H1N1: Battle at the Front Lines

A battle between public safety and personal freedom is brewing in hospital emergency departments.

With staffing already compromised by the economic downturn, workers who contract H1N1 could further reduce emergency room staff by infecting others.

Hospitals are developing programs to help reduce the spread of H1N1 among staff, but education alone may be inadequate to ensure the ability to address the epidemic. Many emergency department workers now face mandatory vaccination.

Public safety

CDC experts project that H1N1 may affect as many as 40 percent of Americans. H1N1 has already caused 7,511 hospitalizations and 477 deaths in the U.S. (CDC) That number is expected to soar. 160 million doses of injectable swine flu vaccine are slated to be available by October. Our emergency departments must be ready.

Personal freedom

People have a variety of good reasons for opposing mandatory H1N1 vaccination. Two major objections are possible allergic reaction to the egg products used in vaccine production and compromise of religious beliefs. Fear is also a factor. Previous swine-flu vaccination efforts in 1976 were halted when unexpectedly high numbers of patients developed a paralyzing condition called Guillain-Barre Syndrome. Although no report conclusively blamed the vaccine, apprehension lingers.

The Realities

Caught between serving the public interest and honoring their employees' personal preferences, some hospitals will require employees to prove the validity of their objections if they want to avoid vaccination.

At the time of employee vaccination, skin testing will be performed to prove claims of egg allergies. For religious objections, workers will be required to submit correspondence from religious officials on letterhead with a phone number for verification. Behind the scenes, hospital officials most likely are asking their legal departments if they can fire employees who refuse vaccination without sufficient grounds.

Emergency workers are like soldiers. They are called to serve and may be required to sacrifice in the public interest. Could mandatory vaccination be overkill? Maybe, if the pandemic peters out. Otherwise, minimal risk now could save many lives later.

— Tom DeSanto

Image: H1N1 virus, CDC