Labor Unions Oppose Mandatory Flu Shots as AMA Cherry-Picks Ethics to Endorse Vaccine Mandates

In February I reported on the National Vaccine Program Office’s (NVPO) federal advisory committee, the National Vaccine Advisory Committee (NVAC), and their recommendation that health care facilities consider mandatory flu shot policies as a condition of employment for health care professionals in order to meet Healthy People 2020 goals. NVIC is on record as opposing the NVAC’s recommendation due to the absence of flexible medical, religious and personal/philosophical/conscientious belief exemptions in the recommendation.

Long-awaited Response from NVPO

AMA's Medical Code of Ethics SUPPORT Exemption Provisions

“The breath of organizations that strongly support flu vaccination, but are on record concurring with SEIU in opposing a flu vaccine employer requirement in the absence a basic philosophic or personal exemption for healthcare workers include: OSHA, CDC's NIOSH, the EEOC, the AFL-CIO, the AMA (15), the ANA, ACOEM (the largest organization of occupational health physicians), and the Association of Occupational Health Professionals in Healthcare  (AOHP), the California Nurses Association {CNA), Leading Edge (the trade association for the non-profit long term care industry), National Nurses United {NNU), the New York State Public Employees Federation {PEF), and the New York State Chapter of the American Civil Liberties Union {ACLU)."

“The AMA believes that as professionals committed to promoting the welfare of individual patients and the health of the public, and to safeguarding their own and their colleagues’ well-being, physicians have an ethical responsibility to take appropriate measures to prevent the spread of infectious disease in healthcare settings. Thus, AMA ethical policy states that physicians have an obligation to accept immunization absent medical contraindication, as recommended by the medical staff leadership or healthcare institution. This is consistent with the subgroup’s recommendation that facilities that are unable to achieve the Healthy People goal of 90 percent influenza vaccination coverage of healthcare personnel in an efficient and timely manner consider an employer requirement for influenza immunization.”

AMA Code of Medical Ethics - Opinion 9.133 Routine Universal Immunization of Physicians: As professionals committed to promoting the welfare of individual patients and the health of the public and to safeguarding their own and their colleagues’ well-being, physicians have an ethical responsibility to take appropriate measures to prevent the spread of infectious disease in health care settings. Conscientious participation in routine infection control practices, such as hand washing and respiratory precautions is a basic expectation of the profession. In some situations, however, routine infection control is not sufficient to protect the interests of patients, the public, and fellow health care workers. 
 

In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues, or threatens the availability of the health care workforce, particularly a disease that has potential to become epidemic or pandemic, and for which there is an available, safe, and effective vaccine, physicians have an obligation to: 

(a) Accept immunization absent a recognized medical, religious, or philosophic reason to not be immunized. 

(b) Accept a decision of the medical staff leadership or health care institution, or other appropriate authority to adjust practice activities if not immunized (e.g., wear masks or refrain from direct patient care).  It may be appropriate in some circumstances to inform patients about immunization status. (I, II)

 

Issued June 2011 based on the report "Routine Universal Immunization of Physicians for Vaccine-Preventable Disease," adopted November 2010.

 

 

• American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) representing 9 million workers: “The Healthy People 2020 Objective of 90 Percent Seasonal Influenza Vaccination Among Health Care Personnel Is A Goal Rather Than a Mandatory Requirement”
   
  “Unilateral Implementation Of Mandatory Seasonal Influenza Vaccination Programs In Unionized Healthcare Facilities Is A Violation Of The National Labor Relations Act - NVAC Should Not Endorse Illegal Acts By Employers”
   
  “Healthcare workers must be permitted to refuse the annual seasonal influenza vaccination without fear of reprisal for medical, religious, or personal reasons.” 

• American Federation of State, County and Municipal Employees (AFSCME) representing 1.6 million members:  “… cannot endorse Recommendation # 4 urging that employers require influenza vaccination without allowance for medical, religious and philosophical exemptions”  

• American Federation of Teachers (AFT) representing 1.5 million members: “The mandate should be the adoption of a comprehensive standard similar to OSHA blood-borne pathogen standard with requirements for training, voluntary immunization and declination after education." 

“The AFT believes that establishing a mandatory seasonal influenza program is a change to the terms and conditions of employment. Therefore those healthcare employers with unionized workforces cannot unilaterally implement mandatory influenza programs with the consequence of discipline or discharge for those unwilling to do so without negotiating with the union should the union wish to do so. The National Labor Relations Board (NLRB) recently upheld that right in its decision in the Virginia Mason Hospital and Washington State Nurses Association, Case 19-CA-30154, August 23, 2011.” 

• Association of Flight Attendants-Communications Workers of America (AFA) representing 60,000 flight attendants at 23 airlines: “AFA does not support making influenza vaccination a condition of employment for HCP. As stated in the draft report, this is a controversial and hotly debated recommendation. It is also one that if adopted will have significant, career-altering consequences for workers who object strongly (for whatever reason) to influenza vaccination.” 

• Association of American Physicians and Surgeons: “The Association of American Physicians and Surgeons (AAPS), a national organization of physicians in all specialties founded in 1943 to preserve the sanctity of the patient-physician relationship, objects strenuously to any coercion of healthcare personnel to receive influenza immunization.”

“It is a fundamental human right not to be subjected to medical interventions without fully informed consent.”

• National Nurses United (NNU) representing 170,000 members across all states is the largest professional association and labor organization of director care registered nurses: “…we cannot support mandatory vaccination policies, because, rather than being educated on the importance of vaccination, employees are instead coerced into accepting the vaccine, or risk being punished, retaliated against, and, in some cases, fired by their employer. Mandatory flu vaccination programs engender distrust and resistance among employees; offer a disincentive to providing vaccination education to employees, and raise ethical and legal questions about the personal employment rights of employees. This is not the way to protect public health.” 

• The Coalition of Kaiser Permanente Unions representing 28 local unions with 95,000 frontline employees: "Employee relations and public health are not well served by the use of coercion to achieve flu vaccination ends. And it is not consisted with our national values openness, respect, and informed consent around medical treatments we receive.” 

• The Occupational Safety and Health Administration (OSHA): “OSHA is a strong supporter of appropriate education, ready access and signed declination statements for HCP vaccinations. OSHA's bloodborne pathogen standard regarding Hepatitis B education and vaccination is a best-practice model. Influenza vaccination exemptions should be allowed for HCP with valid medical contraindications to vaccinations, or religious and/or personal objections.” 

• United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial and Service Workers International Union is among the first unions in the United States to organize health care workers and represents 30,000 members throughout the health care sector: "The USW supports effective, voluntary programs for influenza vaccination ofhealthcare workers..." “Employers are prohibited by the National Labor Relations Act, and other labor laws with similar provisions, from making unilateral changes in conditions of employment including health and safety. A mandatory vaccination policy would certainly fall within this category..."

"In conclusion, we urge NVAC to drop the recommendation for mandatory vaccination as a condition of employment for healthcare workers...” 

Some of the above comments are from organizations not limited to representing health care professionals. Perhaps these organizations can see the writing on the wall; that if health care professionals can be bullied and coerced into vaccination against their will, then what profession is next? Teachers, daycare workers, government employees and public transit employees?

For myself, I have to ask, how long will it be before those not bowing to the recommended schedule will be forced to wear a scarlet letter announcing their vaccination status? What other areas of medicine will informed consent be deemed too inconvenient to be followed and the consumer told that they have no say in matters of their health?

The line drawn in the sand by the organizations opposing flu shot mandates without comprehensive exemption provisons has far reaching implications and it would appear that their words are fighting words.