Nurses and Anti-Vaccination

Last week I wrote about the current pertussis epidemic in my home state of Washington, coincidentally the state with the highest percentage of parents opting out of vaccinating their children for all of the usual vaccine-preventable diseases such as polio, tetanus, diptheria, pertussis and hepatitis B. I concluded by hoping that my own pertussis booster would protect me against a planeload of Washington State coughers I recently had the pleasure of sharing a red-eye with on our way to NYC. Since the average incubation time from exposure to pertussis to symptoms is 7-10 days (and can be as long as 21 days), I’m not yet breathing a non-congested sigh of relief. But I’m hopeful.

I am a critical health care consumer and I teach my students to be critical health care providers.  On a personal basis I don’t accept all health care screening and prevention guidelines without first examining the evidence and deciding for myself what is best for my own health. For instance, I tend to agree with the conclusions about mammography screening written about (beautifully) by Veneta Masson, a nurse practitioner and poet living in Washington, D.C. in her essay “Why I Don’t Get Mammograms” (Health Affairs/Narrative Matters October 2010). I have used naturopathic, acupuncture and other ‘alternative’ medicine modalities for illnesses that are beyond the abilities of allopathic mainstream medicine to treat. But for most vaccinations, I am a discerning early adopter. Having been threatened with an attack by rabid dogs in Northern Thailand, I have even gotten my rabies vaccine series. Doing street outreach has extra hazards in a country like Thailand. I did get the rabies vaccine series in Bangkok since they cost significantly less there—Bangkok is one of the main WHO rabies centers in the world. (Thailand, a Buddhist country opposed to euthanasia of animals—even rabid ones—has one of the highest rates of rabies in the world).

As a health care provider I consider it my professional duty to stay current on recommended vaccinations, including the annual flu vaccine. I have the option of receiving it at my work site (limited times/places so not very convenient) or at my doctor’s office, or—as I usually opt for—at my local Safeway pharmacy. My annual flu shot comes between shopping for groceries, is immediately covered in full by my health insurance, and is administered by a very friendly and knowledgeable pharmacist within about five minutes of registering for it. (I fully realize all of these lack of barriers/facilitators do not exist for everyone). I have read the evidence on risks and benefits of the annual flu vaccine and am convinced on the side of getting the shot. I listen respectfully to my nurse colleagues who opt out of the flu vaccine, but I am dismayed by how many opt out for anything other than religious or valid medical reasons. I haven’t tried to convince them to change their minds because I never saw that as my job. But if any of them happen to be reading this, I hope they will at least reconsider their decision.

The evidence is fairly overwhelming in favor of nurses and other health care workers getting an annual flu vaccine, in terms of reducing the risk of transmission to their patients as well as co-workers. The flu vaccine has proven to be safe and effective, and the flu vaccine ‘industry’ is not exactly a huge profit making one. Since 1981 the CDC has recommended that all health care workers get the flu vaccine on an annual basis. (A good review from a nursing perspective is Paula Sullivan’s “Influenza Vaccination in Healthcare Workers: Should It be Mandatory? OJIN/available on ANA’s website). Most hospitals have relied on voluntary participation of health care workers, sometimes accompanied by vigorous (and I would suspect costly) education campaigns. While rates of flu vaccine compliance are high for most physicians’ groups (with the notable and not surprising exception of surgeons), the rates of flu vaccine compliance among nurses remain much lower. Why the difference?

A recent article in the journal Vaccine “What Lies Behind the Low Rates of Vaccinations Among Nurses Who Treat Infants?

English: Avian flu vaccine development by Reve...
English: Avian flu vaccine development by Reverse Genetics technique. Basa Sunda: Ngembangkeun vaksin flu unggas maké téhnik reverse genetics. (Photo credit: Wikipedia)

” (O. Baron-Epel, et al, 30(21), 5-12-12) explored this question (in this case for pertussis vaccination). Researchers in the UK conducted a series of focus groups with 25 public health nurses working at several Mother and Child Healthcare Centers, about their understanding and beliefs on vaccination. Common themes that emerged from the focus groups included the usual barriers to vaccination: fear of side effects, and a lack of perception of personal risk or risk of harming patients. Other barriers included lack of trust in health care authorities (and of health information), strong value of personal autonomy (being able to refuse vaccination), lack of respect of nurses by hospital administrators, and the fact that they did not view themselves as role models for patients. The researchers concluded “There is the need to increase the nurse’s awareness of the unethical aspect of not being immunized and increase the perception of themselves as transmitters of disease.” (p 3154).

