To protect the population at large against diseases, public health authorities generally aim to immunize 90 to 95 per cent of the population. To the dismay of the authorities, however, one segment of the population is surprisingly resistant to getting the flu and other vaccines recommended for them -- doctors, nurses and others working in the health care sector.

Public health authorities have good reason to want health care workers vaccinated -- they believe the vaccines will keep workers healthy, helping to protect patients while also saving the health care system money through fewer sick days. No less important, when highly knowledgeable people in the health care field balk at getting vaccines, they belie the common claim that only the misguided or misinformed question mass inoculation programs. As explained by Saskatchewan Health Minister Dustin Duncan, "It makes it harder for health officials, it makes it harder for me as the health minister to encourage people to get their vaccinations when they only see half of health care workers getting them."

Officialdom's failure to convince its own health care workers to follow its vaccination policy spans much of the Western world. In the UK, only 46 per cent of health care workers -- slightly less for doctors (45 per cent) and nurses (41 per cent) -- are vaccinated for the flu, despite concerted government efforts according to Public Health England. This startling failure is similar to that seen in Canadian jurisdictions for health care workers today, and those seen in the recent past in the U.S.

Public health officials in the U.S., though, have had success in the last five years by increasing pressure on health care workers, sometimes through laws mandating their vaccination, more often by making vaccines a requirement of employment. According to a Centers for Disease Control Internet survey, when employers remain neutral on vaccinations only 44% of health care workers get vaccinated. That figure rises to 70 per cent when the employer recommends it and 89 per cent when the employer requires it.

Now Canada may follow the U.S. lead in twisting the arms of its health care workers. Officials in Saskatchewan will consider mandatory measures next year if inoculation rates don't improve. British Columbia actually began mandatory measures last month, despite vehement opposition from various unions representing, among others, BC nurses, pharmacists and psychologists. In Alberta, where unvaccinated nurses have been told they may be sent home without pay during flu outbreaks, the government has promised to consider stronger medicine still if inoculation rates, currently at 40% to 50% for doctors, nurses and other health workers, don't improve.

Unvaccinated workers are also subject to psychological pressure. As of this month, Alberta's health ministry will be publicizing the vaccination rates of health workers at various facilities, a move whose "intent appears to be to shame or publicly embarrass workers into rolling up their sleeves," the Edmonton Journal states in an article decrying "quack pseudo-science [that insists] the flu vaccine is dangerous or ineffective, a Big Pharma conspiracy." Such strong medicine is necessary because when "health workers refuse vaccination, it feeds the paranoia, suggesting immunization must be dangerous after all."

Alberta's chief medical officer, Dr. James Talbot, seems to agree: He has marginalized some of his province's health workers as being "in a sense of denial" about flu risks and alluded to an irrational or ideological opposition from "a small number of them [who] are actually opposed to immunization." This kind of talk gets pushback from professionals who decry the ad hominem attacks.

"We don't think that demonizing those who choose not to be vaccinated is an appropriate response," states United Nurses of Alberta president Heather Smith, who also challenges the official view that flu immunizations are effective. Other nursing associations agree. The Ontario Nurses' Association plans to file grievances against hospitals that require them to either become vaccinated or wear a face mask. In the U.S., National Nurses United, the country's largest organization of nurses, cites a National Institute of Allergy and Infectious Diseases study that found increased flu vaccination rates didn't lower death rates among the elderly, as is often claimed, or among any other age group either.

Stated National Nurses United president Karen Higgins last year, "nurses, joined by many physician organizations and researchers, reject the notion that vaccination is a fail-safe solution to prevent the spread of the flu virus... there are health reasons why some elect not to be vaccinated. Some vaccine products have been withdrawn, as when Bell's palsy developed for many recipients. It has just been reported that 800 European children contracted narcolepsy, an incurable sleep disorder, after receiving the swine flu vaccine." The notion that the flu vaccine can be both ineffective and harmful, a CDC survey confirms, is common among health care workers.

In the immunization wars between health care workers and the government public health authorities, the government authorities are inexorably advancing -- in British Columbia, for example, early indications are that workers are grudgingly acceding to their employers' demands, sometimes more than doubling their compliance rates, from 30 per cent to 75 per cent. In the U.S., the CDC has gained ground in pushing for mandatory universal vaccinations of health care workers against pertussis, measles, and a host of other infectious diseases. If governments ultimately succeed in this quest, they will have eliminated the argument that health professionals shun vaccinations for themselves and be one step closer to their ultimate goal -- to make universal vaccinations mandatory in the general public.

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