Health workers in British Columbia must be vaccinated against flu or wear a mask, new policy says

BMJ 2012; 345 doi: (Published 20 November 2012) Cite this as: BMJ 2012;345:e7860
  1. Charlotte Santry
  1. 1Toronto

A Cochrane reviewer has accused a Canadian health chief of misquoting his work to justify a “tyrannical” policy forcing staff to be vaccinated against flu or wear a mask.

Under the policy, being introduced from 1 December, health workers in British Columbia who refuse to be vaccinated must wear a mask throughout the flu season. All those who have had the vaccine will be given a distinctive badge to wear.

British Columbia’s provincial health officer, Perry Kendall, told the Vancouver Sun earlier this month that a Cochrane review had referenced studies showing that vaccinating workers protected patients from flu and pneumonia and reduced hospitalisations and deaths.

However, the Cochrane reviewer, Tom Jefferson has claimed that Kendall’s comments misrepresent a 2010 Cochrane study that he co-wrote. The study concluded that vaccination had showed “no effect” on laboratory proved influenza, pneumonia, or deaths from pneumonia.1

Where it did seem to affect outcomes, such as in patients with influenza-like illnesses, the reasons were difficult to interpret, it said.

Jefferson told the BMJ, “What’s incredible is [that] the people who keep pushing these vaccines, despite the evidence, keep quoting these figures without understanding what they’re saying.”

Putting pressure on workers to be vaccinated by making them wear badges and masks was “tyrannical,” he added. He highlighted concerns that wearing a mask may not be conducive to communicating effectively with patients.

In response, Kendall said that several other groups, including the British Medical Association, did support flu vaccinations for healthcare staff.

Asked by the BMJ how the policy’s effect on outcomes among patients would be measured, a British Columbia health ministry spokeswoman said this was yet to be decided. Anyone who refused to wear a mask or have the jab would be dealt with “on a case by case” basis, she said.

Most years, less than half of British Columbia’s health workers are vaccinated against flu. Average uptake rates are similar across Canada, but some hospitals already enforce mandatory vaccinations through staff contracts.

The Canadian Healthcare Immunization Network’s research manager, Lois Crowe, said that support for mandatory flu vaccination was “gathering steam” worldwide as authorities recognised it as a “patient safety issue.”

Since 2009 New York state has required all its healthcare employees have the vaccine, and many organisations across the United States reserve the right to sack workers who refuse it.

In the NHS in England healthcare workers have traditionally been reluctant to volunteer for flu vaccination; national uptake across the NHS was 45% in 2011-12, although this was up from 35% the previous year.

Last month England’s chief medical officer, Sally Davies, urged doctors to get vaccinated to set a good example for colleagues and to help to protect vulnerable hospital patients.


Cite this as: BMJ 2012;345:e7860


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