The American Public Health Association (APHA) considered a "late breaker" resolution at its annual meeting earlier this month that would have supported mandatory vaccinations, but tabled the resolution after opposition was raised by the group's occupational health and safety section. The resolution will now go through a longer review process as it is considered for approval. It was written and submitted on Nov. 7 by the public health nursing section of APHA.

Jo Anne Bennett, an APHA governing council representative of the public health nursing section, said voluntary programs have generally been ineffective in ensuring that an adequate proportion of health care workers are vaccinated to provide "herd immunity." "We look at the resolution, not only from the science perspective, but also from the ethical perspective of health care workers' responsibility," she said. Bennett said she was disappointed that the resolution wasn't discussed further at the governing council meeting and instead was deferred for discussion next year.

She noted that the resolution was supported by a number of other APHA sections, including the epidemiology, maternal child health, gerontology, school health and education and HIV/AIDS groups. It was also supported by some state affiliate representatives, she said.

The proposed resolution notes that CDC has recommended annual influenza vaccination for decades. It backs the idea of state health departments and other regulatory agencies requiring "influenza vaccination of health care workers as a precondition of employment and thereafter on an annual basis, unless medical contraindication recognized in national guidelines is documented in employee health service or vaccine supplies are inadequate." It also encourages other stakeholder groups to endorse a similar position.

However, members of the occupational health and safety section of APHA submitted written opposition to the draft resolution, which eventually led to it being tabled. The opposition statement calls the proposal a "flawed public health policy" and adds that "a number of the justifying statements are incorrect." It also states that "APHA should not adopt coercive recommendations," particularly as efforts are being made to encourage health care workers to get vaccinated in other ways. The health and safety section suggests in the statement that a substitute resolution be drafted to encourage CDC and state health departments to adopt regulations that would require employers to conduct education programs to increase vaccination rates.

Celeste Monforton, APHA occupational health and safety section chair, said members in the section reviewed the policy and found a number of problems related to it, including the need for multiple forms of infection control and a misunderstanding of the outcome of a mandatory vaccination policy in New York State -- which was eventually suspended due to shortages of vaccine supplies, and following a union lawsuit against the regulation.

Other stakeholder groups have recently endorsed mandatory vaccinations, citing patient safety as a rationale. The Infectious Diseases Society of America (IDSA) unveiled a policy last month that would require health care workers to receive seasonal flu and H1N1 vaccinations. Under the policy, those who refused would need to wear masks -- an approach generally being referred to as a "scarlet letter" by union groups -- or be re-assigned from patient care.

Additionally, Lisa Maragakis, a liaison for the Society for Healthcare Epidemiology of America (SHEA) at the Healthcare Infection Control Practices Advisory Committee (HICPAC), said at a recent committee meeting that SHEA will soon convene a group to discuss mandatory flu vaccinations. The group will address implementation issues that may arise if flu shots are required.

The debate is also continuing in the courts between SEIU and HCA facilities in Nevada and California. SEIU Local 1107 was granted a restraining order earlier this month in a lawsuit against two state HCA facilities, but it was later withdrawn. The judge ordered HCA to remove a component of the policy stating that workers could be suspended or terminated if they don't get a flu shot, a union spokeswoman said. However, she added that the union wishes the judge had "taken it one step farther," as employees will still be required to either get the vaccine or wear a mask while the case goes through arbitration. The union wanted the judge to issue an injunction on the policy until the case was heard by an arbitrator, the spokeswoman added.

The union feels confident an arbitrator will find that the facilities broke their collective bargaining agreements by instituting the mandatory policy without going through the proper protocol, she said.

SEIU unions in California were also recently granted a restraining order in their case against HCA facilities in the state. A judge ordered expedited arbitration in the case last week to negotiate a policy with HCA and that the parties meet to discuss eliminating "any stigmatizing procedures associated with the new policy," such as mandatory masking or identifying badges.

Charlotte Kenney-Pickard, a union member and nurse at one of the California hospitals involved in the lawsuit, argued that flu vaccinations vary in effectiveness and other measures are important to prevent the transfer of infection. She said the union wants the hospital to meet with the union to develop a comprehensive infection control program. Voluntary vaccination would only be one aspect of it, she added. -- Sara Ditta