Letter to Colorado Public Health Officials on Mandatory Influenza Vaccine for Health Care Workers

AAPS, a national organization of physicians in all specialties, objects to the mandatory immunization of health care workers (HCWs).

Fewer than half of American HCWs choose to be immunized annually against influenza. We believe that the professional judgment of these workers should be respected.

The proposed Colorado policy requires that facilities inform workers of the benefits and risks of influenza immunization. It does not specify what these are. What is the purpose of this information if workers are not allowed to make a decision based upon it? What provisions are made for indemnifying workers who experience an adverse effect, some of which can lead to death, hospitalization, or long-term disability?

In the age of “evidence-based medicine,” it is shocking that there is so little evidence that the influenza vaccination program is effective. Indeed, there is evidence that it may be ineffective (http://www.jpands.org/vol11no3/geier.pdf). Safety data are reported in very few studies: only five randomized studies with 2,963 observations extending only one week after the injection. In fact, the coordinator of the vaccines section of the Cochrane Collaboration called for an urgent reevaluation of the UK’s influenza vaccination program (Jefferson T, Influenza vaccination: policy versus evidence. BMJ 2006;333:912-915). In particular, the safety of many repeated similar vaccinations is not addressed. Allergic, anaphylactic, hyperimmune, and dysimmune reactions are possible.

The New Mexico study cited in support of the policy, which is unfortunately not made available in its entirety, shows only a tiny effect: an adjusted odds ratio of only 0.97 for confirmed influenza incidence in long-term care residents upon increasing vaccine coverage.

I am not aware of any studies of the relative risk of transmission by unimmunized workers compared with immunized workers who may have a subclinical, asymptomatic illness with viral shedding.
If there is an outbreak of novel, virulent influenza, routine immunization will not be protective and may actually increase susceptibility (Globe and Mail, Sep 29, 2009, cited in Doctors for Disaster Preparedness Newsletter, September 2009).

The proposed religious exemption is grammatically flawed and incoherent. It refers to an exemption based on a “religious belief,” but then refers to the “teachings” of such belief. Section 10.7(A)(2). A belief by itself does not “teach.” Belief, as in an individual’s interpretation of the Bible, should be adequate without requiring a “teaching.” Better yet, to avoid inquisitions into matters of faith, the religious exemption should be changed to a philosophical exemption as already recognized in many states.

The mask requirement is particularly unjustified. Unless the physician has reason to expect that he is carrying a virus, it is senseless to insist that he always wear a mask. Patients are likely to become needlessly alarmed, and care will be slowed down by such a requirement. Those who are vaccinated could transmit influenza or other infectious disease just an unvaccinated person could. The mask requirement seems to be nothing more than a punitive retaliation against those who decline the vaccine. The mask requirement should be dropped.

AAPS recommends that vaccine and relevant information be made conveniently available to all who wish to receive it, and that the right of Americans to make their own medical decisions should be respected.

Jane M. Orient, M.D., Executive Director
Direct line: (520) 323-3110, .(JavaScript must be enabled to view this email address)