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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

A house divided: Will mandatory flu shots stand?

'Cannot stand'The medical community appears to be deeply divided over a draft federal recommendation that would push the health system toward mandatory flu shot policies for health care workers. The National Vaccine Advisory Committee (NVAC) will consider the recommendation at its Feb. 7-8, 2012 meeting in Washington, DC. NVAC is an advisory committee to the Department of Health and Human Services (HHS). Flu recommendations drafted by NVAC’s Healthcare Personnel Influenza Vaccination Subgroup include the controversial Recommendation 4, which states that facilities failing to reach a 90% immunization level “in an efficient and timely manner, should strongly consider an employer requirement for influenza immunization.” A summary of the comments to NVAC obtained by Hospital Infection Control & Prevention reveals the following breakdowns: Public comment was submitted by 145 individuals including a number of health care personnel across the health care sector. These comments are almost exclusively in response to Recommendation 4 and represent opinions and personal accounts. In general, the majority of individual comments can be categorized into themes:

Individuals that oppose Recommendation 4: • Personal Autonomy (94 responses) • Concern over adverse events (specific to the influenza vaccine) (45) • Concern over vaccine effectiveness (specific to the influenza vaccine) (43) • Concern over vaccine safety (specific to the influenza vaccine) (26) • Concern over exemption policies that did not include religious, philosophical, and personal exemptions (26) • Concerns that there in an insufficient scientific basis for mandatory vaccine policies (23) • Concerns over vaccine safety (general) (20) • Concerns over adverse events (vaccinations in general) (19) • Liability for adverse events under mandatory policies (8)

Individuals that support Recommendation 4: • Support for draft recommendations (general) (10) • Support for draft recommendation 4 (as a patient safety measure) (5)

More evenly divided were public comments submitted on behalf of 37 organizations/ associations in response to the recommendations, with most of them specifically commenting on the mandatory provision. Overall, 15 groups directly stated support for Recommendation 4, including 13 professional associations and 2 non-profit organizations. In contrast, 16 organizations/associations directly opposed Recommendation 4, including 12 labor organizations, 2 non-profits, 1 professional association, and 1 federal agency (OSHA).