Public, Professional Responsibilities

What level of confidence should the public take in being scrupulous about their responsibility to themselves and to the larger community, in choosing to be vaccinated against yet another winter's flu onslaught, when health professionals themselves are surprisingly resistant to acceding to the general medical community's urging in that direction?

"We always encourage our members to get vaccinated, but we also believe that they have a right to make their own personal health choices", explained a spokeswoman with the Health Sciences Association of British Columbia, the union that represents the province's non-nurse, non-doctor health-care professionals.

The members in question represent those working in close contact with elderly patients, and those with chronic illnesses that lower their resistance to deleterious health impacts, leaving them with compromised immune systems.  These are the people who, refusing to be part of the larger health community to be vaccinated, are referred to by their critics as "killers of the sick and elderly".

Their union, while on the one hand, encourages them to respond positively to the impetus for vaccination, also assures them that it is their right to resist a mandatory flu shot, if this is the direction they wish to take.  Public health efforts to put a crimp in the number of vulnerable people who will come down with the flu this winter by having all those who come in contact with them vaccinated will be for naught.

"Philosophical or religious objections" are cited as acceptable reasons for refusing to opt into the general program to obtain a flu shot that will lessen the impact of flu if they do become infected, or help them avoid it entirely, while working with the health-compromised and the elderly, susceptible to fatal effects from a bout with the flu.

People have a natural enough aversion in general to being pricked with a needle.  And many people don't believe in the efficacy of the vaccines.  Many others believe that pumping vaccines into their bodies may result in unexpected and complicating health outcomes, unrelated to the flu.  The resistance of many people to obtaining flu shots results in a hampered 'herd effect'.

The herd effect is the supposition based on evidence that the greater the number of those that are vaccinated, the less the opportunity for flu bugs to circulate in the population, resulting in fewer cases of seasonal flu.  "More patients are alive at the end of flu season if health care workers get vaccinated ... we have lots of supportive evidence for that", stated Dr. Allison McGeer, infectious disease consultant at Toronto's Mount Sinai Hospital.

University of Toronto bioethics researcher Ross Upshur equates eschewing a flu shot with the violation of the credo of "do no harm".  If, he posits, health care workers "are vectors of disease for hospitalized patients, they are putting patients at risk for increased harm".  It is an unassailable argument based on logic and observable outcomes.

According to Maher El-Masri, a nursing professor at the University of Windsor, it is "disheartening" that so many Canadian health professionals choose not to be vaccinated against the flu.  "I think we have a responsibility to protect our patients", he emphasized.  Even so, he balks at the notion that British Columbia has taken the step of obliging its health care community by law to be immunized.

It is, without doubt, a problem.  On the one hand, to make it unlawful as a health care worker not to agree to immunization seems like an occupational hazard; forcing people to do what they prefer not to.  On the other hand, there is that professional obligation: "If we don't vaccinate", he asks rhetorically, "how many people are we killing, and how many people are we putting at risk for increased complications?"

Figures for uptake in the general population in Ontario are a tepid 32% for 2011, despite the province advertising and encouraging people to be involved in the vaccination program to protect the wider community.  Ottawa residents come in at a slightly more but still relatively pallid uptake rate, at 44%.  Which translates to over 50% of the population choosing not to become immunized, gambling they will still avoid infection.

"We think that some people are in general afraid of vaccines, so we like to remind people it's a very safe vaccine", said Riccardo Lucchini, a public health nurse with Ottawa Public Health's immunization campaign.

"We would have some difficulty with health-care workers deciding to risk not only their own lives and health but those of their patients", was the comment from Susan Eng, a CARP spokesperson representing one of Canada's most actively vocal seniors' advocacy groups.