The BC health care worker influenza protection policy is an evidence-supported, systematically implemented, and ethically defensible program that has successfully improved influenza vaccine coverage among health care workers in the province and, as a result, improved protection for our vulnerable patients. In response to Mr Offley’s critique of the policy, we present the following evidence.
First, the policy is supported by the majority of health care workers in BC, according to a recent survey, and has been upheld as reasonable at arbitration in BC.
The policy is, in fact, predicated on several factors: • The universal recommendation that health care workers receive annual vaccination against influenza.[2,3] • The failure in Canada of voluntary programs to achieve anything close to high coverage levels. • The evidence that high vaccine coverage provides patient/resident protection.[5-9] • The fact that health care workers can and do transmit influenza to those they care for, and they do work while sick and may transmit influenza while asymptomatically shedding virus.
The BC policy recognizes that health care workers have the right to refuse vaccination and provides them the option to wear surgical masks in patient care areas during influenza season when influenza is circulating in our communities. There is evidence that masking will reduce influenza virus transmission,[11-22] and while the body of evidence is not as robust as that supporting influenza immunization, it is at least as strong as that supporting hand washing in the prevention of nosocomial transmission. Where evidence is lacking (as described in testimony to the arbitrator in Ontario that Mr Offley quotes) is on the issue of whether there is any additional benefit to an individual wearing a mask over and above immunization.
It is recognized that the current technology for making influenza vaccines produces less than optimal effective antigens. The continuing annual drift in viral antigens is challenging and does result in varying degrees of protection from year to year (from the low of 13% in 2014–15 to over 80% in 2010–11 in Canada with an accepted average of 60% protection over many seasons).[23,24] Nonetheless the great majority of infectious disease specialists and influenza experts continue to recommend that people get vaccinated against influenza if they are at higher risk of severe influenza or complications from influenza or if they are in contact with higher-risk individuals.
While a universal vaccination and mask policy might be the logical approach in the face of vaccine and circulating virus uncertainty, the BC policy seeks a balance of protection of the health care worker and the patient without posing undue hardship on health care workers. As Mr Offley observes, “masks are extremely uncomfortable to wear for 12 hours a day continuously over a 4-month period.”
Consistent application of the policy in BC has been recognized since its inception as a very important feature and considerable resources are spent on this. That some unvaccinated health care workers may seek to subvert the program by inferentially claiming vaccination status by not wearing a mask is regrettable, but fortunately it is not a characteristic of the overwhelming majority of our professionals.
Vaccinate or mask is a coherent policy based on the time-proven ethical principle primum non nocere (first, do no harm).
Dr Henry is Deputy Provincial Health Officer, British Columbia. Dr Perry Kendall is Provincial Health Officer, British Columbia.