Tuesday, October 29, 2013

Mandatory flu shots just plain wrong for hospital staff and visitors - flawed science, high cost, low efficacy, intrusion into personal health

Soon, BC hospital staff and visitors must either get vaccinated for the flu or wear a mask at all times. And that's just plain wrong.

Flu shots are ineffective 41% of the time, on average
Bill Tieleman’s 24 Hours Vancouver / The Tyee column

Tuesday October 29, 2013
By Bill Tieleman
We simply don't have good evidence that vaccination of healthcare personnel prevents influenza transmission to patients."
When flu season starts, mandatory flu shots or wearing a mask will be required not only for hospital and care home staff in British Columbia, but visitors as well.
And that's just wrong.
Wrong on the science. Wrong on the approach to healthcare workers, including doctors and nurses. Wrong for the intrusion into people's personal choices about their own health. And wrong on the hundreds of millions of dollars spent by both governments and individuals on vaccinations that fail at least 41 per cent of the time, perhaps more.
But starting around December, neither visitors nor workers will have a choice -- you will take the shot or wear a mask if you are in a hospital or care home.
Visitors who refuse could be blocked from entering -- but workers could be fired, after an arbitrator rejected healthcare unions' objections last week.
"We're expanding our policy to visitors," B.C. provincial health officer Dr. Perry Kendall told media last week, saying everyone visiting hospitals or long-term care facilities should either have had a flu shot or wear a mask.
London, Ontario hospitals will enforce the same choice and others will likely follow, according to that province's health promotion agency.
But the science behind both flu shots and masks is simply nowhere near good enough to make such a draconian decisions on our rights.
Flawed flu studies
Start with the fact that most studies on flu shots are flawed, according to the Center for Infectious Disease Research and Policy at the University of Minnesota.
"Applying very strict criteria to filter out potential bias and confounding, a U.S. research team sifted more than 5,000 studies and found only 31 that they felt provided reliable evidence about the efficacy and effectiveness of flu vaccines. The findings were published online today by Lancet Infectious Diseases," it found.
One of Canada's most prominent infectious disease specialists agrees.
Dr. Michael Gardam argued in the Canadian Medical Association Journal that flu vaccine is only modestly effective and making shots mandatory could lose in court.
"Any sort of policy decision where you're going to make a vaccine mandatory is going to be an uphill battle, right? It's going to be a real fight. And so you have to decide if you're going to make that fight, is this vaccine worth it to make that fight? And I personally don't think it is," said Gardam, head of infection control at Toronto's University Health Network. Gardam himself is in favour of the vaccine and gets a flu shot.
Professor Nick Kelley, who is also pro-vaccine, points out that new analysis of past studies shows that the flu shot is no cure-all for healthcare workers.
"We really don't have a good grip on the epidemiology of influenza in the healthcare setting," Kelley said.
Kelley added that even if hospitals achieved 100 per cent vaccination rates for staff, there would still be a 41 per cent failure rate for the flu shot, leaving patients vulnerable to infection from sick workers.
Vaccination no fail-safe solution: US union
In B.C., the Health Sciences Association, the Hospital Employees Union and the BC Nurses Union all oppose mandatory flu shots for members, while still supporting voluntary immunization.
"Crucially, there is simply no evidence to support the assertion that vaccination of healthcare workers will prevent the transmission of influenza to patients," Lindsay Lyster, the HSA lawyer who argued the arbitration for the unions, told CBC Radio.
National Nurses United, the largest U.S. organization of nurses, also opposes mandatory flu shots.
"Nurses, joined by many physician organizations and researchers, reject the notion that vaccination is a fail-safe solution to prevent the spread of the flu virus," said co-president Karen Higgins. "We oppose forced vaccinations or the related mandate that those who decline the shots must wear masks or risk losing their jobs."
Higgins said the science simply doesn't support it.
"A 2005 National Institute of Allergy and Infectious Diseases study over 20 years found no correlation between increased vaccine use and a decrease in deaths," Higgins argued.
Professor Nick Kelly summed it up succinctly on Twitter last week: "Overstating the data on flu vaccines is shooting ourselves in the foot... reduces the need for innovation & confuses public."
Let sick workers stay home
National Nurses United promotes a better solution to preventing flu: make sure all workers can take sick time when they need it.
The organization cites a American Journal of Public Health study in 2011 that estimated that lack of sick time helped spread five million cases of illness during the 2009 swine flu outbreak in the U.S.
In the U.S., private healthcare companies would rather vaccinate than grant sick time or take additional preventive measures to reduce the spread of disease.
"Too many hospitals whose mantra is profits, not patient safety, favour forced vaccinations while cutting nursing or housekeeping staff, and denying paid sick leave," Higgins said.
The alternative to a flu shot -- wearing a mask at work in a hospital or during a visit -- is also of dubious medical value.
"Very little information is available about the effectiveness of face masks and respirators in controlling the spread of pandemic influenza in community settings," a U.S. government document reported.
For many healthcare workers, wearing a mask all day is irritating and gets in the way of developing an interactive relationship with their patients.
There are obvious occasions where a mask is required, as well as other protective gear and precautions.
But a blanket policy seems more designed to force workers to get a flu shot and punish those who refuse. It will also cause patients and co-workers to potentially shun those who wear masks while feeling falsely secure with workers who don't.
There are clear alternatives short of demanding healthcare workers be forced to have a flu shot or be fired. The famed Mayo Clinic's policy is that staff who don't want to take a flu shot must sign a statement that explains why. It has a 90 per cent vaccination rate.
Immense expense
Lastly, flu shots are an immense expense for both governments and individuals.
The cost of flu vaccines in Canada alone is likely more than $100 million, according to Dr. Danuta Skowronski of the B.C. Centre for Disease Control.
Those at particular risk, such as the elderly or those with chronic illnesses, can get a free flu shot, as can healthcare workers -- but for others it can cost between $20 to $30 per person. That adds up to a lot of revenue for drug companies.
Dubious scientific evidence, heavy-handed government intervention, high costs for low results, healthcare professionals' opposition and an intrusion on personal freedom all add up to one conclusion: "mandatory flu shots or else" is just plain wrong.



