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HEALTH POLICY AND ETHICS: Olga Anikeeva, Annette Braunack-Mayer, and Wendy Rogers Requiring Influenza Vaccination for Health Care Workers Am J Public Health 2009; 99: 24-29 [Abstract] [Full text] [PDF]

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Influenza Vaccination and Health Care Workers: What About the Patients?

Christian T. K.-H. Stadtländer, PhD, MPH, MBA   (16 January 2009)

Influenza Vaccination and Health Care Workers: What About the Patients? 16 January 2009
Christian T. K.-H. Stadtländer, PhD, MPH, MBA, Microbiologist and Epidemiologist University of St. Thomas, EdD Program, College of Applied Professional Studies, Minneapolis, USA Send letter to journal: Re: Influenza Vaccination and Health Care Workers: What About the Patients? stad0077{at}stthomas.edu Christian T. K.-H. Stadtländer, PhD, MPH, MBA	Anikeeva et al. (1) analyzed the ethical dimensions associated with the low annual influenza vaccination rates of health care workers (HCWs) by focusing primarily on this group. I would like to provide some ethical arguments from the point of view of patients since this group is most vulnerable and is the main reason for the employment of HCWs. Let's assume the following scenario: A patient visits a health care clinic and after he had left developed the flu. It was determined that a HCW at the clinic who refused influenza vaccination came in close contact with the patient and transmitted the virus. What could the patient think? The patient may ask: "Why is the clinic employing a HCW who makes patients sick?" The patient could interpret the behavior of the HCW as egoistic because it appears he pursued primarily his own interest (i.e., he chose not to get vaccinated) and thus did not care much about the patient's health (theory of egoism; Baier [2]). The patient could also argue that the HCW missed the opportunity to express a positive character trait by demonstrating personal and professional integrity in that he did not respect the patient (and himself) enough to protect him (both) from disease (virtue theory; Pence [3]). It is also possible that the patient would ask: "Does this clinic not have a program in place to ensure that HCWs are vaccinated?" The patient could point out that it is the clinic's responsibility to minimize the risk of nosocomial infections. Thus, the patient could argue the clinic missed the opportunity to maximize utility in that all people (including patients and HCWs) could have experienced the good of the prevention efforts of the clinic (theory of utility and the good; Goodin [4]). Finally, the patient needs to ask himself: "Did I get vaccinated this year?" This discussion shows that i) there are significant ethical tensions between the key players in this scenario, ii) a clash between individualistic (in its extreme: egoistic) and collectivistic behavior is likely, and iii) annual influenza vaccination programs require all key players to participate and focus on the common good. When individualism turns into egoism the society will suffer and infectious diseases can spread. A solution to the problem could be replacing "the idea of the individual as a social atom with the idea of individuals in their social roles within an organic community" (theory of rights; Almond [5, p. 267]). References 1. Anikeeva O, Braunack-Mayer A, Rogers W. Requiring influenza vaccination for health care workers. Am J Public Health. 2009;99:24-9. 2. Baier K. Egoism. In: Singer P, ed. A Companion to Ethics. Malden, MA: Blackwell Publishing; 1993:197-204. 3. Pence G. Virtue theory. In: Singer P, ed. A Companion to Ethics. Malden, MA: Blackwell Publishing; 1993:249-58. 4. Goodin RE. Utility and the good. In: Singer P, ed. A Companion to Ethics. Malden, MA: Blackwell Publishing; 1993:241-8. 5. Almond B. Rights. In: Singer P, ed. A Companion to Ethics. Malden, MA: Blackwell Publishing; 1993:259-69.