsenal for more than 50 years. It should be clear by now whether they work.
Moreover, this is not an academic tussle over some obscure doctrine. Lives are at stake.
Flu is responsible for 20,000 hospital admissions each year in Canada, and between 4,000 and 8,000 deaths. Yet here we have senior members of the medical profession slugging it out in public, with precious little common ground. What on earth is going on?
Part of the uproar can be traced to queasiness about imposing an invasive procedure like vaccination. Some health-care employees are understandably upset, and groups such as the B.C. Nurses' Union are working vigorously to reverse the policy.
It appears this anger has spilled into the research community. Scientists who believe flu vaccines are oversold have been prompted to speak out by what they consider a heavy-handed policy.
But while that may explain some of the agitation, what about the underlying facts? Are flu shots really on thin ice?
That certainly isn't the consensus among public health agencies. Canada's National Advisory Committee on Immunization strongly supports vaccination. According to this group, flu shots are effective on 50 to 80 per cent of mid-life adults.
When it comes to people over 65, the benefits decline somewhat. But that's one reason for requiring health workers to be immunized. Older patients they interact with can't rely on vaccines for protection. Nevertheless, flu shots are advised for adults of all ages.
Dr. Brendan Carr, chief medical officer at the Vancouver Island Health Authority, has a simpler take: "There is strong evidence that comprehensive vaccination strategies reduce harm in those who are most at risk. While scientists continue to debate the merits of vaccination, ethicists see this as a pretty straightforward proposition."
Carr's point is surely the critical one. While there may be disagreement about exactly how many lives are saved, some certainly are.
And while the mandatory aspect of the policy is indeed an imposition, it was only adopted after attempts at persuasion failed. Across B.C., fewer than half the staff members in regional health authorities were getting shots when the option was voluntary.
In short, this is more a question of medical ethics than a search for mathematical precision. But even cast in statistical terms, the answer seems clear. As long as some patient deaths are avoided, doesn't that justify proceeding?
It would be ideal of course, if medical science could offer a better solution. But until it does, caregivers have a moral obligation to get vaccinated.
© Copyright 2013