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Kamryn Bennett

Professor Loudermilk

ENG 1201- Online

06 April 2019

Are Mandatory Vaccines of Health Care Employees Acceptable?

Have you ever wondered when you go to the doctor's office or the hospital if the

employee’s are up to date on their vaccines? If they have came into contact with a patient that

has the flu? Have you thought maybe they have came in contact with someone that does and now

your at risk of getting it as well? When I go to the doctor, he tells me about the latest

vaccinations I should be getting, or that it’s flu season and I should get the vaccination. When he

tells me this, I think about whether or not he has gotten his flu vaccine. Doctors offices and

hospitals have patients coming in and out daily with many different illnesses. The staff in these

facilities are in contact with patients and could contract the illness if they are not properly

vaccinated. This could lead to other patients getting ill as well because they have been in contact

with the staff. If mandatory vaccinations of health care employees were put in place, there would

be less speculation on whether people are getting sick from being at facilities that are suppose to

be treating illness. Mandatory vaccination policies would be beneficial in health care facilities

because they boost the number of employees getting vaccinated, are legally supported, and

protect safety of patients.

The suggested vaccinations healthcare employers would like their employees to have

help fight diseases such as Hepatitis B, Influenza, Measles, Mumps, Rubella, Chickenpox,

Tetanus, Diphtheria, Pertussis, and Meningococcal (Recommended Vaccines 1). The

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vaccinations that fight these diseases can be combined, for example measles,mumps and rubella

make MMR, and tetanus, diphtheria, and pertussis make Tdap (Recommended Vaccines

1).These vaccinations are recommended for healthcare employees in contact with patients on a

daily basis. All of these vaccinations, except the flu vaccine, can be given as children and would

not be needed again. The flu vaccine would be needed once a year to be effective. The CDC says

there are two types of flu vaccines; the trivalent vaccine and the quadrivalent vaccine. They say

the trivalent vaccine guards against influenza A (H1N1), influenza A (H3N2) and influenza B.

They explain that the quadrivalent vaccine guards against the same strains as the trivalent

vaccine but adds another influenza B strain. Employers would like employees to have the

quadrivalent vaccine because it guards against the most strains.

Therefore employers wanting the quadrivalent vaccine for employees gives less people in

the facilities the chance to contract the flu. According to the article “Influenza Immunization for

All Health Care Personnel: Keep It Mandatory” by Rebecca Schneyer, influenza can be ideally

halted by having a minimum of 90% of health care workers vaccinated, which is coherent with a

2020 goal for people (1). Schneyer shares that the nation has a goal of 90% of health care

personnel they would like to be vaccinated by 2020. If 90% of the personnel are vaccinated

sanguine protection for the flu is achieved. Schneyer goes on to explain that health care workers

at hospitals in 2013-2014 achieved 81.8% getting vaccinated. The employee’s working at

facilities have a higher quantity of 86.1% and the employee’s connected to facilities but not

employed by them have a lower quantity of 61.9% (Schneyer 10). The information given shares

how the 90% mark has not been met. In the 2013-2014 year the goal was almost met but was off
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by 8.2%. When vaccinations are optional for healthcare professionals not all of them will take

advantage of the opportunity.

For British Columbia, low vaccination rates are not acceptable which has led them to

create an Influenza Prevention Policy. Research from the article “Mandatory seasonal influenza

vaccination or masking of British Columbia health care workers” written by Doran Ksienski

states, “According to the Policy, all employees and volunteers working in patient care areas are

to receive influenza vaccination annually or wear a mask while at work for the entire flu season”

(8). Ksienski tells how the employees in British Columbia must get the vaccine or wear a mask

to ensure the safety of the patients. Later in the article, it is explained how policy is successful at

increasing the number of employees at acute care facilities from 40% to 74% and residential care

facilities from 57% to 75% (Ksienski 9). These are large increases in the number of employees

vaccinated. Each type of facility has high risk of the flu, acute care facilities deal with patients

coming in and out and residential facilities have elderly people who get sick easily living there.

Workers have to be cautious in these situations not to transmit the flu to the elderly because they

have weaker immune systems. Since large portions of workers have vaccines the overall health

of these facilities has improved.

