Mandatory flu shots for health-care workers should be put on hold until there is a more effective influenza vaccine, a prominent infectious diseases specialist says.
In a commentary published in this week’s issue of the Canadian Medical Association Journal, Dr. Michael Gardam argues that making the vaccine mandatory could lead to legal challenges that may not be winnable, given the modest efficacy of the vaccine.
Gardam, who is pro-vaccine and who gets a flu shot annually, is essentially arguing that this is not a hill worth dying for.
“Any sort of policy decision where you’re going to make a vaccine mandatory is going to be an uphill battle, right? It’s going to be a real fight,” said Gardam, who is head of infection control at Toronto’s University Health Network.
“And so you have to decide if you’re going to make that fight, is this vaccine worth it to make that fight? And I personally don’t think it is.”
The commentary was swiftly rebutted by influenza vaccine proponents, who countered that it’s faulty logic to link the fact that the vaccine could be better with the question of whether mandatory flu shot policies for health-care workers are legitimate.
“The premise of a relationship between those two things just doesn’t make sense,” said Dr. Allison McGeer, head of infection control at Toronto’s Mount Sinai Hospital and a vocal advocate for mandatory flu shot policies for health-care workers.
“Yes, influenza vaccine is only 60 per cent effective. Yes, we very clearly need better influenza vaccines, because despite fairly widespread use of a vaccine that’s 60 per cent effective there’s still a lot of morbidity and mortality” – illness and death – “due to influenza.
“The fact that we need a better vaccine does not mean that our current vaccines are not useful. We need better treatments for cancer too, but we’re not going to stop treating people for cancer because our treatments are not perfect.”
The commentary and the heated discussion that will surely follow its publication flow from an evolving debate within infectious diseases circles over flu shots.
One of the only tools available to combat influenza, flu vaccine used to be thought to be between 70 and 90 per cent effective at preventing illness in healthy adults, though less effective at protecting the elderly and young children.
But in recent years, the efficacy estimate has taken a big step back, with the U.S. Centers for Disease Control and Prevention now suggesting the vaccine protects about 50 to 70 per cent of healthy adults who get a shot.
Some infectious diseases experts have rallied to the vaccine’s defence, arguing that 50 to 70 per cent protection is still sizable. But others see support for the existing vaccines as undermining efforts to push the pharmaceutical industry toward finding ways to make better flu vaccines – products that last longer and protect against more strains of the always-changing virus.