paul said...
This comment has been removed by the author.
paul said...

The article starts with a quote from Prof. Nick Kelley on evidence gaps. But his conclusion, in the article you cite, is pro-vacination
"It's the best intervention we currently have, so we need to keep using it while working toward a better flu vaccine," Kelley said.
The U.S. government document you cite is specifically referring to mask use in community settings, like malls, not health-care facilities.
The article on it you link to concludes:
'Meanwhile, it is worth repeating: The single most important thing that older people and caregivers can do to prevent the flu is to be vaccinated, Dr. Bridges said. “It’s the best tool we have,” she said.'
It's wrong to overstate the benefits, but equally wrong to ignore them.

Tara Snyder said...

Bill....I greatly admire your educated response to questioning the flu vaccine evidence. There's appears to be a strong fear in mainstream media to delve into this issue ever since the Andrew Wakefield controversy.

Having done my own investigation into the subject, I've come across several disturbing issues. For the sake of brevity, I will post links to my 2 top issues.


Number two, from what I can tell, only Quebec has a Vaccine Compensation Program in Canada.


These and other concerns are not being discussed so hopefully posting the links here may help others get a more balanced picture. hank you for being brave enough to openly voice your opinion.

Andrea DeSantis said...

Yes thanks Bill, It takes courage to stick your neck out when everyone truly has been lead to believe this vaccine is a magic bullet for them and their loved ones. Yes Tara, very good points, the lack of liability for this vaccine and poor tracking of late and subacute onset autoimmune conditions is troubling. You might also be interested in the article by Ohmit (at http://www.ncbi.nlm.nih.gov/pubmed/23413420) that found the flu vaccine substantially increased risk for contracting the flu and read the commentaries afterward as well that once again ask for a double blind randomized placebo controlled trial once and for all on this vaccine.( the gold standard scientific litmus test which we have been totally denied!)

However, I think the biggest problem we face with this issue is the utter mislabelling of the "flu" as influenza. Truth the public has has NO idea what they are suffering from so that every single seasonal ill is called the "flu" when in fact influenza only comprises about 10-20% of droplet spread illness.

Please read the fabulous article by Crowe from CBC if you want to see what a joke our tracking system is of this virus. See http://www.cbc.ca/news/health/flu-deaths-reality-check-1.1127442.

The only single year they actually tracked the virus properly with culture confirmed specimens found only 300 cases of influenza in the country!! and they tell us cases are 2000-8000. This is more in line with what Peter Doshi says from the cochrane who estimates influenza cases are exaggerated by 10x in the united states due to shoddy scientific models and improper testing.
thanks again Bill

Anonymous said...


Taking this vaccination/mask issue to its ultimate conclusion, persons in need of medical care should be required to produce proof of currently-valid flu shot, wear a mask or be denied treatment at a hospital?

Anonymous said...

Will physicians in hospitals also beheld to the same standard as the nurses then? Will they be banned as well if they do not either wear a mask or show proof of mandatory flu shots?

e.a.f. said...

Flu shots are big business, not just for those producing the vaccine but those who administer it. It is part of a hospital's budget, they want the money.

If hospitals were truly concerned about infections, the flu or other ones, they would simply ensure staff washed their hands each time they touched someone and ensured the hospital was kept clean at all times. Hospitals are not cleaned properly so people simply touch a wall or a handrailing and they get an infection. More people die from infections in hospitals than they do from the lack of a flu shot.

Tara Snyder said...

Here's a very interesting W5 report. Keep in mind too...that the Globe and Mail article I mentioned above, shows evidence that people were more susceptible to the H1N1 virus if they had had the annual flu vaccine the previous year. There's a growing web of factors we need to be considering here!