Health Care Heresy

The most virulent vector for virus contamination is the very place where ill people venture for treatment. Hospitals are the place to go to share germs, bacteria, viruses. Doctors' offices may represent the next-best bet. And of course, crowded, popular areas of entertainment, including movie theatres, concert venues, and shopping malls. The solution to avoidance is not easily found, particularly for parents of children who attend school daily, where invariably germs and viruses are readily spread.

People-to-people contact is the surest way of making certain that whatever is going the rounds in making people ill, will succeed. No man is an island can be interpreted in many ways, it seems. We cannot fulfill ourselves independently of contact with others, and our propensity to gather in crowds also leaves us vulnerable. Humankind is generally gregarious by nature; we seek others out, shunning a solitary existence.

So how to make sense of a First World medical culture where health professionals are fearful of taking steps to ensure they do not contaminate the very people whom it is their professional duty to look after in illness, by themselves taking flu shots? In North America concerted public health efforts get underway seasonally to convince the general public of the usefulness of flu-shot vaccinations.

The vaccinations work. The generalized theory is that the greater the number of people who agree to be vaccinated against the seasonally prevailing flu virus, the greater the 'herd effect', protecting the general population by controlling the numbers who become ill and represent a vector of a communicable illness. With insufficient public defences in place due to an ineffective vaccination program, the incidence of potential epidemics arise.

This year in North America the annual influenza season began early and has struck hard. And we are apprised of the fact that thousands of hospital employees who come in direct contact with hospital patients have refused to take part in vaccination programs. Placing a strain on the health care system in Ottawa, for example, through their refusal to take advantage of the flu shot.

Of the Ottawa Hospital's 12,000 employees - inclusive of nurses and other front-line staff - at sites such as the Civic, General and Riverside hospitals, along with the Smythe Road Rehabilitation Centre and the University of Ottawa Heart Institute, 43% of staff have not been vaccinated. Managers are required to be vaccinated, but for other employees it is held to be voluntary in nature.

The hospital and health-care workers' union has written a clause in language specific to their contracts forbidding management to enforce vaccination upon workers who do not wish to participate. Quaintly enough, these educated health-care professions submit to what may be termed irrational fears such as:

• A belief that the vaccination doesn't work;
• Concern that the vaccination will give them flu (a myth);
• A fear of side effects; Needle phobia (when in fact they have access to nasal-administered vaccines.

"We have a problem. We feel our staff are at risk if they haven't had the flu shot and we are seeing higher numbers of them off sick with respiratory symptoms. And we're having higher patient loads. So we have more patients and fewer staff to take care of them. The situation is acute.
"A flu shot is free and readily available. You can hardly walk down the hall at the hospital to get a coffee without passing a vaccine station."
Dr. Virginia Roth, medical director, infection control

The latest available figures indicate that 87% of physicians working at the hospital have submitted to vaccination. If they, above all, aren't aware of the beneficial effects both personally and socially, related to the flu vaccine, then who should be? But front-line workers, including many nurses, remain shy of the vaccination.

"We have some units where 90% of nurses have been vaccinated and others where 30 percent are vaccinated. There is a sense that the vaccine doesn't work or something bad might happen. Nurses are the same as everyone else." Which is to say, as intelligent, or as stupid as any from within the general public, who like to believe that health professionals like nurses enjoy specialized health confidence.

Flu vaccines in Ottawa are widely available, at doctors' offices, temporary health clinics, even at 43 pharmacies which have elected to administer flu shots for the convenience of their neighbourhood clientele. Ottawa Public Health provided hundreds of thousands of doses to hospitals, clinics, pharmacies and doctors' offices back in September; there are no shortages.

In Canadian hospitals where flu shots for employees are not mandatory, the most engaging programs emphasizing the safety and practical solutions against transmission among staff, have been successful only in achieving up to 70% compliance. "In some U.S. hospitals where they have said, 'If you want to work in the hospital you have to get the flu shot', they have been able to achieve 90- to 95% vaccination rates. But the culture in Canada is different", explained Dr. Roth.

Time to change the culture.