In the United States, it has been proven that many patients in hospitals or other health care facilities can become infected with an illness solely based off of it being transmitted from their health care provider. One of these common illnesses is influenza, which can be prevented with a vaccination shot. In a review of twelve hospitals with influenza outbreaks, it was shown that hospital acquired influenza had a high median mortality rate of 16% and for more at-risk patients, such as people in the Intensive Care Unit (ICU), the rate rose to 60% (Cortes-Penfield 2060). Coming to a hospital, people expect to be treated in the best possible conditions to the extent that they will eventually recover and return to a good state of health. Knowing patients could potentially contract an illness that may be life threatening, if he or she is physically vulnerable enough, is terrifying due to the fact that hospitals should be a place of healing. It should be expected, in most cases, that a person will get better as opposed to worse solely based off of the health care workers in the facility. The implementation of a mandatory vaccination policy for health care workers (HCWs) in the United States is necessary in order to significantly reduce the spread of hospital-originating illnesses throughout the workplace.

The idea of mandatory vaccinations among a specific group of people is a controversial topic in the health care industry due to a number of reasons. There are two main categories of people regarding controversy when discussing a mandatory vaccination policy, which are children and HCWs. The category of children is more controversial and covers a variety of different vaccinations in addition to the influenza vaccine. The issue being discussed further focuses on mandatory influenza vaccinations specifically for HCWs. Although it is clear that the more people vaccinated, the lower the spread of infection, people have differing opinions on whether or not it is a logical policy. One of the opposing arguments is that “the choice to vaccinate one’s self and one’s children is a fundamental human right… without free and informed consent, mandatory vaccinations violate the rights to liberty and security of person” (Holland 39). People have differing opinions on vaccinations against infections and may feel that making them obligatory goes against their personal autonomous rights as a human being. 

Another one of the common reasons for opposition is that some people may have health reasons or disabilities that prevent them from being able to receive a particular vaccination, in which the Center for Disease Control and Prevention (CDC) recommended certain reasons for exemption. The exemption states that people who have severe allergies to components found in vaccines, people who have had previous reactions to flu vaccines, and people who have a history with Guillain-Barré Syndrome should not be required to receive the influenza vaccine (Johnson III). Guillain-Barré Syndrome is a disorder in which a person’s immune system attacks their nerves, in which there was a slight increase of risk of the syndrome following vaccination in the past (Guillain-Barré Syndrome). In a study done by the BJC HealthCare system in which they enacted a mandatory vaccination policy, medical exemption requests showed that employees tended to be misinformed about vaccinations. Some requests stated exemption due to chemotherapy, but it is proven that individuals undergoing chemotherapy are at high risk for complications due to flu and are actually recommended to get the vaccine (Babcock, et al. 462). Other employee’s requests for exemption stated their reasoning as pregnancy, but vaccinations are highly recommended for pregnant women as well (Babcock, et al. 462).  This proves that people should be well informed of the medical conditions that would or would not restrict them from receiving certain vaccinations in order to be more compliant of them. Once the disabilities and health concerns preventing a person from being vaccinated are understood, it is logical to allow exemption from the policy in order to ensure the personal health of the employee. 

Another common opposing argument is the financial aspect of the policy and concerns about the funding of the vaccinations. Some argue that “resources for enforcement and debate may be better devoted to educational programs” (Galanakis, et al. 3), claiming funding by different organizations should be given elsewhere. Even though the cost for a single vaccination is small, it is reasonable for a health care facility to manage the burden that the vaccinations may cost them. Evidence even proves that, “an investment can reduce days lost to medical leave during the influenza season and is probably cost-neutral or cost-effective” (Cortes-Penfield 2062). Knowing that, influenza shots ultimately keep employees at work during flu season which benefits the facility when comparing it to the cost of supplying vaccinations to all HCWs that work there. 

The next opposing argument involves the physical effects of the vaccine that people would prefer to avoid such as, “injection cite pain and inflammation, red eyes, hoarseness, and cough… other common reactions including fever, myalgia, and malaise are also self-limiting and occur in similar frequencies to placebo” (Cortes-Penfield 2061-62). Although some are uncomfortable reactions, others may be more severe and the potential threat of the illness could cause some people to be against receiving the vaccination. 

