This year again the BC Ministry of Health has mandated that all healthcare providers must receive the influenza vaccine and if they choose not to, they must wear a mask for the duration of flu season whilst providing patient care. I applaud this decision and am frustrated by some of my colleagues who argue against science and common sense. Let’s examine some of the arguments.
Point 1: Flu kills. It doesn't tend to kill healthy people. I could care less if I personally get the flu but I care a lot if some nurse or doctor gives my elderly grandmother the flu and she becomes very sick (or worse). I care a lot if some family doctor, NP or public health nurse gives my two week old baby the flu during a home visit. Flu kills our young, our elderly and our sick. It really is that simple. And these are the people we have agreed to take care of.
Point 2: "I'll stay home from work if I get the flu". Great thinking….but you've already spread the virus before you even knew you had the flu. Most flus and colds work that way. You're spreading it before you have any symptoms. Why should I have to cover for your sickness at work? I took personal responsibility for my health and the health of my patients and co-workers to prevent getting sick but I'm supposed to cover for you because you didn't? Thanks. Why should your employer and taxpayers have to pay more because you didn’t take responsibility for your own health? Something seems pretty unfair about that.
Point 3: Mandated vaccines. We are already mandated to get a vaccine, it’s called Hepatitis B. When healthcare providers are accepted into their schools and training programs and when we're hired we are asked to prove we've had hepatitis B vaccine and also that our level of protection is adequate. So, we're already mandated to get a vaccination because of our chosen profession. This isn't new. Why is flu vaccine different? Why aren’t we crying “human rights” about Hepatitis B, Tetanus and MMR vaccines too?
Point 4: TB Skin testing. Read point 3...same thing for TB Skin testing. The fact is that healthcare providers have agreed to care for our most vulnerable populations and this includes a personal responsibility to do our best not to bring additional disease and infection to our patients.
Point 5: Shoddy science and “Big Pharma”. Healthcare providers who are citing out of date, scare tactic "research" just to support their points need to check their professional commitment to evidence based practices. I look to the science, the evidence and the experts. Conspiracy theorists abound and it’s difficult to sort through the rhetoric on both sides. Who should be making these vaccines instead of pharmaceutical companies? I would love nothing more than to have self-sacrificing scientists who are barely paid a living wage come up with amazing scientific breakthroughs. This isn’t happening in Canada. It’s a problem. But it doesn’t mean that the scientists who are working for pharmaceutical companies are all corrupt and out to kill and maim people. Our government has a vested interest in keeping the population healthy and out of emergency rooms.
Point 6: Only a few strains are covered. Sure, flu vaccine might only be 40% effective and only protect against two strains - but it's better than 0%. It's the best we have for now. We have a vaccine for hepatitis A and B but not for C so does that mean I won't take Hep A and B vaccines? If I took this logic into any other harm reduction strategy, my credibility could be called into question. This argument is like not wearing a bicycle helmet because it only protects my head - but I still might fall and break my arm.
Point 7: Safety. I've been involved in flu vaccine campaigns for more than 12 years now. I have yet to see a reaction more serious than redness at the injection site or a sore arm. But, because I also don't support anecdotal evidence as actual scientific evidence I look to the research. It supports my observation. Rare reactions (which can happen with any food or drug) do occur but at such super low rates you'd be more likely to win the lottery first.
Point 8: Getting the flu from the flu vaccine. Read up on first year immunology. Flu vaccine is an inactivated vaccine. It cannot infect you with the flu. It simply stimulates an immune response. Now, this being said, there are a lot of anecdotes about people getting the flu right after getting the vaccine. The fact is, you have a different strain or you were already infected before you got the shot. Just as you don't get hepatitis B from the hepatitis B vaccine, you don't get flu from flu vaccine...but wait, even if you did, I thought you said you didn't mind getting the flu?
Point 9: Human Rights and Bullying. Ok, so yes, you as a Canadian, have a right to your decision-making about your own healthcare. No problem with me. Your employer and patients also have a right to ask you to protect those around you and stay healthy in order to work. I wear gloves during procedures because it protects me and the patient. I change the gloves to protect the patients, not me. I don’t ever need to change gloves to protect myself…but I do, because I know it’s important to protect my patients. Don't like these policies? Feel free to go work somewhere else or chose a different career. Feel free to go work where the elderly, young and sick are happy to have the flu. Just let me know where you're going....because I'll be going the other way and taking my family with me.
Unfortunately, the logic and evidence is unlikely to change the minds of those people who are staunchly against flu vaccine. It makes me sad that they are closed to logical arguments and so entrenched in poor science, conspiracy theory and anecdotal evidence that they are willing to put the lives of their patients at risk. This winter, I'll be wearing my "Flu Sticker" on my employee badge with pride. It shows that I care about the people around me. It shows that I care about my health. It shows that I support evidence based practice. I will stand united in herd immunity to decrease the spread of the flu this year. It's part of my job, my career, my profession and my humanity.
