Should the H1N1 flu vaccine be mandatory for all health care workers?

[ERDoc]

I don't believe that we should be mandated to get a vaccine for a virus that is just going to mutate over time and get stronger. Now I do believe that people who are at rick should get vaccinated but I do not believe that everyone should have to get it.

I also think that this entire "pandemic" is over rated. My service has already had to go through training for the emergency dispensing site for the H1N1 vaccine. I will keep my opinion to myself about how I feel with that.

I think everyone needs to remember just how many people a year die from the regular flu. It sure beats H1N1 but no body is freaking about that.

So you are not worried about a repeat of the 1918 flu which killed 60 million people? It started out rather benign in the spring and was quiet during the summer. Once fall hit it came back with a venegnce and was killing young, healthy people. Was this a one time thing or is history due to repeat itself?

[MedFire]

No actually I am not that worried about what happened in 1918 it may have been a pandemic that killed that many people back the but it is now 2009 and our medical care is a lot better than it was back in 1918. But just remember we are the ones creating these super viruses and bacteria. I'm not saying no one should get the vaccine just saying that I will not be getting one. But hey if we have a repeat of 1918 again you can call me out on it. Don't worry its only my opinion.

[HERBIE1]

I'll withold my opinion for now, but just to add some food for thought. Those that say that it should not be mandatory, does personal freedom outweight public health/safety?

When what is being offered as a benefit for public safety may infringe on MY personal safety, then the public loses.

This is not a completely innocuous idea and has real risks, which I don't think have been fully explored, not to mention the questions of it's actual efficacy. There is a huge rush to get this vaccine to the people and I am afraid they are cutting corners. We are talking about millions of dollars here and the manufacturers have a gold mine on their hands, but it would not be the first time a medication was found to have some real problems later. I'm thinking about Vioxx- a wonder drug for many, including myself, until oops-they later learned it caused an increased risk for cardiac problems.

So you are not worried about a repeat of the 1918 flu which killed 60 million people? It started out rather benign in the spring and was quiet during the summer. Once fall hit it came back with a venegnce and was killing young, healthy people. Was this a one time thing or is history due to repeat itself?

Aren't we just a bit more knowledgeable now on prevention, transmission, and treatment of diseases these days? Do you really think we could have an epidemic of that magnitude here?

[ERDoc]

Aren't we just a bit more knowledgeable now on prevention, transmission, and treatment of diseases these days? Do you really think we could have an epidemic of that magnitude here?

Knowledge by those in the field does not mean that the public is any more knowledgeable. Look at the issues that we had during the spring. People were being told to stay away from the ERs and call their doctors. The doctors were then telling the pts to go to the ER. Even if they didn't have doctors, they were still rushing the ERs. The three hospitals I work at had their highest census since they we open during that period. Just because we have the knowledge does not mean we have the ability. I think there is a great potential for an epidemic of the magnitude seen in 1918 because people are dumb. They will panic and do the wrong things. Do I think H1N1 will be that epidemic, I'm not sure. We are more at risk now than in 1918 because we have become a global community. It will spread from one area to another because of our ability to move around so quickly. I could be infected here in SW Michigan. I could take my family on a trip to Hawaii. On the way I have infected people on the planes, people on the ground in Detroit, LA and Honolulu. All of those people will bring it with them to their final destination thus infecting even more people throughout the world. I'm not one of these doomsday people but I think our ability to contain something should there be an epidemic is poor because of the mindset of people.

[emt11]

Aren't we just a bit more knowledgeable now on prevention, transmission, and treatment of diseases these days? Do you really think we could have an epidemic of that magnitude here?

I believe we are a lot more knowledgeable now than we were in the 1918's. Just look in the EMS field...how long have gloves and protective eye wear been a part of the attire? What about washing hands after using the restroom?? I'm sure that wasn't being taught in the 1918's.

From the CDC website: "For all-cause deaths, CDC estimates that approximately 51,000 deaths are associated with seasonal flu." Seasonal flu never received the same news attention until the N1H1 came around....

