Don’t coerce healthcare workers

WHAT A TALENT Governor Paterson’s administration has for mixing the best of intentions with the worst political skills imaginable. Some of these missteps only hurt the officials who make them, but the unfortunate decision to require mandatory H1N1 swine flu vaccinations for healthcare workers in this state could have far wider and more profound consequences.

Some people fear all kinds of vaccinations regardless of the evidence. Others believe that concern over the H1N1 variant of the influenza virus is overblown. After all, the state Department of Health says that statewide the number of cases is low and holding steady. Maybe this version of the virus will just peter out.

Public health experts don’t share that optimism. Last spring the HH1N1 virus spread with startling speed from Mexico to the rest of the planet in a matter of weeks, just as the experts predicted would eventually happen with some sort of bug. Compounding matters, the new swine flu virus upset previously held notions about the “flu season,” usually the winter. This flu caused illnesses that appeared well into the spring and summer.

The first cases reported at Columbia Memorial Hospital drew attention, but public concern has faded here and elsewhere, because this H1N1 flu has killed relatively few people. But the overall profile of the victims is disturbing. The high risk groups include pregnant women, healthy children and young people from 19 to 24 years old. The flu usually preys on the elderly and people with pre-existing health problems, but this one affects people whose immune systems should shrug off a common infectious illness. That’s creepy.

Then there’s history. A great aunt of mine, who often told stories from her youth, spoke only once about the flu. She had lived in Washington, D.C., during the great flu pandemic of 1918-19. “You have no idea how many people died,” she said quietly. It’s true. That plague was lost in the history books until the last few years. Hundreds of thousands of people in the U.S. died, and the possibility of something like that happening again has driven the current policy of preparedness.

A new vaccine that appears to offer a significant amount of protection from the H1N1 flu virus is in production, so the question now becomes who should have access to it first. The obvious answer includes the high-risk groups mentioned above as well as healthcare workers, who have a higher likelihood of exposure to the virus because of where they work. These workers also need it to remain healthy so they can care for the influx of people who have the flu.

The federal Centers for Disease Control and all states but one recommend that healthcare workers get vaccinated against the H1N1 flu. In New York, the state is requiring that hospital and certain other healthcare industry employees be immunized or lose their jobs. This is a foolish demand because it is unenforceable and could cause more problems than it cures.

The state has no needle police, so in typical fashion, Albany has placed the burden of enforcement on the hospitals. If serious cases emerge at a pandemic scale this fall and winter, that would put hospitals in the untenable position of having to fire workers at just the time when demand for their services is greatest. Some percentage of those people not vaccinated will get the flu, depriving hospitals of their services. But unlike dismissed workers, they will come back to their jobs.

In the meantime the state order nurtures the paranoia of people susceptible to the easy answers of anti-vaccination junk science and reinforces skepticism about the ability of government to manage healthcare.

Everyone who works in a licensed healthcare facility should get vaccinated against both the H1N1 and seasonal strains of flu. Those who don’t believe in or trust approved vaccinations have an ethical obligation to find some other line of work; they pose a risk to patients. But state coercion is not the answer.

The state should rescind its blanket mandate and instead grant individual hospitals the tools they need to identify and address the problem of employees who refuse to cooperate with vaccination guidelines. Those tools should include dismissal if the pandemic grows in severity. But until things get worse, the hospitals’ efforts to foster ethical behavior may yield new ideas for dealing with a threat that operates on a timetable beyond our control.

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