Hannah Varto is a family nurse practitioner and an ARNBC Network Lead. She enjoys working as a part of interdisciplinary teams of health care providers. Her career focus has been primarily in the field of sexual and reproductive health, specific to women and adolescent populations. She has worked in a variety of settings including public health, youth clinics, walk-in clinics, telehealth, education, travel medicine, communicable disease and as a sexual assault nurse examiner. Hannah is on the board of directors for the McCreary Centre Society, a leading non-profit organization focusing on adolescent health research. Currently Hannah is leading the implementation of ARNBC’s first community of practice – the BC Contraceptive Management Community of Practice.
It is so important that this constructive message is heard by the public as the perspective of the nursing profession. It is distressing that a counter-message from a nursing organization has attracted so much press. We need to stand together to ensure that the people of BC are well informed about the strong body of available evidence, able to put the contradictory messaging into context, and understand the very serious risks of uncritically accepting the anti-vaccine ideology. As a profession, we all know how to deal with the exceptions in the everyday world of practice. However, it is the general policy that MUST represent our public voice on this issue. Lives will be saved. Many of them. And each one of them matters.
FINALLY. Someone says what most of us are already thinking. When we had a choice to get the shot, something like 60% of us never got around to it, even though we could WIN PRIZES (for being responsible adults and professionals?)
I feel embarrassed that they had to offer nurses prizes in order to do this one small thing that just might save a life. I would do something way more scarier than getting a flu shot if I thought it would save the life of one of my patients.
To add to Hannah and Dr. Thorne's point...it is up to nurses as a profession to set an example for the public. Dr. Samir Gupta states, "...every year we struggle with low influenza vaccination rates in the public and the choices that health care workers make send a powerful message to a public which can either hurt or help vaccination rates. It helps if health care workers practice what they preach." Dr Gupta reminds us that being a nurse is a privilege, not a right. As such, it is a morale and ethical responsibility for nurses and all healthcare workers to protect those we care for by acquiring the flu vaccine. We need to stand up as a profession and send a consistent message to the public that the flu vaccine is not only safe but it saves lives.
In 2003 I recieved the flu shot. I did not feel well the evening of the shot. The next day I was very dizzy and began experiencing vertigo. I had a shower and when I got out I fell due to the vertigo.It seemed to subside and I thought it must just be a bit of a reaction to the shot.
I was working in an ambulatory clinic at the time. The vertigo seemed to subside a bit so I decided to go to work the next day. I answered the phone at work and noticed that I was deaf in the right ear and also became very dizzy again. I went home and got an appointment with a DR.who told me I was getting older and needed a hearing test. I had told him my symptoms and felt he had not listened to my concerns. I was falling with vertigo and unable to sleep well as if I moved during my sleep I would wake with uncontrollable vomiting. I went to a physician I knew from work as I knew she would listen to my concerns. She said the symptoms were either a possible brain tumour or a viral/bacterial infection. She ordered a viral test, and did other blood work and had me seen by a neurospecialist. She stated the viral count was elevated and felt it could be from the "flu shot" . I had an MRI and it was negative for tumor. I researched the side effects of the flu shot and one was Guillian-Barre type symptoms -1 in a thousand. I was the one in a thousand and understand why people are not often told about the side effects because if you knew the side effects it would be frightening. My right ear rings constantly. I have learned to block it out. I was off work for a month . After 3 weeks I went to an acupuncturist and the vertigo went away. The neurospecialist said to never have the flu shot again.That year when I went back to community nursing I made a point of asking patients who had vertigo if they had had the flu shot and there were many. My own Dr. had a severe headache for a week after the flu shot and could not work. My nephew felt ill and had headaches after his shot. I went to report it to the health unit and they stated that I could not prove my symptoms were caused by the flu shot so I was not able to make a report. I went to a small town nearby to go report it at a public health unit there.
When my son had his first immunization he siezured for 4 hours and he is compromized because of it.
My daughter recieved the Hepatitis vaccine when she was in grade 7. One hour after the vaccination, she was in ER with a siezure. The public health nurse phoned when it was time to get the next vaccine and asked why I was not signing papers to allow her to have the vaccine. I asked if she would allow another vaccine if her child had siezured.
My daughter also recieved 60* the dose of live Polio vaccine when she was 2 months old.
Informing clients and parents about side effects is of great importance, so they can be aware if anything should happen. I think the public health nurses need to encourage the reporting of side effects, otherwise the Pharmaceutical companies are not accountable. The studies which show few side effects are often funded by the pharmaceutical companies.
I am not against vaccinations but I am in favour of more education and awareness about the side effects so people can make an informed decision for themselves or thier children.
This year's flu vaccine was stated to be between 18-23% effective depending on what you read.