Similarly, if the vaccines are available at work then more people are going to be inclined

to receive them. When the option of receiving vaccines at no cost to them, and at the facility they

work in more employees will get the vaccine. The CDC article “Influenza (Flu)” describes, “

Vaccination coverage was highest (94.8%) among health care personnel working in settings

where vaccination was required… health care personnel whose employers did not have a

requirement for vaccination coverage was higher among those who worked in locations where
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vaccination was offered at the worksite at no cost for 1 day only (70.4%) or >1 day (76.0%)...

personnel working in locations where employers did not have any vaccination-related

requirements or provisions (47.6%)” (5). This quote points out that when vaccinations are

This graphic shares the information from the last quote in a chart. It shows that when vaccination are required the

number of employees with the vaccination is just under 100, when they are not required but promoted there are just

above 60, and when they are not required or promoted there are a little above 40.(Bowers)

required the most employees 94.8% get vaccinated, and if vaccinations are offered at work for 1

day 70.4% will get it, and lastly if available for more than a day 76.0% will get it. These are high

numbers of employees getting vaccinated compared to the 47.6% of employees that will get

vaccinated if it is not required or offered at work for no cost. The range from not getting

vaccinated and having to get vaccinated is broad. If vaccines were mandated, 94.8% of

employees would be vaccinated, making the spread of the flu difficult. There would only be

5.2% of employees left to contract the disease, and potentially spread to patients.
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Another idea to consider, is the fact that mandatory vaccines are justified by preceding

laws, organizations and acts that exist. For example “Employer-Mandated Vaccination Policies:

Different Employers, New Vaccines, and Hidden Risks” written by Teri Baxter shares, “ The

Occupational Safety and Health Administration (“OSHA”) imposes an obligation on employers

to ensure that the workplace is ‘free from recognized hazards that are causing or likely to cause

death or serious physical harm to [their] employees’” (28). Baxter also shared that this statement

is called the “general duty clause”. This statement means that if there are known hazards in the

workplace, then employers are legally supposed to fix the issues to ensure the employees safety.

The clause can be extended to vaccinations because health care personnel are at risk of the flu

everyday when in contact with patients. The general duty clause was brought up in a court case

Baxter mentions, “As illustrated in Safeway, Inc. v. Occupational Safety and Health Review

Commission, even if the employer has complied with applicable safety standards, it can be liable

for violating the general duty clause if the employer knows of an obvious hazard” (29). This

quote can be used to justify mandatory vaccines, by how it shares that even though employers

have safety standards they can still be violating the general duty clause. Health care employers

have safety protocols, but don’t have any for a hazard, the flu, that happens every year.

Employers have to guarantee the safety of their employees through this clause, and can be done

through mandating vaccines.

In addition, the legality of mandatory vaccines can be upheld by court cases as well. An

example comes from Jared Cole and Kathleen Swendiman, authors of “Mandatory Vaccinations:

Precedent and Current Laws”. They bring up the Jacobson v. Massachusetts case, which is the

first case regarding a mandatory vaccination program in 1809. Cole and Swendiman explain,
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“Jacobson v. Massachusetts is the seminal case regarding a state or municipality’s authority to

institute a mandatory vaccination program as an exercise of its police powers. In Jacobson v.

Massachusetts, the Supreme Court upheld a Massachusetts law that gave municipal boards of

health the authority to require the vaccinations... against smallpox... ‘as will protect the public

health and public safety”... and that such laws were within full discretion of the state…’” (3).

The authors justify how the Jacobson case gives power to the states to mandate vaccinations

under their police powers. The states are able to mandate vaccinations if the health and safety of

the public is at danger. Mandatory flu vaccinations for healthcare personnel fall under this

category, because they protect employees and patients from getting the disease, and spreading it

to other people. Policy can be put into place by providing clear evidence that the flu is a threat to

the health, and safety of workers and patients.

Coinciding with the Jacobson v. Massachusetts, a hospital in Seattle, Washington became

the first to make vaccinations mandatory as a part of their employment. The same article from

the last paragraph, “Mandatory Vaccinations: Precedent and Current Laws.”, shares about this

hospital in Seattle, Washington. The authors mention that after three years 98% of workers in the

hospital had been reportedly gotten vaccinated, and only 2% of workers did not for medical or

religious reasons (Cole and Swendiman 11). This information shares how effective mandatory

vaccinations can be, having 98% of the staff in a hospital with the flu shot decreases the risk of

the flu not only for the employees but for the patients as well. Cole and Swendiman share that in

2008 the Department of Defense also took action, mandating vaccinations for their health care

employees. They explain that the Department of Defense’s policy “requires all civilian health

care personnel who provide direct patient care in DOD military treatment facilities to be
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immunized against seasonal influenza infection each year as a condition of employment…”

(Cole and Swendiman 12). This statement gives another example of how mandatory vaccines can

be enforced by employers to create safe work and patient care environments. If workers do not

want to get vaccinations at their own will, then there is an option to make it apart of the contract

for employment. In a preceding paragraph we found that mandatory vaccines are legal if there is

a threat toward public safety and health, anyone working in a health care environment has a

threat of contracting the flu.