The last opposition to mandatory vaccines is on a religious basis. There are some strong-held religious practices that could potentially conflict with workplace practices that need to be accommodated for by the employer, mandatory vaccinations being one of them (Johnson III). It is known that there are different religious groups that discourage or completely forbid the use of specific types of medicines and treatments, which in turn effects the use of those particular services (Benjamins and Brown 111). Therefore, people believe that requiring someone to receive a vaccination if it goes against their religious practices is a violation of the constitution’s First Amendment to freedom of religion. In addition to this idea, the U.S. Supreme Court actually developed a law regarding cases in which religion conflicts with public interests, stating that mandatory vaccinations against infections does not violate the First Amendment right to freedom of religion (Salmon and Siegel 289). This was decided on the basis that, “the right to practice religion freely does not include the liberty to expose the community to communicable disease or the latter to ill health or death” (Salmon and Siegel 291). This means that religious views preventing one from getting vaccinated is technically not a logical basis for exemption because it can harm other members in the community. In consideration of this, health care facility directors do have the right to decide whether or not they will allow exemptions to mandatory vaccinations based on religious views in their health system. Many people believe workplaces should respect employee’s religion in that aspect despite the fact that it is not illegal to disregard religious views when implementing the policy. For some people, religion is a sacred aspect of life that should be valued on all occasions and should be accommodated for in the workplace industry. All of these reasons for opposition against mandatory vaccinations are logical and need to be considered when constructing a nation-wide policy for HCWs.

It is important to consider all of the benefits that come with increased rates of vaccinations among HCWs for all members in those facilities in which they are employed. In a 2010-2011 study conducted by the CDC, only about 64% of workers receive vaccinations when they are made voluntary, as opposed to a high rate of 94% when they are made mandatory (Johnson III). This is the main reason why it is important to inform people of the benefits surrounding influenza vaccinations in order to allow people to be more pro-policy, or in support of the policy. Lack of knowledge on all of the aspects of vaccinations is a leading force on why people may be opposed to it. A Med-Star Health System study, conducted during the 2010-2011 flu season, showed a 98% compliance rate for mandatory influenza vaccinations. Bioethicist Arthur Caplan stated, “if you can get close to 100% vaccination rates, you can cut patient death rates from flu by 40%” (Biton 68-69). This statistic proves the efficiency of vaccinations among health care workers, clearly stating the reduction of morbidity (death) among patients. There was a study published in 2016 that discussed the spread of nosocomial, originating in a hospital, disease among cancer patients who tend to be more susceptible to respiratory illnesses such as the flu. The study was conducted over an eight-year period and it found that when vaccination rates significantly increased in HCWs, the proportion of nosocomial infections significantly decreased in patients (Frenzel, et al. 1019). The study shows the importance of high vaccination rates among HCW’s when working with patients who are more susceptible to contracting illnesses due to low immunity and vulnerability when it comes to personal health. This could apply to a variety of patients such as people who come out of surgery, are significantly weak due to different diseases, or other complicated health issues. In an article discussing reasons why vaccinations should be mandatory, Kristen A. Feemster states her point of view on why “individual choice can be subverted for public good” when talking about the autonomous rights of the employees (Feemster). She claims that people in this country do a variety of things that may go against their beliefs such as drug testing at work, obeying traffic laws, and paying taxes; but everyone does it in order to keep the community safe and in check. Those types of things are a responsibility shared by all people within society, and public health should not be any different (Feemster). If people have the ability to keep their community healthy and safe, it is their duty, especially as a public health worker, to do so. People who work in the health industry chose that career path to help others, hence it should be their will to do whatever it takes in order to ensure the health of their patients if there is little to no consequence for them. For this mindset to be acknowledged by all HCWs, it is important to inform them on all things concerning mandatory vaccinations in order to increase compliance rates and allow people to be more comfortable with the policy. In a study done in 2014, researchers from the department of infectious diseases at the Detroit Medical Center surveyed over 3,000 employees to determine what factors influenced vaccination rates and what the HCW’s attitudes were towards the subject. The data showed that workers who strongly agreed with any of the questions regarding the ethics of vaccinations were more likely to receive the shot as opposed to people who were answered “neutral” or “disagree” (Awali, et. al. 650). This shows that the more educated people are on the topic, the more willing they are to receive the vaccine. The authors stated that, “higher rates of vaccination have been documented in many health care facilities that implemented well-organized educational programs that focusing on the vaccine benefits and side effects” (Awali, et al. 651). Understanding all of the benefits and potential consequences for patients and HCWs themselves ultimately increases the willingness of workers to receive mandatory influenza vaccines and proves that a lack of knowledge is what reduces vaccination rates. 

