In September 2004 the Virginia Mason Medical Center in Seattle, concerned about the "deplorable" number of their workers getting vaccinated, about 50%, issued a memo requiring all staff to be vaccinated against influenza or to face termination. The immunization would be part of the "fitness for duty" requirement, likening it to existing policies at Virginia Mason and most hospitals that require employees with patient contact to show immunity to hepatitis B and varicella or receive the vaccines. The hospital allowed for religious or medical exemptions and offered free antivirals to exempt employees.

The Washington State Nurses Association (WSNA), representing more than 600 nurses at the hospital, filed a grievance soon after. According to a report in the Seattle Times the WSNA said the policy violated an individual's right to make health care decisions and also violated labor laws because the hospital did not negotiate with the union before issuing the new policy. In August an arbitrator decided in favor of the WSNA and Virginia Mason was ordered to discontinue the policy.

But with health care worker vaccination rates still dismally low at less than 40% nationwide, some argue that the time has come to take the next step and mandate vaccination. In a 2005 paper by Poland and colleagues, the authors make the case that "the medical community has a moral imperative to take appropriate action to protect the vulnerable patients for whom they care, their fellow health care workers, and the public at large." 1

What do you think? Send your thoughts to [email protected] by November 15 for possible publication.

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