It has never ceased to astound me that so many health care workers refuse to get an annual flu shot. We’re not talking about that small, cranky minority of Canadians who dispute all vaccinations, including those for their young children. These are individuals on the frontlines of caring for vulnerable patients, and every year, upwards of 50 per cent of them simply decline to be vaccinated against influenza. Some wear a mask instead, but not many.

In vain have public health officials, hospitals and long-term care facilities rolled out education campaign after education campaign, stressing the value of flu shots in preventing the spread of a potentially serious, even fatal, condition to those they care for. Vaccination percentages in health care settings remain stubbornly low.

Reasons vary, but mostly they boil down to protecting the right to decide what goes into one’s body, and questioning whether vaccinations do much good. Indeed, the effectiveness of flu shots is relatively low, compared with vaccinations against other diseases. But public health officials are unanimous that they still offer the best protection there is against the spread of influenza. Having a flu shot provides more protection than not having one. Yet, vast numbers of health care workers continued to go unshot.

Finally, B.C.’s Provincial Health Officer Dr. Perry Kendall and others in the field decided something more had to be done. Last year, they unveiled a policy that mandated  all health care workers in contact with patients to be vaccinated against influenza, wear a mask, or face the possibility of discipline. This province-wide dictate was the first of its kind in Canada.

Not surprisingly, health care workers and their unions strongly opposed the get-tough measure, prompting the province to withdraw the proposed policy and institute, temporarily, a more collaborative approach. Meanwhile, the matter of mandatory flu shots or mask wearing went to arbitration.

Today, following 15 days of hearings, involving international and Canadian public health experts on both sides, including the renowned Dr. Allison McGeer, director of infection control at Toronto’s Mount Sinai Hospital and advisor to the World Health Organization, we have a verdict. In a comprehensive, 115-page judgment, Robert Diebolt, law professor emeritus at UBC, ruled that, given all the evidence, the policy of compulsory immunization or mask,  while not perfect, was reasonable.

He wrote: “It is indisputable that influenza can be a serious, even fatal, disease. Immunization also indisputably provides a measure of protection to health care workers and I have found that their immunization reduces influenza transmission to patients. I have also concluded that there is some evidence to support the masking component of the Policy. In short, there is a real and serious patient safety issue and the Policy is a helpful program to reduce patient risk.”

This is a victory on many fronts: for patients, for common sense and for sound public health. I hope those reluctant health care workers now get the point!

Rather than accept my word for it, however, here is Professor Diebolt’s ruling, in its entirety. Happy reading.




  1. One recent systematic review show promising evidence that Influenza vaccination of health care personnel can enhance patient safety
    -Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of Influenza Vaccination of Health Care Personnel on Morbidity and Mortality among Patients: Systematic Review and Grading of Evidence.Clin Infect Dis. 2013 Sep 17. [Epub ahead of print]

    Please also read the accompany Editorial-
    -Griffin MR. Influenza Vaccination of Health Care Workers: Making the Grade for Action. Clin Infect Dis. 2013 Sep 17. [Epub ahead of print] No abstract available.

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