In order to construct a logical policy that makes influenza vaccinations mandatory for all HCWs, both sides of the debate need to be acknowledged. Instead of creating a policy that forces every single health care worker to be given a flu shot, the vaccines should be mandated on a case by case basis. It is important to give a person the option to be excluded from a mandatory vaccination policy if they cannot receive one based on personal reasons such as disability or religion. Creating a policy that would be accepted by most people in a health care facility requires the means and opinions of each person to be recognized. When considering the disabilities of HCWs, the Equal Employment Opportunity Commission (EEOC) states an employee could be “entitled to an exemption from a vaccination requirement based on an Americans with Disability Act (ADA) disability that prevents him from taking the influenza vaccine” (Jonhson III). The EEOC also stated that despite the medical conditions of the employees in a facility, the employer has the right to require workers to wear personal protective equipment such as gloves or gowns (Johnson III). This is a compromise that can be made for the people who physically are not able to receive the vaccine and will not get terminated as a result. If non-compliance with the mandatory vaccination policy is shown after all accommodations for that employee have been rejected, then “termination of the employee is not only ethically permissible but the responsivity of the health care institution, because its primary ethical obligation is to protect the safety and well-being of its patients” (Cortes-Penfield 2063). The other potential reason for exemption mentioned previously is religion. With the intention of possibly being exempt from receiving a vaccine, it is said that an institution needs to have a very clear definition of who can be excused based on religious reasons and who cannot (Johnson III). This allows for exemptions to be considered for each individual while still trying to reach the goal of a high vaccination rate. 

An example of a health care system that found success in putting a mandatory vaccination policy into practice is BJC HealthCare. It is a large Midwestern health care organization that conducted a study in which the policy of mandatory flu vaccination was made a condition of employment for all workers in 2008, and people could request exemption based on medical or religious reasons. Following this, those who were not vaccinated or exempt were terminated as a result. To ensure fairness for potential exemptions based on religious views of employees, “religious accommodations required a letter from the employee to Human Resources that stated a religious conviction opposed to vaccination” (Babcock, et al. 460). For medical exemptions, “a letter from a licensed physician (MD or DO) that stated a medical contraindication to influenza vaccination” was required (Babcock, et al. 460). These requirements allowed employees to have their personal conditions preventing them from the vaccines considered in the fairest and most equal way. After exemption requests were accepted, 98.4% of employees were vaccinated (Babcock, et al. 461). This is an example of how a vaccination policy offering exemptions for medical and religious reasons could be highly successful in achieving vaccination rates close to 100%, which significantly decreases the spread of influenza among health care facility employees and patients. 

Overall, after considering all of the facts regarding influenza vaccinations, the benefits do out weight the potential consequences. Although there are people who are opposed to the idea for logical reasons, most of those reasons can be refuted or can be proved to be minimal when looking at the entire spectrum of the concept. There is plenty of research proving that vaccinations need to be made mandatory in order to increase vaccination rates to a high percentage closer to 100%. In an online video source posted by the Seattle Children’s Hospital, pediatrician Wendy Swanson states a new policy that the American Academy of Pediatrics (AAP) enacted a mandatory vaccination policy among HCWs, because the organization believes it is the ethical and necessary thing to do (SeattleChildrens). Due to the fact that there are health organizations implementing this policy ensures that it is the most efficient and ethical thing to do. It is the most effective precaution to implement a mandatory vaccination policy for all health care workers in the nation in order to significantly reduce the spread of influenza among patients in health care facilities. 
