Point: Mandatory Influenza Vaccination for All Heath Care Workers? Seven Reasons to Say "No"

In the United States, influenza immunization of health care workers (HCWs) clearly has had a poor track record, as evidenced by studies documenting a vaccination rate of 35%–40% [1]. We also know from reports in the literature that HCWs can be a point source for outbreaks of nosocomial infection [2, 3], and a few studies are frequently cited as evidence that HCW vaccination reduces influenza infection and mortality rates among the older, institutionalized population [4, 5]. However, because confounding and bias are inherent in these studies' designs, their findings are less than compelling. On the other hand, HCW influenza vaccination does confer benefits to HCWs directly, as it does for healthy adults in general, by reducing influenza infection, its complications, and absenteeism [6, 7]. Thus, on the basis of benefits to be gained by institutions and organizations, there are valid arguments for well-organized, institutionally supported vaccination programs, but not to the extent of mandating vaccination for all HCWs [8–10]. For the purpose of this article, mandatory vaccination programs are defined as those that allow an exemption only for medical or religious reasons. Programs that have the options of active declination or exemptions for “personal reasons” are not truly mandatory; they are included as voluntary vaccination programs for this discussion.