No one could question the positive impact vaccines and the immunization they provide have had on global health. The World Health Organization estimates that immunizations prevent the deaths of between 2-3 million people each year - and could prevent an additional 1.5 million deaths if vaccination efforts were more globally available and accepted. Despite being one of the most cost-effective medical interventions, vaccines are still not universally available, especially in the developing world. And yet, even in those countries where vaccines are readily available, many individuals still choose not to be vaccinated. Who is impacted by this choice?
While the individual choice might be mitigated by the communities' overall vaccine coverage (called herd immunity), some individuals are still at risk of contracting a preventable disease.
Protecting the Healthy Adult
One group for whom vaccines are particularly important are health care workers (HCW). Because doctors, nurses, technicians, janitors, and others are exposed to patient blood and/or body fluids, the risk of exposure to illnesses is significant. In fact, no one is more at risk of exposure than health care workers.
|In 1983, over 17,000 health care workers contracted hepatitis B at work. After years of immunization efforts, there were only 263 cases in 2010.|
Thanks to increased HCW vaccination efforts over the past two decades, fewer and fewer healthcare workers become infected with hepatitis B, measles, and other contagious viral diseases each year. While vaccines are not required to work in health care, they are strongly recommended by the CDC and professional associations.
Protecting the Vulnerable
Another group for whom immunizations are important are those most vulnerable to disease: The elderly, infants, and immuno-compromised individuals, including those in hospital care. Many in this vulnerable portion of our population cannot get vaccinated. Therefore, they depend on the rest of us - the herd - to get vaccinated so that the virus stops before it gets to them. And this herd includes health care workers, whose vaccines not only protect the workers, but the patients they work with.
Unfortunately, vaccine-preventable viruses do spread in hospitals. For example, 20.8% of all hepatitis B cases are nosocomial (healthcare-associated). While many of those cases are exacerbated by a particular facility’s faulty infection control practices, other viruses, such as measles, varicella (chicken pox) and influenza are spread from healthcare worker to patient just through regular, day-to-day contact. And while the the infection may be a minor inconvenience to the HCW, the patient confronts a possibly life-threatening condition.
There is currently no requirement for vaccination among health care workers. While some states have attempted to enact a vaccine requirement, opponents to mandatory vaccination cite the (however slim) chance of vaccine complications and the issue of personal choice/rights. From a legal standpoint, mandatory vaccination requirements are permissible “for the public good” (Jacobson v Massachusetts). However, from a employment standpoint, mandatory vaccination requirements can impact the desire to enter the field of health care and come into conflict with collective bargaining organizations (who strongly recommend vaccinations, but stop short of requiring them).
So, for now, the choice to vaccinate is left to the health care worker, as well as to the rest of us. We hope this post has give you an opportunity to think about vaccines and the importance of immunization!