Here is a question to discuss around the water cooler: Should your boss be able to force you to get a flu shot?
Put another way, should an employer be allowed to require certain employees to get a needle stuck into them for the common good?
After all, the flu is miserable. It can bring severe body aches, a pounding headache that just won’t stop, and a deep cough that burns from the inside. And that is often just for the lucky ones. Severe cases can lead to pneumonia, hospitalization and even death.
Given that people might spread their suffering to others, why shouldn’t a flu shot be obligatory?
We know the vaccine works. Each year, the World Health Organization convenes a panel of experts to predict the strains of the flu that are expected to cause that year’s seasonal infections. The overall efficacy is based on how close their predictions come. But even if it’s not a perfect match, it still provides some protection against other strains of the virus.
And yet, the Centers for Disease Control numbers show the rates of flu vaccination vary greatly based on age. In children, it is 45 percent. For people 18-49, it falls to 26 percent. For people aged 50-64, it rises back to 43 percent. And for people over 65, it jumps to 67. percent.
One of the goals of the Healthy People 2020 Initiative is to have 90 percent of the general population receive the flu vaccine. To do that, some people will likely have to get more comfortable with a needle.
But before asking everyone to get a shot, it might help to look at places like medical centers, where sick people go for care to see how they are handling the issue.
But the very health care workers who diagnose and treat someone with influenza — and who are not protected — can easily spread the infection to other patients, their own families, and anyone else they might come in contact with.
Right now, it is not mandatory for health care workers in Hawaii to receive the flu shot. Yes, you got that right, the people who care for people with bad cases of the flu may not have gotten vaccinated.
Some medical centers are strongly suggesting that all employees get it. But, according to the National Healthcare Safety Network, Hawaii’s rates for flu vaccinations among health worker is far from the 90 percent goal for most medical centers.
North Hawaii Community Hospital has the highest rate of vaccination for the 2013-2014 season that was reported this June, at 91 percent. They are followed closely by Shriner’s Hospital for Children, at 88 percent.
But at the other end of spectrum, the immunization of health care personnel at Castle Medical Center is just over two in five, at 43 percent. In between there are places like Queen’s Medical Center, where just over three in four people, 78 percent, had been vaccinated. This suggests that a patient going in there who interacts with five people will likely have come across one person who is not immunized.
The numbers at Wilcox Memorial and Hilo Medical Centers were both 70 percent, while those for Kaiser Permanente, Kapiolani Women’s and Children’s, Kona Community Hospital, Straub Clinic and Hospital were all between 60 and 70 percent. This level of immunization in medical staff is unacceptable.
Why is it so difficult to get health care workers — the very people taking care of people suffering from influenza — to receive a flu shot to avoid getting, and spreading, the flu?
I get my flu shot every year, so I just don’t understand. But I’ve asked a few of the staff where I work to get different perspectives.
The top three reasons in my informal survey were a little surprising. The first is inconvenience. People said they just don’t always find time during their lunch break to go to a flu shot clinic, stand in line and wait. (This, even though flu shots are available at nearly all doctors’ offices, local pharmacies and — for many people — right in their workplace.)
Second, people are afraid they will get sick from the shot. People sometimes develop a mild case of body aches and a fever, or just don’t feel right after getting the shot. People do get sick, but usually it is from something else.
Now, it’s true that the immune system mounts a response to the shot. That’s the whole purpose of the vaccination, and this includes mild symptoms of aches and a low-grade temperature. But the flu shot itself can’t make anyone get the flu. It isn’t possible. It is made up of proteins on the surface of the virus, not the actual virus, and it can’t reproduce in the body, which is how the flu virus usually takes over.
The last reason people don’t get the shot is that it’s not required. There is no mandate that anyone get it. Highly recommended, yes. Mandatory, no. The shot can be refused, even without an explanation — and without any consequences.
But the very health care workers who diagnose and treat someone with influenza — and who are not protected — can easily spread the infection to other patients, their own families, and anyone else they might come in contact with.
Think about an average day for most of us. How many people might that actually be?
Unless it’s required, we might not be able to reach the goal of 90 percent vaccination in the medical community, let alone in the general public.
But here are some numbers to convey why need to do better. The flu shot does reduce the number of cases of influenza. On average, each year, influenza causes up to 200,000 hospitalizations each year and up to 36,000 deaths.
Those who get the shot are 71 percent less likely to be hospitalized with the flu, the improvement is even greater in people with diabetes or other chronic medical conditions.
That sounds like motivation to be vaccinated, but it might not be enough. I asked staff who don’t usually get the shot what might change their mind.
The most common answer: Make it a requirement. That and having extra sick leave if they get the flu, even though they had the shot, which is unlikely.
So, should medical centers force their employees to get vaccinated?
Other shots are already required, like those for measles, mumps, and rubella. Why not flu shots? Of all places that might mandate flu shots for protection, hospitals and clinics are in a special place and should start setting an example.
Then, if we can get all health workers immunized, a plan could be rolled out to cover other state and public workers.
The more people are immunized, the less likely others will be to get sick. In the medical world, it’s called “herd immunity.”
Let’s make it a stampede, after all, no one who has ever had influenza would recommend having it again.
By the way, it’s time — have you had your flu shot yet?