It's the flu people....wash your hands and cover your cough

[MS Medic]

I'll withold my opinion for now, but just to add some food for thought. Those that say that it should not be mandatory, does personal freedom outweight public health/safety?

Let me paraphrase Benjamin Franklin (if I have the wrong person, feel free to correct me), if you give up your freedom to the government in the name of safety, you will find yourself with neither.

To give you a good example, I was in the Navy from 1992 to '96. When I was getting discharged, a representative of the Disabled American Veterans informed us that there is documented proof that people in the Persian Gulf during a time that included my first cruise were given a unknown vaccination during our normal cattle call inoculations. At that time the DOD would not admit it and what we were given was unknown. So with that in mind my opinion on mandatory vaccinations is no.

[Just Plain Ruff]

It's sad that we are even having this discussion. What I mean is that we have a vaccine that has from all accounts been rushed to production and distribution and the studies have not been completed.

We have a public health discussion and concern that what is in the public health concern should trump personal choice. That personal choice is sacred if you ask me. I can refuse every medical procedure that is offered me but if we make vaccination mandatory then we take that choice away.

We know more about the spreading of diseases and how to decrease the spread yet we are talking on here of forcing people to get the vaccination. There were mandatory evacuations during hurricane season yet many stayed. That was their choice to stay.

If you refuse the vaccination and I'm still truly on the fence on this one, then if you get sick then by golly, it's your own fault and you need to take responsibility. If you get sick and you are not vaccinated then you pay the piper.

I do think that if you are sick and not vaccinated then if you get sick you need to sequester yourself in your home till you are better.

[HERBIE1]

Knowledge by those in the field does not mean that the public is any more knowledgeable. Look at the issues that we had during the spring. People were being told to stay away from the ERs and call their doctors. The doctors were then telling the pts to go to the ER. Even if they didn't have doctors, they were still rushing the ERs. The three hospitals I work at had their highest census since they we open during that period. Just because we have the knowledge does not mean we have the ability. I think there is a great potential for an epidemic of the magnitude seen in 1918 because people are dumb. They will panic and do the wrong things. Do I think H1N1 will be that epidemic, I'm not sure. We are more at risk now than in 1918 because we have become a global community. It will spread from one area to another because of our ability to move around so quickly. I could be infected here in SW Michigan. I could take my family on a trip to Hawaii. On the way I have infected people on the planes, people on the ground in Detroit, LA and Honolulu. All of those people will bring it with them to their final destination thus infecting even more people throughout the world. I'm not one of these doomsday people but I think our ability to contain something should there be an epidemic is poor because of the mindset of people.

I agree about the potential for transmission. Look at the AIDS epidemic and how it spread. The vectors were amazing and it clearly illustrated HOW such a problem can quickly escalate world wide. I still question the possibility for millions of people to die here from H1N1- especially when we are able to provide treatment for even severely ill patients. Critical care has come a long way since 1918. Does it have the potential to overwhelm the system- sure, but not everyone who becomes infected become so ill they end up on a ventilator in an ICU, will they?

I think that the knowledge we have is a factor in helping mitigate problems and keeping them from getting out of control. I think we have the benefit over 1918 providers because of awareness, early recognition of signs and symptoms, clusters of cases, etc, and we can mobilize to slow and stop the spread of the problem.

Will we still have places in this world where thousands may die- yep. These are also the places where sanitation is poor, lack of medical care, and other resources where similar numbers of people can die from things like starvation, cholera, chicken pox, and the common cold.

I don't think I have blinders on, but I simply think we underestimate our capabilities. I'm most concerned about some thing like a small pox release or other such event(probably intentional) that will take us by surprise.

[Eydawn]

This is not a simple issue.

Here are my thoughts, in no particular order:

1. The influenza vaccine does not afford a high degree of known protection against influenza infection, as Vent so concisely pointed out earlier in this thread. It is impossible to predict which strains will be dominant and the most virulent. Therefore, mandating vaccination really can't be proven to reduce the risk of transmission to the point where those who are opposed to vaccination for various reasons will be convinced of its merit. Also, many people have had personal or anecdotal bad experiences with the flu vaccine- my husband being one of them. Since people are already leery of the traditional influenza vaccine, they are that much more so about the H1N1 vaccine due to its speedy production.

