- Hundreds of health care workers in Massachusetts are declining the annual flu shot.
- Health care worker flu shot requirements vary from state to state.
- A recent study questions the scientific validity of mandating annual influenza vaccinations for hospital workers.
Hundreds of health care workers in Massachusetts, including those in nursing homes and kidney dialysis centers, are declining free annual flu shots, according to a report cited by the Boston Globe.1 The report, which tracks vaccination coverage of health workers in Massachusetts, found that health care worker vaccination rates in ambulatory care facilities and long-term care facilities were 79.8 percent and 67.9 percent respectively, falling short of 90 percent coverage goals set by federal government officials in the Healthy People 2020 initiative.2
In response to the low vaccination rates among health workers, Massachusetts regulators are increasing their efforts to improve vaccination rates by sending reminder letters to facilities that did not report their vaccination numbers, visiting kidney dialysis centers to review vaccination policies and also providing cash incentives to nursing homes to improve their health care worker vaccination rates.1
Massachusetts does not require health care workers get an annual flu shot.3 However, in 2008, Massachusetts Department of Public Health mandated that all licensed health care facilities offer staff the annual influenza vaccinations for free. Facilities are required to document and report receipt of influenza vaccine by staff as well as the number of staff members who decline vaccination.2
“Some of our staff decline vaccination for religious or health reasons and others are concerned that the vaccine is ineffective or dangerous,”1 said Tara Gregorio, president of the Massachusetts Senior Care Association,
Health Worker Flu Shot Requirements Vary According to State
The Journal Gazette reports that public health experts say doctors, nurses and other staff who work with patients play a role in stopping the spread of the influenza virus.4
Eighteen states have laws mandating influenza vaccination for hospital health care workers. These laws establish requirements based on the hospital type and the type of vaccination requirements.5 There are 32 states with no regulations requiring health care providers to be vaccinated or have hospitals developing guidelines for which employees should get flu shots.4
“Very few states set out requirements in statute when it comes to vaccination requirements for hospital employees,”5 said, Dixie Platt, Vice President of Communications and Federal Relations for the Indiana Hospital Association. “It appears that in most states, hospitals work with the department of health or other regulatory bodies, as is the case in Indiana, in addition to complying with federal rules related to infection control.”4
Flu Vaccine Now Mandatory for Health Workers in New Jersey
New Jersey recently passed and signed a law that requires all health care workers at hospitals, nursing homes and licensed home health care agencies to get an annual influenza vaccination.6 The bill A1576 passed the Assembly on Dec. 16, 2019 and was enacted into law by Governor Phillip Murphy on Jan. 13, 2020.7
The bill defines a health care worker as anyone employed by a health care facility that provides direct patient care or has contact with patients.6 Thomas Giblin, who was the primary sponsor of the bill, said, “Annual flu vaccinations have been recommended for health care providers by the Centers for Disease Control and Prevention since 1981. However, only 78.4 percent of health care workers in the U.S. reported receiving the flu vaccine during the 2017-18 seasons. Requiring health care providers to get the flu shot each year will potentially help reduce cases of the flu in hospitals, care facilities and the greater community.”8
Health care workers in New Jersey who do not wish to be vaccinated must submit a request for a medical exemption.6 The law requires any employee who does not receive an influenza vaccine to wear a surgical when in direct contact with patients and in common areas, as specified in facility policy or to be removed from direct patient care responsibilities during influenza season.6
Study Questions Scientific Validity of Mandating Annual Flu Shots for Health Care Workers
A 2017 study published in PLOS One questions the scientific validity of annual influenza vaccine mandates for all hospital workers. The flu vaccination policy, which is often a condition of employment, has been based on the assumption that it reduces influenza-associated morbidity and mortality among hospital patients.9
To justify mandatory influenza vaccination policies for health workers, employers usually point to four cluster randomized control trials (cRCT) conducted in long-term care facilities. The PLOS study reveals that the methodology used in all four cRCTs has been found to be flawed. None of the studies were conducted in hospital settings.9
One of the cRCT’s from Great Britain calculates that one death from influenza can be avoided for every eight health care workers vaccinated. If this calculation were true, then vaccinating all 1.7 million long-term care workers in the United States should prevent 212,500 patient deaths from influenza. However, the Centers for Disease Control and Prevention (CDC) estimates between 3,000 to 49,000 deaths from the flu per year, depending upon the influenza strain circulating in a given flu season, and that estimate includes people of all ages.9
If this were to be extrapolated to the 5.5 million hospital workers in the U.S., it would mean that 687,500 patient deaths from influenza could be prevented. This figure is more than the number of Americans that died in the 1918 Spanish influenza pandemic.9
In an article in STAT News, Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy stated, “The study today does not refute that vaccination could have some impact on reducing transmission from infected health care workers to patients. But it clearly shows there’s no well-conducted study that demonstrates that at this time. Our public policy should be guided as such.”10
1 Lazar K. Many health care workers are refusing flu shots, endangering patients, regulators say. The Boston Globe Dec. 20, 2019.
2 Commonwealth of Massachusetts. Flu vaccination reports for healthcare personnel. Dec. 2019.
3 Flu shots protect health care workers — and their patients. The Haverhill Gazette Jan. 2, 2020.
4 U.S. Centers for Disease Control and Prevention. Menu of State Hospital Influenza Vaccination Laws. Feb. 28, 2018.
5 LaBlanc M, Slater S. Hospitals set own policy on flu shots. Journal Gazette Jan. 5, 2019.
6 State of New Jersey. A1576. Dec. 16, 2019.
7 Davis T. NJ Gov. Phil Murphy Signs 55 Bills Into Law, Vetoes 5. Patch Jan. 14, 2020.
8 Faughnan S. Why Isn’t Anyone Talking About These New Vaccine Laws? Tap into Roselle/Roselle Park Jan. 14, 2020.
9 De Serres G, Skowronski DM, Ward BJ, Gardam M, Lemieux C, Yassi A, Patrick D, Krajden M, Loeb M, Collignon P, Carrat F. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLOS One 2017 12:(1).
10 Branswell H. Contentious flu vaccine policies at hospitals are based on flawed research, study says. Stat News Jan. 27, 2017.