This blog post was inspired by a discussion on the Dec 10, 2014 "Know Your Rights Hour" podcast of Alan Phillips, JD and Dr. Mayer Eisenstein, MD, JD, MPH - you can subscribe via iTunes. Dr. Eisenstein's website is: http://www.homefirst.com/ and Alan Phillips website is:
Healthcare providers are now required to receive influenza vaccine yearly or risk losing their jobs. This in spite of the fact that "evidence" for the efficacy of this policy is sketchy at best. For those who are successful in obtaining a waiver in declining to be vaccinated are required to wear a mask even though they may be completely healthy and free of symptoms. There is no evidence this protects either patient or healthcare provider (in the absence of symptoms); Adding insult to injury is the fact that the CDC is admitting, very early in the season, that this year's vaccine is a poor match to circulating strains of the virus, so any "efficacy" is expected to be low.
One could speculate as to why a mask is required of those who do not get vaccinated - there is no logical reason to believe it would be helpful in risk reduction to either patient or healthcare provider (especially when the healthcare provider is free of symptoms) as bacteria and viruses are so small that only a specialized respirator with an air tight seal could prevent them from entering (or exiting) the respiratory tract.
But in light of the fact that this year's vaccine is expected to provide very little risk reduction (and according to the Cochrane Database this is generally true even when there is a "good match" between vaccine and circulating strains, see above link) it seems that everyone should be wearing a mask! If the policy of requiring the use of a mask for unvaccinated HCW's is about protecting patients from getting ill it makes sense that a mask would be required of everyone in a year where there is higher odds than typical that the vaccine will not reduce risk of becoming ill. If the vaccine does not protect the recipient how could anyone else (ie: patients and/or co-workers) passively benefit, therefore shouldn't all be wearing masks since that is the goal of mandatory vaccination of HCW's?
To add insult to injury there are articles in press (by vaccine proponents no less) that document receiving flu vaccine on a yearly/consecutive basis may actually lower what little risk reduction it provides! This may be due to an effect called "original antigenic sin" where exposing the immune system to an antigen may make it less able to recognize a similar antigen (like an influenza virus that has mutated ever so slightly).
Neither policy (mandating masks for unvaccinated HCWs and/or mandating receipt of annual influenza vaccine) is based on solid, significant science. This type of heavy-handed approach is paternalistic and condescending. While many enter the healthcare with noble motives no one gives up their personal, civil rights because they go into healthcare, nor should this be expected of them.
The receipt of any medical procedure should be voluntary - vaccines should not be exempt from this. Those who want a vaccine should get it. Those who do not want a vaccine (regardless of their reason or motivation for declining) should not be forced to get a vaccine, nor wear a mask (or any other token) that makes it easy to identify them as a "refuser".