HEALTH CARE/Joan Retsinas

Vaccinations: Strategy for Little Brother

A truly Big Brother would line everybody up, make them roll up their sleeves, and vaccinate, vaccinate, vaccinate against the flu. A simple if draconian solution to a draconian virus. Americans, though, are historically myopic: nobody remembers much about the past. Try asking a teenager to identify the Axis nations, Pol Pot, or Jim Crow. Perhaps that myopia explains a Pollyannish optimism that helps us ignore glum disease projections.

In reality, the influenza pandemic of 1918 infected more than one-quarter of the population of the United States. Worldwide, it killed as many as 5% of the population. But we don’t feel the frisson we should at the word “flu.” Even the outbreak of 2009 was severe enough to earn the term “pandemic,” yet few Americans recall it.

So each winter public health departments rise up to urge vaccinations against this contagious disease. Although the vaccine does not give 100% protection (though why we expect anything to offer 100% protection is strange – maybe we’ve seen too many television infomercials guaranteeing 100% satisfaction), it is the best recourse. Hand-washing of course is a safeguard against contagious diseases in general; but experts caution that protection against this bug demands more than soap and water.

The logistics of vaccination are simple. The process takes a few minutes. There are a few varieties, including nasal sprays, concoctions for people who are allergic to eggs, higher doses for people over age 65. Insurers will pay; for patients without insurance, the state will generally pay. You don’t need an appointment with a physician: pharmacies, health clubs, schools all can morph into drop-in flu clinics.

Yet a lot of Americans pass on the shot. Too busy. Too tired. Too sick. Leery of modern medicine. Maybe cynical of government: if the state wants you to do this, you shouldn’t.

The beauty of a democracy is that we don’t force people to roll up their sleeves. Yet hospitals, which care for patients who are by definition sick, fear that while their patients may finish their surgeries, their treatments, their regimens according to plan, those patients may end up with the flu – an iatrogenic illness. The patient will have gotten sick during treatment. But the staff, not the treatment, will be to blame. A doctor, a nurse, an orderly with the flu can transmit the virus. That unvaccinated Clara Barton, exuding compassion, may be a Grim Reaper.

Hospitals have tried the tack of enthusiastic encouragement, urging staff to get vaccinated. But while those campaigns raised facilities’ vaccination rates, the rates rarely surpassed 70%. The more successful tack has been mandation. Staff must get flu shots. Otherwise, staff must wear paper face masks to limit the spread of the germs. In a 2011 survey, the federal Centers for Disease Control and Prevention found that more than 400 hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees. Arkansas, Maine and Rhode Island back up hospital mandates with fines: in Rhode Island, a worker who refuses to be vaccinated risks a $100 fine.

On one hand, the mandates work. Hospitals report vaccination rates above 90%. On the other hand, the mandates have spurred intense opposition, even lawsuits, from unions representing staff who reject both the flu shot and the mask, which they argue is both uncomfortable and ostracizing.

Now the federal government has waved its Little Brother stick. Staff need not get vaccinated. (Laura Landro, Wall Street Journal Oct. 31) But hospitals must report their vaccination data to the Centers for Disease Control and Prevention. The Centers for Medicare and Medicaid will publish the data on its Hospital Compare web-site for all -– insurers as well as patients – to see. Hospitals that do not report their data will lose money.

Uncle Sam has taken a Little Brother step to bolster vaccination rates and make hospitals safer. Non-reporting hospitals will lose money – suffering consequences. Patients have already been suffering consequences for some hospitals’ low rates. We all should applaud this move.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, February 1, 2014