Ontario paramedics are challenging a provincial regulation that requires them either to get annual flu shots or give up their jobs. The new law, an amendment to the Ontario Ambulance Act, took effect in fall 2000 and is the first of its kind in Canada. Since then dozens of Ontario paramedics have been suspended without pay for refusing to get the mandatory influenza vaccination, prompting numerous protests and a legal challenge.
![Figure](https://www.cmaj.ca/content/cmaj/166/6/796.1/F1.medium.gif)
Figure. It's about choice: paramedics protest compulsory flu shots in Peterborough, Ont. Photo by: Canapress
“They're basically saying if a drug is going to be put into my body [I] want to be able to have some say about it,” says Sid Ryan, president of the Canadian Union of Public Employees, which represents Ontario's 4500 paramedics. Ryan says they are concerned about potential health risks posed by the annual vaccinations.
Paramedics are required to be vaccinated against tetanus, polio, diphtheria, measles, rubella, hepatitis B and chickenpox, but when the province added influenza to that list many paramedics resolved to defy the order. Since then 28 have been suspended without pay across the province and another 30 are facing reprimand and potential suspension if they fail to comply.
The defiance is especially strident in Toronto, where the city's 790 paramedics have launched a Charter challenge. They allege it is unfair that ambulance workers have to be vaccinated against influenza while nurses, doctors and other health care employees do not.
Ontario Health Minister Tony Clement can't understand why the requirement has become an issue. “Whereas other health care professionals have a little bit more say about who they are in contact with within their work environment, ambulance paramedics really don't know what they're going to be in contact with.”
Ryan disputes this, pointing to the fact that firefighters, police and other emergency service workers share identical work environments yet are not mandated to get the vaccination. Many paramedics are also questioning Ontario's aggressive promotion of flu shots as illness prevention. Citing commentaries in CMAJ (2001; 164 [1]: 36-7 and 38-9) about the effectiveness of Ontario's program, Ryan said physicians appear split on the flu shot's usefulness and “paramedics reckon that if the evidence is inconclusive, why should they take it?”
Despite the mounting protests and legal challenges, Ryan is convinced a simple solution is possible. “These are reasonable people,” he said. “I think if you used voluntary incentives and began working with them you would get a really high compliance.” — Brad Mackay, Toronto