As a result, if mandatory vaccination policies among health care employees were put into

place then the safety of patients would be protected. The flu can be spread easily, but can be

spread even easier in a place that treats sick people all of the time. According to the CDC article

“Influenza (Flu)” , the flu can be spread when people having the flu cough, sneeze, and talk. The

saliva of the person can go as far as 6 feet away from them. Anyone that touches the surface with

the saliva on it and then touches their mouth or nose can contract the flu. In hospitals

This image displays how far disease droplets can spread when they come out of your mouth. The visual displays

that large droplets can travel 1-3 feet, small droplets can travel 3-5 feet, and droplet nuclei can travel 5-160 plus feet.

(Hashmi)
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patients with the flu get their saliva on many things, even their doctors and nurses. Those doctors

and nurses can get the flu by simply touching something the bacteria is on, and then can spread it

to other patients. If the workers that are in contact with patients had the flu vaccination then the

spread would be less common, because they would be immune to the disease.

Another safety point is that health care professionals are in contact with fragile patients,

who are at a higher risk of getting sick than other patients. The CDC article “Influenza (Flu)”

states, “ Some people, such as people 65 years and older, children younger than 5 years, pregnant

women, and people with certain chronic health conditions like asthma, diabetes, or heart and

lung disease, are at a high risk of serious complications from flu. Since health care workers may

care for or live with people at high risk for influenza- related complications, it is especially

important for them to get vaccinated annually” (8). This quote shares how it is important that

health care workers, in contact with patients at a high risk of complications, should be vaccinated

to ensure the patients safety. It is imperative that these patients health is top priority, and with

mandatory vaccines they won’t have to worry about getting sick from the staff working with

them.

Lastly, a study has been completed comparing flu vaccinations of health care workers to

patients catching the flu in hospitals. Thomas Benet, writer of the article “Influenza Vaccination

of Healthcare Workers in Acute-Care Hospitals: a Case-Control Study of Its Effect on

Hospital-Acquired Influenza among Patients”, carried out this experiment to see whether health

care workers with vaccinations are decreasing the risk of patients getting the flu while in the

hospital. The results supported the idea that health care personnel with vaccinations decreased

the likelihood of patients acquiring the flu while at the hospital. Benet shares, “ Our results
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indicate that a proportion of vaccinated healthcare workers of more than 35% in short-stay units,

in comparison to a lower proportion was protective against laboratory-confirmed

hospital-acquired influenza among patients…” (15). The results of this study show that only a

small amount of employees need to be vaccinated to cut the amount of patients getting the flu

from the hospital. With that being said, later on in the article mentions 35% of healthcare

employees vaccinated is not ideal, larger amounts of employees vaccinated will deter the amount

of patients getting the flu (Benet 19). This information gives proof that vaccinations of

employees benefits the health of their patients.

On the other hand, some people believe that mandatory vaccinations are not acceptable.

Some say that mandatory vaccinations obstruct their freedom of religion and health related

issues. There is legal backing for religious opposition to vaccinations, like the “Religious

Freedom Restoration Act”, which requires there to be strict evidence as to why all people must

have the vaccination, or else people with religious beliefs that go against vaccinations can waive

receiving the vaccine (Baxter 18). There is also the “Americans with Disabilities Act” which

talks about if an employees has a physical or mental disability they may be exempt from having

to get the vaccination (Baxter 22). Both of these legal acts show that they have the right to not

receive mandatory vaccinations because of what they believe and disabilities they cannot help.

Another point of opposition towards mandatory vaccinations comes from the people that

have been fired for refusing to get vaccinated. Workers who don’t believe in mandatory

vaccinations and refuse to get them have been fired for what they believe. Janice Lloyd, who

wrote the article ​ “Mandatory Flu Shots Opposed by Some Health Care Workers.”, shares a story

about a woman named Carla Brock who was let go from her job at “Springfield (MO.) Cox
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South Hospital” for her choice in not receiving the annual vaccination. She did not want the shot

because of her beliefs against adding harmful toxins into her body (7). This story shares Carla

Brock’s beliefs got her fired because she refused to get the vaccination. There are more similar

stories about people getting fired for what they believe in.

Although religious beliefs and disabilities are unchangeable and people believe that these

reasons are enough to stop mandatory vaccines, there are ways to supplement policy around

them. There can be exceptions made in mandatory vaccination policies for religious beliefs, as

long as there is support to why they cannot get the vaccine. People with disabilities, both mental

and physical, can be excluded to vaccination policies with evidence from a doctor. Mandatory flu

vaccinations are meant for everyone but if there are clear reasons why someone cannot receive

them, then there are safeguards in place. For those who cannot get vaccinated, surgical masks

and gloves can be worn. Alternatives are available to those who need them, but not for those who

do not want to follow protocol.