11 thoughts on “Nurses and Anti-Vaccination

  1. The decision to get a vaccine or not should be a matter of “Choice.” If I research the issue and decide either way, it is my decision.

    I do not agree with mandatory vaccinations as condition of employment, I do not agree with getting vaccinated solely to contribute to “Herd Immunity.”

    We do not put our patients at risk. Nurses are smart enough to realize when they have the flu, to call out, cover their mouths when they cough and take precautions.

    Have gotten flu shots in the past and felt miserable enough with low grade fevers, aches & pains to call out sick. Can see why many choose not to get the Flu and other shots.

    Leave it a matter of choice.
    Andrew Lopez, RN


  2. Thanks Andrew. I agree with you to a large degree and if you look at the ANA article I link to in the post, the author has the same conclusion: keep the mandatory out of the equation. I still wonder about it though for staff on certain units like NICU and transplant units. Also, the problem with waiting until we feel the symptoms of flu/calling in sick is that we are already infectious a day before the symptoms start–so we’ve already potentially spread flu to patients and co-workers before we even knew we were sick.


  3. This issue irritates me for a number of reasons. First, the number of nurses which refuse immunizations for spurious reasons of “health concerns” or “personal choice” is truly disturbing. Vaccinations work, and you will not get the flu from the shot, nor will will kids end up autistic (to cite the commnest memes around the flue shot.) The plain fact is that nurses who refuse immunizations are putting their patients and colleagues at risk for disease and death. Seriously. I don’t see ethically how you get around this. As for personal choice, I am afraid that ship has sailed long ago: all nurses are subject not only to mandatory vaccinations but invasive testing for TB and in some cases illicit drug use. What’s the difference?

    Like the blog, btw.


    1. I have a question regarding Torontoemerg’s comment. I’ve seen many people argue that unvaccinated people are putting others at risk, but I don’t understand why these people are upset. I theoretically understand the concern that nurses who refuse to be vaccinated are putting their patients at risk, but if the vaccines work as claimed, why would their colleagues be at risk? Shouldn’t their colleagues have been vaccinated and therefore, be immune? If vaccines work, wouldn’t the only people who would presumably be affected are the unvaccinated?

      Patients may not be required as citizens to be vaccinated, but if they choose not to be vaccinated, then they are choosing the consequences of that risk just like I choose the risk of being exposed to MRSA and other pharmaceutical-resistant strains of bacteria when I go to the hospital.

      As Veritas mentioned though, many of the vaccinated population are spreading the pertussis bacteria, and probably a mutated vaccine-resistant more virulent strain at that.


  4. I HIGHLY agree with the first commenter, Mr. Lopez, that getting vaccinated should be a matter of choice. Mandatory vaccinations are such an obvious offense to personal liberty.


  5. The pertussis vaccine in not solving the problem
    CDC data shows 84 percent of children under the age of three have received at least four DTaP shots and yet, despite high vaccination rates, whooping cough still keeps circulating, largely among the fully vaccinated. This is because pertussis is a cyclical disease where natural increases in infection tend to occur every four to five years no matter how high the vaccination rates are.

    81 percent of 2010 California pertussis cases under the age of 18 were fully vaccinated children. In a pertussis outbreak in Texas, the CDC statistics show that 81.5 percent of cases were fully vaccinated with four DTaP shots. Washington State health officials are saying this year’s pertussis cases could top a 60 year old record in spite of approximately 84 percent vaccination coverage. Reuters recently reported that according to the CDC, the number of pertussis cases is growing – in the fully vaccinated population!

    In a very recent DTaP vaccine study, researchers reported a dismal 24 percent vaccine effectiveness among those aged 8-12. With this ridiculously low rate of DTaP vaccine effectiveness, the public health brainiacs have come up with their best plan for everybody to have three primary shots and three follow-up booster shots.

    Learn more:


    1. Is good to hear a different perspective, although I do not agree with you on this one. The ‘problem’ is also the fact that the newer/acellular pertussis vaccine ‘wears off’ or loses its effectiveness faster than expected. I continue to state that nurses who work within ‘western medicine’ should all be fully vaccinated unless there is a compelling and credible medical reason not to be.


  6. “I continue to state that nurses who work within ‘western medicine’ should all be fully vaccinated unless there is a compelling and credible medical reason not to be.”

    Side effects of disability and death are not compelling enough for you? Especially given how ineffective the flu vaccine is. Some studies have shown vitamin D3 injections to be equally effective, without any side effects.


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