Monday, July 15, 2013

Rep. Jeremy Thiesfeldt: Making It Easier to Get Sick at Hospitals

I know I've been remiss in writing new posts lately. "Real" life has intruded and kept my time limited and my mind a bit preoccupied. But I'm back, and what better way to come back from a lag than to follow up on a previous post?

At the end of May, I wrote about how Wisconsin Representative Jeremy Thiesfeldt was working on legislation that would ban employers (and not just health care employers) from requiring influenza immunizations as a requirement for employment (or, as noted, even internship or being a volunteer). The bill has been submitted and has a designation, now: Assembly Bill 247. AB247 was introduced on June 17, 2013, read and referred to the Committee on Health.

The text of AB247 has not changed since I last discussed this.

Before the bill was introduced, I contacted Rep. Thiesfeldt's office to ask some questions about it, such as whether Rep. Thiesfeldt consulted any relevant experts (e.g., infectious disease specialists, immunologists or vaccinologists) while drafting the legislation. I may be a bit naive, but I would have expected that, when drafting legislation covering a scientific or medical matter, one would consult with relevant experts to ensure that the legislation accurately reflects the state of scientific or medical knowledge. Especially if I'm the primary name associated with the legislation, that, to me, would be a very important step to take.

I managed to get a response from Rep. Thiesfeldt, but not before having to deal with one of his legislative aides (more on that in a bit). How did he respond? With this:
This is about personal choice in health care decisions.  Additionally, as I am not the primary researcher on this issue I can say that we have drawn our conclusions from numerous sources—I’m sure many of them came from experts.
Pardon me, Rep. Thiesfeldt, but as the lead sponsor of this bill, "I'm sure many of [the numerous sources] cam from experts" is a bit thin. What would have been better? "Yes, we did, and here is the list of supporting materials that informed our decisions..."

Actually, I should revise what I said earlier. I assume that this statement came from Rep. Thiesfeldt, because it was his email address, but it was signed by his legislative aide. Speaking of whom, here is what she had to say in response to my question:
I [sic]sure the CDC consulted all of the specialists you referenced when they arrived at their conclusion.  You are more than welcome to follow up with them if you have questions regarding their research.  Here is what they concluded:

[CDC] “believes there is insufficient scientific evidence for the federal government to promote mandatory influenza vaccination programs that do not have an option for the HCP [healthcare professionals] to decline for medical, religious and/or personal philosophical reasons.”
Well, if the CDC said that, then maybe I should amend my criticism of this bill. Unfortunately for Rep. Thiesfeldt's aide, the CDC did not say that. That quote comes from OSHA (Occupational Safety and Health Administration). I'll chalk that up to a typo, since a memo from Rep. Thiesfeldt's office got the attribution correct. That little quibble aside, there's still another problem with this quote; OSHA states that there's insufficient evidence for the federal government, not state or private employers, to promote mandatory influenza vaccination programs. For those who are interested, that quote comes from the September 2011 meeting minutes of the National Vaccine Advisory Committee. I urge you to go read it, because you will also find that the OSHA position statement also included the following:
While OSHA does not believe that there is sufficient evidence to meet the bar necessary to support mandatory vaccination programs, we nonetheless are convinced that influenza vaccination is generally beneficial and are supportive of efforts to promote vaccination.
Now that we know OSHA is supportive of efforts to promote vaccination among workers, what does CDC have to say about influenza immunization of health care personnel? Well, they actually have a page devoted to the question, where they state:
CDC, the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza.
They go on to cite research showing that health care personnel who get vaccinated reduce the transmission of influenza, reduce staff illness and absenteeism and help reduce "influenza-related illness and death, especially among people at increased risk for severe influenza illness" (e.g., among the patients for whom they are mandated to care).

On the topic of mandatory vaccination programs in particular, CDC found that:
Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%. Widespread implementation of comprehensive HCP influenza vaccination strategies is needed, particularly among those who are not physicians or nurses and who work in LTCFs, to increase HCP vaccination coverage and minimize the risk for medical-care–acquired influenza illnesses.
With a vaccine that has the kind of variable efficacy as the influenza vaccine, in order to have a strong, positive effect on health outcomes for staff and patients, it is vitally important to have high uptake rates. For those institutions that fail to achieve high uptake through voluntary or incentive programs alone, mandatory immunization programs should be an available option, particularly considering the ethical responsibility these facilities have to their patients.

Now, I feel it's important for me to restate, at this point, my views on mandatory programs. As I've said before, it is the job of health care providers to ensure the health of their patients, including the risk of hospital-acquired infections, such as influenza. I join the American Academy of Pediatrics, the Infectious Disease Society of America and many more professional organizations in supporting mandatory influenza immunization programs as an available means of improving influenza uptake and, thereby, decreasing the risks to staff and patients. That said, I also share some other views expressed by these organizations, that such programs should not be all-or-nothing, vaccinate or be fired. Any such program must provide for medical exemptions and, where required by law, religious/philosophical exemptions. I'm not aware of any program that does not have such exemptions. In those cases where an employee does not get the vaccine, no matter the reason, they should be required to wear a mask. If an employee refuses a vaccine and refuses to wear a mask, then they are clearly in the wrong field, care little for their patients and ought to seek employment elsewhere. In short, employers should be able to fire them if it gets to this point.

Rep. Thiesfeldt focuses so much on the vocal minority clamoring that mandatory vaccination and masking policies are unfair or an imagined violation of personal rights (you have a right to life, liberty and the pursuit of happiness...you do not have the right to be employed by a specific employer), that he completely ignores the rights, health and well-being of everyone else. Instead of wanting health care facilities to be places of healing, it appears that Rep. Jeremy Thiesfeldt wants to make it easier for you to get sick.

As I concluded in my previous post, if you live in Wisconsin, I urge you to contact your representatives and urge them to vigorously oppose this bill once it is introduced. You can find your representative's email address here. I also suggest contacting the members of the Committee on Health, especially considering that one of the bill's co-sponsors, Rep. Erik Severson, is the committee's

UPDATE: One of the bill's coauthors, Kathleen Bernier, has requested that her name be removed from the bill as a coauthor. In an email exchange with her office, I was informed that she removed her name due to concerns raised by constituents, but that, at this time, she is neither for nor against the bill.

2 comments:

  1. As an RN, I agree with you Todd. Not vaccinating is like leaving an infectious patient without washing your hands. Mine are all up to date. Who wants to have an infected health care worker looking after their sick relative? I wonder how many of these refusers would allow it for their family?

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  2. Thanks for your comment, John. What boggles my mind is that we already require certain immunizations for health care providers in order to reduce the risk of disease transmission. Quite frankly, if the argument to oppose flu vaccination rests on its variable efficacy, then we can just respond that everyone should be required to wear fitted N95 respirators during flu season. I suspect that if such a policy went into effect, there would be a lot more complaining than there is currently with regard to the vaccine.

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