In conclusion, even though some people do not agree with mandatory vaccinations, the

benefits of them out way the bad. Mandatory vaccinations are supported by the number of health

care employees vaccinated, legal support has been found and patient safety is provided.

Vaccinations protect not only the employee receiving it but the patients and other people they see

on a day-to-day basis. The spread of disease would be limited within hospitals, a place where

people come to be treated for their illnesses not given more. Statistics and studies have proven

that vaccinating employees is beneficial and legally acceptable. Even though some may say that

religious and health related concerns are reasons to not mandate vaccines, protocols can be put in

place to modify policy. By 2020, to ensure ideal health of health care facilities 90% of
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employees must be vaccinated, and as mentioned before the number of employees getting

vaccinated right now without being forced is to low (Schneyer 1). The only way to get 90% is by

mandating vaccinations of employees. If you would like ensure your safety around your doctors

and nurses mandatory vaccinations is the way to do that. Why would you risk getting sick from

someone taking care of you, when a vaccination can prevent it?

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Works Cited

Baxter, Teri Dobbins. “Employer-Mandated Vaccination Policies: Different Employers, New

Vaccines, and Hidden Risks.” ​Utah Law Review​, vol. 2017, no. 5, Oct. 2017, pp.

885–938. ​CINAHL Plus,​

sinclair.ohionet.org:80/login?url=​https://search.ebscohost.com/login.aspx?direct=true&d

b=a9h&AN=127012284&site=eds-live​. Accessed 27 February 2019.

Bénet, Thomas. “Influenza Vaccination of Healthcare Workers in Acute-Care Hospitals: a

Case-Control Study of Its Effect on Hospital-Acquired Influenza among Patients.” ​BMC

Infectious Diseases,​ BioMed Central, 1 Feb. 2012,

www.ncbi.nlm.nih.gov/pmc/articles/PMC3293022/​. Accessed 20 March 2019.

Bowers, Lois. “Flu Vaccination Low among Long-Term Care Workers.” ​Flu Vaccination Low

among Long-Term Care Workers | I Advance Senior Care,​ Vendome Group, 18 Sept.

2014,

www.iadvanceseniorcare.com/article/flu-vaccination-low-among-long-term-care-workers

Accessed 19 March 2019.

Cole, Jared and Kathleen Swendiman. “Mandatory Vaccinations: Precedent and Current Laws.”

Congressional Research Service Informing the Legislative Debate since 1914,​ 21 May

2014, fas.org/sgp/crs/misc/RS21414.pdf. Accessed 20 March 2019.

Hashmi, Anjum. “H1N1 Influenza A Virus, Its Transmission Indoor Air & Role of HVAC.”

LinkedIn SlideShare​, 2 July 2013,

www.slideshare.net/anjumhashmi61/h1-n1-influenza-virus-its-transmission-indoor-air-rol

e-hvac​. Accessed 19 March 2019.

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“Influenza (Flu).” Edited by Office of the Associate Director for Communication , ​Centers for

Disease Control and Prevention​, Centers for Disease Control and Prevention, 16 Nov.

2018, ​www.cdc.gov/flu/healthcareworkers.htm​. Accessed 27 February 2019.

Ksienski, Doran S. “Mandatory Seasonal Influenza Vaccination or Masking of British Columbia

Health Care Workers: Year 1.” ​Canadian Journal Of Public Health = Revue Canadienne

De Sante Publique,​ vol. 105, no. 4, July 2014, pp. e312–e316. ​MEDLINE,​

sinclair.ohionet.org:80/login?url=​https://search.ebscohost.com/login.aspx?direct=true&d

b=mnh&AN=25166135&site=eds-live​. Accessed 27 February 2019.

Lloyd, Janice. “Mandatory Flu Shots Opposed by Some Health Care Workers.” ​USA Today,​

Gannett Satellite Information Network, 16 Jan. 2013,

www.usatoday.com/story/news/nation/2013/01/16/mandatory-flu-shot-nurses/1832813/​.

Accessed 28 February 2019.

“Recommended Vaccines for Healthcare Workers.” ​Centers for Disease Control and Prevention,​

Centers for Disease Control and Prevention, 20 Apr. 2017,

www.cdc.gov/vaccines/adults/rec-vac/hcw.html​. Accessed 17 March 2019.

Schneyer, Rebecca J. “Influenza Immunization for All Health Care Personnel: Keep It

Mandatory.” ​APP News and Journals Gateway,​ vol. 136, Pediatrics, Oct. 2015,

pediatrics.aappublications.org/content/136/4/809. Accessed 28 February 2019.