Dear Colleagues

Below you will find a copy of a letter we sent several weeks ago to Mr. Graham Whitmarsh, the BC Deputy Health Minister. This letter addresses the concerns we share regarding the current BC influenza policy of compulsory vaccination-or -masking for all provincial health care providers. We are making it public in the hope that it contributes to sparking a discussion as to the shortcomings of the current policy, and in the hope that this discussion can help articulate other measures we can all be taking to reduce the transmission of influenza and influenza-like illnesses. If you agree with the points raised in our letter, we would like to ask that you forward it on to any of your colleagues and co-workers who you believe would be interested in it.

If you would like to be kept in touch with on this issue, we urge you to send us your personal email address, and you will be sent further updates in the future.

We will forward you Mr. Whitmarsh's response when it becomes available.

Yours truly,

Tamara Ballard RN
Christine Davie RN
Tracy Johnson RN
Will Offley RN
John Tino RN
Cindy Vanderbyl RN
Tracy Visser RN

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Mr. Graham Whitmarsh
Deputy Minister of Health
Province of British Columbia

Dear Mr. Whitmarsh,

Last November 30 you sent a letter to the CEO's of B.C.'s six health authorities announcing the temporary suspension of the disciplinary provisions of the province's new influenza policy. Prior to this, health care workers were expected to get the flu vaccination or wear a mask throughout the flu season, and those refusing to do so faced possible disciplinary action up to and including dismissal. Your letter went on to state "I would like to afford health care workers the additional opportunity to voice their opinions on how best to achieve our shared objective.... It is my hope that, through the forthcoming dialogue, we can establish a shared vehicle for moving the policy forward."

We welcome this opportunity for dialogue, and are submitting this letter as an initial contribution in the hope it sparks further contributions from others - the physicians, nurses, therapists, paramedics, support staff and all those involved in providing health care and/or providing the services that make it possible. However, we think this debate needs to be somewhat broader if it is to be a fully productive discussion. It should encompass the content of the influenza policy itself, not just the issues concerning how the policy is to be carried out.

Our opposition to the current flu policy is based above all on the understanding that there is no scientific evidence to indicate that immunizing health care workers against the flu reduces the transmission of influenza to our patients. On September 8, 2010 the Acute Respiratory Infections Group of the Cochrane Collaboration reported on five research studies which "found that vaccinating healthcare workers who look after the elderly in long-term care facilities did not show any effect on the specific outcomes of interest, namely laboratory-proven influenza, pneumonia or deaths from pneumonia...." On the basis of this, the Cochrane Collaboration concluded "there is no evidence that only vaccinating healthcare workers prevents laboratory-proven influenza, pneumonia and death from pneumonia in elderly residents in long-term care facilities." (T. Jefferson and T.J. Lasserton "Influenza Vaccination For Healthcare Workers Who Work With The Elderly, http://ow.lv/fF6bW , emphasis added)

The October 2012 University of Minnesota CIDRAP study arrived at the same conclusion, noting that U.S. policies adopted in 2006 aimed at promoting compulsory influenza vaccinations for health care personnel could provide no compelling scientific evidence that this did actually reduce transmission of the flu from health care staff to patients. (The Compelling Need For Game-Changing Influenza Vaccines, Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, October 2012, pp.54-64, online at http://ow.ly/fF6qs)

These findings above completely contradict the stated basis for the flu policy - the presumption that vaccinating healthcare workers will reduce the transmission of flu to our patients.

More than that, we believe the current provincial flu policy fails to reflect the values we believe the health care community should operate on. Specifically, we believe that in addition to being a policy that fails to demonstrate a grounding in scientific evidence, it is coercive rather than persuasive, it constitutes an invasion of privacy, it nullifies informed consent, and it is not even internally consistent.

A coercive policy - We have no objections to the health authorities attempting to persuade employees to receive flu shots, or holding vaccination clinics. We believe that staff who wish to receive vaccinations should be free to do so. Our opposition to the policy is that it is a coercive one, backed up by the threat of future sanctions up to and including termination for those who do not comply. While these measures are temporarily on hold, your letter made it quite clear that this would end by the 2013-14 flu season.

A breach of privacy - The policy requires all staff to wear stickers indicating they have been vaccinated, or else to wear a mask, and in so doing has the effect of requiring staff to publicly disclose private medical information (i.e. whether they have been vaccinated or not).

A nullification of informed consent - All of our clinical practice is based on the premise that a competent patient at all times has the right to make an informed consent to any medical procedure. Requiring health care staff to receive vaccinations or else face termination removes our right to make (or withhold) our consent to an invasive medical procedure.

