Court decision on vaccinations is a blow to public health
http://www.mercurynews.com/mld/mercurynews/news/opinion/13897215.htm
By Arthur Caplan and David Curry
Many Americans are required to get vaccinations. They have no choice. Most of them are children and, in most states, if their parents want them to be able to attend school, they need to prove that they have been immunized against tetanus, whooping cough, diphtheria, polio and hepatitis B.
But there are many Americans who oppose any mandatory vaccinations. Some claim religious exemptions or offer ``philosophical'' reasons, which are often quite imaginative. Others claim that too many vaccines taken too quickly can cause all sorts of problems for children. Some want to rely on ``natural'' foods to protect them against viruses and microbes. Still others think that the government is conniving with industry so that the latter can make a profit.
But little, if any, open opposition to mandatory vaccination comes from those in the health care field. That's why it was so startling when a group of nurses in Washington state went to federal court to fight a plan by Virginia Mason Medical Center in Seattle to require every nurse who works there to get a flu shot. What is just as remarkable is that the nurses won.
The Jan. 5 ruling by the U.S. District Court in Seattle in favor of the Washington State Nurses Association drew little attention. But it could have important implications should we be faced with the prospect of a nasty flu outbreak next year -- or worse, a bioterror attack involving smallpox or anthrax. The ruling hinged, in part, on the question of whether the hospital could impose a new job ``duty'' after collective bargaining had ended. But, the bottom line was that a court ruled that a hospital could not make getting a flu shot a condition of employment.
Officials at Virginia Mason had sought to make flu shots mandatory -- describing them as part of its ``fitness for duty requirements'' -- and to be able to dismiss any registered nurse who didn't comply. The medical center argued that a 100 percent staff immunization goal was ``focused on preventing unnecessary death due to influenza transmission during flu season [and] to protect patients and fulfill the medical center's commitment to patient safety.''
The center's chairman and CEO, Gary S. Kaplan, argued that ``when faced with an opportunity to prevent an avoidable death, the path becomes clear.'' The nurses' association countered that it supports the flu vaccine and, in fact, strongly encourages nurses to get it, but that it ``opposes any health care facility threatening to fire people if they do not submit to the mandatory vaccination, especially in the absence of a declared public-health emergency and a recommendation for mandatory vaccination by the Centers for Disease Control and Prevention.''
The nurses' group proclaimed: ``It's a basic right for people to make decisions regarding their own health care treatment. As health care professionals, nurses know that education, accessibility and incentives -- not brute force -- are the best way to encourage people to comply.''
The case included extensive arguments by the hospital citing numerous agencies recommending such vaccinations as a health precaution. But the nurses chose to fight, and the court found the argument by the nurses' group persuasive. The court wound up promoting the position that choice, not mandates, should be the basis of vaccination policy. Is that sound policy for hospitals where people are sick or frail and highly prone to infection? Is it sound public policy?
Will anti-vaccine activists jump on this court decision to undermine mandatory vaccination for children? And does the Washington State Nurses Association or anyone else really think that health care workers, over 60 percent of whom don't get flu shots each season, are going to respond to ``easy access and education'' and comply with current CDC vaccine recommendations? Even if the CDC or the Department of Health and Human Services or the president declares a national public-health emergency, will health care workers suddenly get vaccinated?
Americans hate mandates. Apparently, so do some nurses in Washington state. As a people who treasure our self-determination, many of us hate having the government tell us what we must do. But, in the war against disease and the threat of pandemics, both natural and human-caused, it may be necessary to give up a tiny bit of freedom or a bargaining chip in labor negotiations in the name of public health.
It is time to engage in more public discussion and debate about the role of mandates and vaccines for health care workers. We should do so now, before the next nasty bug shows up in your neighborhood without your doctor or nurse having been vaccinated against it.
is director of the center's Ethics of Vaccines Project. They wrote this article for the Mercury News.
ARTHUR CAPLAN is director of the Center for Bioethics at the University of Pennsylvania. DAVID CURRY
http://www.bioethics.upenn.edu/vaccines/?pageId=3&subpage=189
Global Alliance for Vaccines and Immunization
http://www.vaccinealliance.org/General_Information/About_alliance/index.php
The Global Alliance for Vaccines and Immunization was formed to harness the strengths and experience of multiple partners in immunization. It is an historic alliance between the private and public sector committed to the mission of saving children's lives and protecting people's health through the widespread use of vaccines. A new type of public-private partnership, GAVI brings together governments in developing and industrialized countries, established and emerging vaccine manufacturers, nongovernmental organizations (NGOs), research institutes, UNICEF, the World Health Organization, the Bill & Melinda Gates Foundation and the World Bank.