2. Some protection is better than no protection, especially when you take into account the dynamics of population immunity. If you have 30 folks and only 10 of them get vaccinated, any given individual in the population doesn't really have his or her likelihood of infection reduced. If you have 28 of them get vaccinated, the remaining 2 un-vaccinated folks are much less likely to become infected, simply because the other folks are less likely to become infected and the risk of exposure is decreased. This is much more certain with something like polio, where there is a good idea of the effectiveness of the vaccine... the flu vaccine is such a crap shoot in all reality that it's harder to determine whether population immunity would come into play here in any significant form. If you assume that there is something like 40% protection (just for giggles), then population immunity would be significant enough to push for higher vaccination rates. If the effectiveness is only 10%, then it's really not worth the time and effort.

3. The issue of personal choice vs. public safety is ALWAYS a matter of contention. ERDoc raises some very valid questions that I think we shouldn't ignore. I personally feel that the choice to refuse vaccines is one that should be safeguarded, but those who choose to forego mandatory vaccination should also be able to accept that there will be consequences if there is a serious, community threatening outbreak. There is a reason that parents who don't vaccinate their children have to sign legal waivers acknowledging that their children will be barred from attending school during disease outbreaks. If you don't get vaccinated, be prepared to be isolated when the caca hits the fan... (this applies more to say, MMR than it does influenza, because you can titer immunity levels with MMR...)

4. The issue of personal choice is much more difficult where we as healthcare workers are concerned. We work with the populations that are the most vulnerable- the immunocompromised, economically disadvantaged, those who suffer from chronic disease, the very elderly and very young... Is it worth it to insist on your own personal preference at the potential expense of your patients' well-being? You might not get a very bad case of the flu (A, B or H1N1) but that grandma you transported for CHF might die from it if you give it to them. How many of us have come to work sick, knowing full well that we could pass on what we have, because we don't have sick time or have employers who are unsympathetic to illness due to short-staffing issues? Even if the vaccine only buys you 40% protection (again, hypothetical number), it is still statistically better than playing the odds with no protection. I really don't have an issue with employers mandating vaccination- they can tell you how to wear your hair, what treatments you can perform, and what your physical fitness level must be... if they deem mandatory vaccination to be in the best interest of the company and the patients the company serves, that is their prerogative. It is also your prerogative to choose to work for an employer who doesn't institute said policies. Most employers know that it is far better to strongly encourage (and provide incentives for) voluntary immunization, and mine has already developed and implemented a policy regarding flu exposure and infection.

5. Anyone who is more concerned about a WMD pathogen than a natural epidemic is really not looking at things clearly. We're much more threatened by something along the lines of an influenza epidemic than we are by an artificial pathogen release... looking at it solely from the perspective of statistics. Also, the quibbling over "personal rights" would not really be a factor in a WMD attack, as martial law and mandatory quarantine (at the expense of all civil liberties and probably enforceable with deadly force) would be implemented fairly rapidly.

I am going to go think about this a little bit more and see if I have some other things to add. I know that I will probably get the regular seasonal influenza vaccine, as I am asthmatic and work in an assisted living for the elderly. I have not yet decided if I will get the H1N1 vaccine, as I would rather wait to see if there are any statistically adverse reactions, and as the protection I would get wouldn't really kick in until after the peak risk time at this point anyway. If my employer offers it for free, and I don't see bad reactions, I will probably get it.

Wendy

CO EMT-B

[Richard B the EMT]

To give you a good example, I was in the Navy from 1992 to '96. When I was getting discharged, a representative of the Disabled American Veterans informed us that there is documented proof that people in the Persian Gulf during a time that included my first cruise were given a unknown vaccination during our normal cattle call inoculations. At that time the DOD would not admit it and what we were given was unknown. So with that in mind my opinion on mandatory vaccinations is no.

The "Gulf Flu", if I recall correctly? Or similar name?