An internally contradictory policy - In its current form the policy is not even internally consistent. We will provide two examples. First, the policy requires health care staff to produce proof of vaccination or else to put on a mask, but it makes no such requirement for visitors. A second example is that we are being sent different messages around management's expectations in regard to reporting unvaccinated coworkers who are not wearing masks. One document states "you are asked to report this behaviour your supervisor" (Health Care Worker Influenza Control Programme, Questions And Answers, p.8). But another document contradicts that, stating instead "individuals who witness any instances of noncompliance with this policy are required to report the incident of non-compliance immediately to their supervisor." (VCH, Influenza Control Program Policy, p.2., emphasis added)

For all these reasons, we ask that the disciplinary provisions of this policy be withdrawn permanently. We would prefer instead to be discussing all the ways we can contribute to lessening the risk to our patients, whether through more consistent handwashing, improved housekeeping standards, encouraging staff to stay home when sick or any other measure.

We look forward to your response this letter and to continuing this dialogue.

Yours truly,

Tamara Ballard RN
Christine Davie RN
Tracy Johnson RN
Will Offley RN
John Tino RN
Cindy Vanderbyl RN
Tracy Visser RN

ooops....link is http://focusonline.ca/?q=node/447 Read it all if you have the time, it's rather good. 🙂

THE COST in B.C alone is over $18,000,000 per flu season to vaccinate.

Are you frigg'n kidd'n me? With so much needed in the way of research, hospitals, staff...we're spending our tax dollars on mass vaccinations that are backed up by highly flawed statistics!! ....

"This is not a trivial, or inexpensive question. BC already buys 1.1 million doses of vaccines each year to provide to those in the province who want one, at a cost of about $17.5 million. Moving to 95 percent coverage of BC’s health workers (assuming about 110,000 health workers) would cost in the neighbourhood of $1 million more per year."

If you slide it forward until 17:40 mark - the story appears. (only 4 minutes long - ends 21:12)
http://www.cbc.ca/player/News/TV+Shows/The+National/ID/2309263526/

BCNU cites evidence from Cochrane Collaboration which is credible and denounces the utility of the flu shot for health care workers. If there is NO proof that health care workers are the vector how could ARNBC support a policy NOT based on credible evidence. As the link above shows, PHAC is not citing credible facts.

Influenza is just another vaccine that we require as people who have chosen to care for the most sick and vulnerable. I'm proud to wear my flu sticker and to tell my patients that I am fully immunized because I care about my health, my family's health, their health and the health of my community.

From a more selfish point of view, when my colleagues are off sick with the flu for 2 or more weeks, the unit may work short (especially during holiday season). It's frustrating that those of us who stay healthy and prevent the flu have to cover for those who didn't. Even if people don't get paid for the sick time, the rest of the team still suffers.

Thanks Lisa,

It sound like you're 'Pro Choice'....as am I !!

An open, unbiased, non coercive discussion on the evidence is what we all need. Wonderful.

🙂

I don't think I have much to add to the discussion, except I really appreciate the wide variance in opinions that have been shared here. I'm learning a lot from both sides of the debate, and I think it's really healthy to host a conversation like this.

I feel like I will get the flu shot this weekend because that's the best choice for my family and I. But I understand that there are a lot of people who won't want to get it, and I respect that choice too. Tara, I've really appreciated your views on all of this and I'm glad that you've spoken up. Thanks for sharing your thoughts. And thanks to ARNBC for letting this discussion take place on the website. It's really great.

"Flegel points to a 2010 study published in the same journal that concluded 55 per cent to 65 per cent of doctors don't get an annual flu shot."

That is from a CBC article...So my next question, would be...why? Why do the majority of Doctors choose NOT to get the flu vaccine? There must be a reason for that statistic and I find it very illogical to claim Doctors are just lazy, misinformed, highly irresponsible, or just too plan stupid to make an informed decision.

So...why? Could it possibly be that they question the science?

Ben Goldacre Ted Talk, (move it ahead half way perhaps), he actually goes on to talk about Tamiflu. The way he ends the..."sunlight is the best disinfectant!" and I agree whole heartedly 🙂

http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

My worry is that, by using public media to challenge the quality of the evidence associated with this policy, nurses may be inadvertently triggering a heightened sense of confusion among the general public as to whether flu shots are safe and effective. From my perspective, we need to be strong, clear and consistent with this message, as it will save lives.

At the same time, I do not believe that vocal support for the new policy has to detract from the very real concerns individual nurses may have if they are unwilling or unable to get immunized. As happens with all policy processes, the devil may be in the details. I hope we would all urge health authorities, employers and professional practice leaders to consult directly with nurses at the front lines of practice. So often it is those most closely affected who will come up with creative and workable measures to keep patients safe while preserving the rights and dignity of the professionals. But that’s an argument that should not be front page news if it puts patients at risk by complicating the message about why flu shots are a good idea. The public trusts us for a reason!