US healthcare company fires 69 employees for refusing flu vaccination

BMJ 2017; 359 doi: (Published 24 November 2017) Cite this as: BMJ 2017;359:j5473
  1. Owen Dyer
  1. Montreal

Essentia Health, which operates 15 hospitals and 75 clinics in Minnesota, Wisconsin, North Dakota, and Idaho, has fired 69 members of staff who refused to have the flu vaccine.

Hundreds of other Essentia workers received their flu shots last week after being warned that they would lose their jobs if they failed to meet a 20 November deadline to either be vaccinated or file an exemption request form. The company employs about 14 000 people.

Some of the fired employees had sought medical or religious exemptions, but these were strictly limited to documented evidence of vaccine allergy or of Guillain-Barré syndrome after previous vaccination. Egg allergy was insufficient grounds for an exemption, as non-egg based vaccines are available.

“Just like other people, we had a voluntary program really encouraging our healthcare personnel to get vaccinated,” Rajesh Prabhu, Essentia’s chief patient safety officer and an infectious disease specialist, told NBC News. “In 2012-15 our vaccination rate among healthcare workers was about 7%. The last flu season, we went to mandatory participation. Everyone who worked at Essentia had to say yes or no.”

Though that program achieved coverage of 82%, it was still not good enough, said Prabhu. This year compliance was 99.5%. “You cannot get to a high immunisation rate without some kind of mandatory flu vaccination program,” he said.

Six US states, including California, require all hospitals to vaccinate their workers against flu and to publish their vaccination rates. Maryland has a searchable database of hospital staff vaccine coverage.

Minnesota, where Essentia is based, has no such requirement. It comes 44th out of 50 states in its rate of coverage of flu vaccination among healthcare workers, said Prabhu.

The US Centers for Disease Control and Prevention reported that flu vaccine coverage among health workers was at 78.6% across the US last year.1 Rates are higher in hospitals than in long term care facilities and higher among clinical than administrative staff.

The Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society for Healthcare Epidemiology of America all support mandatory flu vaccination of health workers and oppose religious exemptions.

Essentia is not the first US healthcare provider to fire a large number of employees for vaccine refusal. TriHealth, a provider in the Cincinnati area, fired around 150 employees for refusing flu shots in November 2012.

Essentia’s move was criticised by several unions, and the United Steelworkers unsuccessfully sought an injunction to block the firings. The Minnesota Nurses Association and the American Federation of State County and Municipal Employees lodged complaints with the National Labor Relations Board.

Steve Strand, negotiator for the Minnesota Nurses Union, told the Minneapolis Star-Tribune, “Essentia Health showed nurses they did not intend to bargain with us in good faith. We tried to sit down with management, but Essentia executives told us they intend to follow through with terminations and mandatory flu shots regardless.”

Prabhu said that healthcare providers had to be stricter than other types of employer. “We are working in a different environment. We’re taking care of patients. We have a different sort of ethical obligation,” he said.


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