In the SARS commission report, Spring of fear, Justice Campbell stresses the importance of the precautionary principle and that “we cannot wait for scientific certainty before we take reasonable steps to reduce risk”1 In their CMAJ article, Gardam and Lemieux2 questioned the merit of mandatory influenza vaccination policies for health care providers because of relatively poor vaccine efficacy (approximately 60%) and what they consider inadequate evidence.
Influenza vaccine is safe and provides net health benefits to both health care workers and their patients. Although we all want better vaccines, we use what is available. The 7-valent pneumococcal vaccine was just over 60% effective when introduced and the quadrivalent human papilloma virus vaccine in use protects against about two-thirds of cervical cancers.
Influenza vaccines are improving; the adjuvanted monovalent pandemic vaccine was over 90% effective.3 Flu vaccination reduced the risk of flu-related hospital admissions by 76.8% in study participants 50 years of age and older during the 2011–2012 season.4 Gardam and Lemieux2 do not clarify the acceptable level of effectiveness or how we decide this before the arrival of the virus and clarification of the virus–vaccine match. Influenza vaccine is clearly “good enough” to save the lives of many patients. The threshold for not acting in the face of good evidence supporting patient safety should be high.
In their review of the ethical considerations, Ottenberg and colleagues5 found overwhelming scientific, ethical and legal justifications supporting mandating health care worker vaccination. They emphasized the professional obligations to benefit individual patients, to do no harm and also to protect public health in the face of preventable infectious disease.
Gardam and Lemieux2 suggest that mandatory vaccination may be legally challenged with implications for other mandatory programs. No evidence is provided to support this and mandatory vaccination is increasingly widespread in the United States, where institutions defending challenges on the basis of patient safety have won their cases.
If mandatory vaccination is a step too far for some of our colleagues, the British Columbia model is a well-rehearsed alternative. Staff unwilling or unable to be vaccinated can opt to wear a mask all winter. A large number of facilities using this model in the US have achieved coverage rates of 95%.