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Pandemic flu in particular, and public health in general, is a subject I hate to see politicized. Up until now, only Dick Armey has been foolish enough to do so. Armey's schtick was this:

"In September or October there will be a hyped up outbreak of the swine flu which they’ll say is as bad as the bubonic plague to scare the bed-wetters to vote for healthcare reform," said Mr Armey. "That is the only way they can push something on to the American people that the American people don’t want."

There's no "there" there, of course. And now the next iteration of made up stuff is noted by the NY Times, though as is often the case with traditional media, wrongly assigned solely to the internet:

And, in the rancor over health insurance reform, unfounded rumors are spreading that the Obama administration will make swine flu shots mandatory. Administration officials have emphatically denied that. But a recent decision by New York State to make them mandatory for all hospital employees has reinvigorated those rumors on the Internet.

As a point of fact, the internet is where rumors spread on cable TV get debunked. For Exhibit A, look no further than Fox News. Fanning the flames of ignorance is priminent nut job Glenn Beck, this time turning to "you can't trust the government" to explain the recent protests in NY over mandatory flu shots.

Mandatory vaccinations have been standard procedure in health care settings all over the country, less by governments than by employers. In fact, it has also been American Public Health Association for 20 years:

Recommends that institutions that train health professionals, deliver health care, or provide laboratory or other medical support services require appropriate immunizations for personnel at risk for contracting or transmitting vaccine-preventable illnesses;

and this APHA article from 2006 is an excellent discussion of the issue:

Low annual influenza vaccination rates among health care workers are putting patients, workers and the public at risk for flu infections and must be improved to prevent spread of the disease, according to new federal guidelines.

The influenza vaccination guidelines, published in February by the Centers for Disease Control and Prevention, not only reiterate the importance of yearly vaccination for health care workers, but also offer specific strategies for boosting vaccination rates. The recommendations include making nasal vaccine available for workers who fear needles, offering vaccine education that spells out the importance of protecting others from infection and providing free vaccines so cost is not a barrier for any health care worker.

When New York State moved to make flu shots mandatory last month, some health care workers protested. In a very good review of the subject on CBS' website, Declan McCullagh notes:

While no state has gone as far as New York, many other institutions have grappled with the concept of mandatory vaccination. The University of Iowa required all staff to be vaccinated for H1N1, but then backed down in the face of a union lawsuit. The University of Alabama requires proof of meningitis vaccination, without any obvious exceptions. Protests are planned in London on October 3 against mandatory vaccination.

All members of the U.S. military will receive the H1N1 vaccine starting in October, according to an American Forces Press Service article. Massachusetts is encouraging its health care workers to be vaccinated against seasonal influenza by December 15, but isn't mandating it; its public health commissioner has even sent out a statement trying to "dispel rumors" about "forced vaccination."

An article last year in the Harvard Law Review suggests that vaccination should be viewed as two different types: inoculation against easily-transmitted airborne diseases, and inoculation against diseases where the person can more easily prevent infection, such as sexually transmitted diseases. There are stronger arguments for mandatory vaccination in the first category than the second, the article argues:

"It makes sense to create this two-tiered system in which medically necessary vaccines are linked with narrower exemptions and practically necessary vaccines are instead linked with generous exemptions. So, vaccine laws could explicitly state that parents can exempt their children from hepatitis B and HPV vaccines with no questions asked, unlike vaccines for diseases listed elsewhere in the statute."

McCullagh also correctly points out that this is traditionally an issue that the states and not the Federal government is involved with, despite Beck's innuendo.

Mandatory vs. voluntary vaccination is an interesting debate in and of itself. But like rumors of FEMA detention camps for bird flu, the paranoid delusions of Glenn Beck don't lend themselves to rational debate.

"Who do we believe? The doctors, the nurses that say, 'wait, hey, you ain't giving it to me,' or the government, who says everybody has to have it?"

The government (in this case, the government of NY State, not the Feds) didn't say everybody has to have it, just health care workers. As to how it plays out, that remains to be seen. But the fact is that the current stats on flu vaccine for health care workers at ~50% annually are pretty disappointing. From the 2006 APHA article:

"We should be role models," said Archer, who has gotten a yearly flu shot since his freshman year of college, first because his football coach required it, and later because as a medical student he started thinking about his part in flu control. "I don’t think there’s any question that we have to practice what we preach. We have to clean up our own house first."

Amen, brother. My arm is sore from yesterday's seasonal flu shot. I don't intend to give flu to my patients, and in support of that, I expect my hospital to have an excellent track record for vaccination this year.

When the H1N1 vaccine gets here, I'll be rolling up my sleeve again. It's the least I can do for the people I work with and the patients I care for.

And the fact that wingnuts Armey and Beck would choose to politicize this, suggesting that it's an example of government lying? I'm shocked, shocked that there's gambling in this casino.

Originally posted to Daily Kos on Wed Sep 30, 2009 at 07:00 AM PDT.

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