Flu Epidemic Leads to Mandatory Vaccinations

With cases of the flu reaching epidemic levels this season, both public and private entities have begun to mandate flu vaccination.

Photo by Daniel Paquet

Although the Ebola virus stirred a national scare in late 2014, it was far from being classified as an epidemic.  Surprisingly, this year’s flu virus has caused even greater concern among health officials from the Centers for Disease Control (“CDC”), who have indicated that “we are in the midst of this season’s flu epidemic.”

The CDC estimates approximately 3,000 to 49,000 people in the United States die from the flu virus annually.

Influenza remains as one of the top ten leading cause of deaths in the United States.  The CDC estimates approximately 3,000 to 49,000 people in the United States die from the flu virus annually.  With the flu season currently at its peak, twenty-two states and Puerto Rico have reported high flu activity with laboratory-confirmed cases of the flu virus as well as hospitalization.

Out of the twenty-two states manifesting high flu activity, South Carolina has been one of the most heavily affected states with 28,000 confirmed cases of the influenza virus and twenty deaths from flu complications.  North Carolina, on the other hand, has recorded eight influenza-related deaths through December 20, 2014.  The worst of the flu activity in North Carolina this season has occurred in the western part of the state, leading some hospitals in that region to restrict family visits in order to help control infections.

Multicare Health System, a non-profit organization based Washington state, is requiring nurses at its hospitals in Tacoma and Puyallup to obtain flu shots or make a plea to a special committee explaining why they should not get vaccinated.

The strain of flu virus circulating this season is a type called H3N2, which tends to spread widely and cause serious illness.  The effect of the flu season reaching epidemic proportions has spurred some healthcare systems to mandate adult flu vaccinations.  While the CDC merely recommends that everyone get a flu shot, some hospitals have gone one step further by conditioning continued employment upon receiving the flu shot.  Multicare Health System, a non-profit organization based Washington state, is requiring nurses at its hospitals in Tacoma and Puyallup to obtain flu shots or make a plea to a special committee explaining why they should not get vaccinated.

As a result of the mandate, nurses at Tacoma General Hospital and Good Samaritan Hospital fear that they risk losing their jobs if they do not comply.  While one nurse has already been suspended, others chose to get vaccinated over their personal or religious objections.  The union representing the nurses has filed a lawsuit against Multicare, alleging that vaccination should be voluntary and that those not getting the flu shot could instead heed the CDC recommendation by wearing a protective mask.  Multicare issued a statement stating, “[w]e know that the flu vaccine is the most effective way to protect our patients and our health care workers.  Requiring an annual immunization demonstrates our commitment to protect the safety and health of our patients, as well as visitors, co-workers, and our families.”  The lawsuit pending in Pierce County Superior Court will be heard on April 10, 2015.

This is not the first lawsuit commenced by a union group against a healthcare system over mandatory flu vaccinations.  In September 2014, the Massachusetts Nurses Association (“MNA”), a union representing 3,200 nurses, also filed a lawsuit seeking to prevent a hospital from requiring flu vaccinations.  Brigham and Women’s Hospital in Boston proposed a policy requiring nurses to get flu shots in an effort to improve the influenza vaccination rate among health care workers.  The policy, which was not yet effective at the time of the lawsuit, also allowed employees to decline the vaccine for medical or religious reasons.

A spokesman for the MNA commented, “every employee has a right to decline.”  The spokesman also distinguished the requirements between polio and measles vaccinations and the influenza vaccine, commenting that the influenza virus requires vaccinations every year in addition to being reformulated to protect against the flu strains prevalent during that season.  Furthermore, with other control measures in place, such as wearing a mask, nurses can protect patients in ways other than receiving a flu vaccination.  A spokeswoman from Brigham and Women’s Hospital responded that the MNA “is putting a pet peeve of theirs above the safety and well-being of the patients they serve, their families, visitors to the hospital, and their colleagues.”

With the growing number of pediatric flu-related deaths, New York City has adopted a new rule implementing a mandatory flu vaccine for children between six months and five years of age.

Despite debates over mandatory flu vaccinations for health care workers, many people still refuse to get vaccinated.  Although the flu vaccine being offered this year may be less effective because the virus has mutated, the CDC still recommends people get vaccinated.  “We’re not even halfway through the flu season,” says Dr. Michael Jhung of the CDC.  “It’s certainly not too late to get vaccinated.”

The influenza virus this season has plunged almost half the nation into an epidemic, and has affected both adults and children.  The flu has been attributed to fifteen children’s deaths this season, including a four-year-old boy from Texas and a seventeen-year-old Minnesota teenager.  The number of children killed by the flu significantly increased during the 2013 season.  While the 2011-2012 season saw thrity-seven deaths, the 2012-2013 numbers spiked to 171 deaths.  Additionally, the 2013-2014 flu season experienced 109 pediatric flu-related deaths.

With the growing number of pediatric flu-related deaths, New York City has adopted a new rule implementing a mandatory flu vaccine for children between six months and five years of age.  The rule, adopted by the city’s Department of Health and Mental Hygiene, calls for one flu vaccination between July 1 and December 31 of each year.  Beginning in 2016, the city will begin charging fines ranging from $200 to $2,000 to schools whose students do not follow the rule.  Consequently, the city’s Department of Education sent letters to parents warning that children who were not vaccinated would be excluded from class.

Opponents of mandatory pediatric flu vaccination expressed two main medical concerns, allergic reactions and the vaccine’s efficacy.  While the flu vaccine can cause severe allergic reactions leading to injuries and even deaths, federal officials from the U.S. Department of Health and Human Services stress that the vaccine may not be the direct cause of the injury.  There are also concerns about this year’s vaccine efficacy.  While a flu vaccine is expected to be about sixty percent effective each year, the vaccine this year is less effective because of the evolving strains of influenza.  Therefore, even though vaccination may reduce the seriousness of the illness, it may not offer perfect protection.

The National Autism Association also expressed additional concerns involving a link between vaccination and autism.  Although no link has been confirmed, Kim Mack Rosenberg, president of the New York metro chapter of the National Autism Association added, “[i]t is a requirement that is putting a burden on children and no one else.  Adults aren’t generally required to get the flu vaccine, and we are asking our most vulnerable children to get it.”

In response to concerns from opponents, New York City has allowed families to apply for religious or medical exemptions from the flu vaccine.  Moreover, although the city insists on charging fines, it cannot force the school principals or directors to exclude children who do not comply because the flu vaccine is not mandated by the state.  Rather, it will be up to each school to decide whether to exclude unvaccinated children, or to incur fines.

While the flu may be something we all hope to avoid each season, it has prompted increased panic this season (compared to the Ebola virus) because of its deadly streak. Having reached epidemic levels, states are taking action attempting to mandate flu vaccinations. While it is still not too late to get vaccinated, people should be mindful of allergic reactions and should consult their physician to discuss whether the flu shot is best for them.

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About Snehal Trivedi, Former Senior Staff Writer (16 Articles)
Snehal Trivedi served as a Senior Staff Writer for the Campbell Law Observer. She is originally from New Jersey and received her Doctorate in Pharmacy from the University of the Sciences in Philadelphia. Following her first year of law school, Snehal worked as a Summer Associate for K&L Gates and assisted a local attorney researching relevant case law pertaining to interlocutory appeals. She graduated from Campbell Law School in May 2015.
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