That’s why the organizations have resorted to what some may see as a hard line on the subject (SHEA recommends that only medical contraindications should be acceptable exemption criteria; AAP, on the other hand, recommends that exemptions for medical and religious reasons be permitted on an individual basis). Fishman points out that vaccine mandates aren’t even unprecedented: Most institutions require vaccination against measles-mumps-rubella, varicella, and hepatitis B, for example, as a condition of employment.
Other arguments aside, Fishman says, there is one compelling reason why health care providers should get their annual flu vaccination. “Health care providers assume an ethical responsibility to prevent disease in our patients when we enter the profession,” he says. “That ethical obligation overrides other beliefs.”
Bottom Line: Get Vaccinated!
How far the push for mandatory influenza vaccination of health care personnel will go remains to be seen, as does what impact the movement will have on NPs and PAs. For the foreseeable future, it may depend on the practice setting. As of now, neither AAPA nor the American Academy of Nurse Practitioners (AANP) has taken a position on the mandate issue. (The American Nurses Association has, stating in a press release that it “does not support such policies” unless they adhere to specific guidelines. The organization does emphasize that it strongly encourages nurses to be vaccinated against influenza, however.)
Could this someday become a regulatory issue or a national health policy? “Initially, I’d be happy—we’d be happy—if more institutions around the country begin to adopt mandatory vaccination policies,” Fishman says. “If that happens, that will create a force around the country, and it will become the standard. If that doesn’t happen, I think we’ll have to see about pursuing more of a regulatory standard.”
Poland is a believer in the idea of a tipping point, and he thinks it’s drawing nearer: “I truly believe that within a decade, we will look back and say, ‘It is really unconscionable that we allowed this to happen,’ given the data that we have.”
Whatever else is accomplished in the immediate aftermath of the release of the SHEA and AAP papers, one thing is clear: It will hopefully encourage discussion about flu vaccine among health care providers, and perhaps encourage many of them to seek vaccination of their own volition. That is something both AAPA and AANP encourage. And perhaps too it will create opportunities for education.
AANP Director of Health Policy Jan Towers, PhD, NP-C, CRNP, FAANP, says that hospitals, clinics, and group practices can provide more education to their employees, showing data to indicate that not getting vaccinated is causing a problem. “Most people are conscientious providers,” she says, “and even though they may never get the flu—or they think they’ll never get it—if they are creating an environment that makes it easier for patients to get it, then showing that data and educating them would certainly be the way to go.”
Towers encourages NPs to receive flu vaccine—and to encourage their patients to get it as well (barring contraindications, of course). “One of the things that I think NPs do better than some other providers is make sure that people are getting their flu shots and that the vaccine is available to them,” she says. “I think that’s important. If you don’t bring it up with some of your patients, they’ll never think to get it. So we have a big responsibility to make sure our patients are aware of the need to get flu vaccine.”
Killeen has a twofold mission for his colleagues. “We really need to challenge our Ob-Gyn practitioners to vaccinate pregnant women,” he says. “Out of all the populations that I see, the one that refuses the vaccine is that population. Again, it’s the safety issues: ‘How will this affect my pregnancy and my unborn child?’ That’s a huge stretch for women.”
The second piece of Killeen’s request to PAs is not to rest on the laurels, so to speak, of that 67% coverage rate reported in 2008: “I would like to see that number significantly increase.”
It is important to remember that the entire concept of vaccination is that it protects you and helps to protect everyone else as well. “[The SHEA position paper] is saying that as a health care provider, you’re responsible to protect yourself and your patients,” Killeen says. “I think that’s the best thing to come out of it.”