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The Debate over Mandatory Vaccinations

posted on Wed, Jan 9 2013 11:05 am by Chris Walker

Vaccines have had a hard go with some of the public lately. The ongoing battle with anti-vaccination advocates seems to be intensifying, with the alleged autism link still persisting and a new issue opening up in worldwide thimerosal use in vaccines. Mandatory influenza vaccination for healthcare workers is yet another front.

I recently read an editorial from the Chicago Tribune that called for making seasonal influenza vaccinations mandatory for health care workers. To date, only a few states have made vaccination mandatory. The debate about mandatory vaccination is an important one: On the one hand this intervention has the potential to reduce the number of people getting sick and dying from seasonal influenza; on the other hand, it involves an exercise of government and/or employer power over individuals. Understanding this trade-off and addressing the concerns of those opposed to mandatory vaccinations will be key for advocates if they hope to be successful in their work.

To get a better sense of popular opinion regarding this measure, I did something I wouldn’t normally do: I studied the reader comments for the editorial. There was actually a pretty good back-and-forth going, and the comments highlighted several concerns and objections that people had with mandatory vaccination.

Among commenters’ concerns:

  • The rights of employees versus the rights of employers, and whether there was a slippery slope in allowing mandatory vaccinations.
  • Who should be vaccinated -- if the concern is for those at high risk (the elderly or chronically sick) why aren’t they the ones being forced to be vaccinated?
  • Vaccine and injection safety.
  • Questions about payment fairness.
  • Vaccine effectiveness, especially with regard to herd immunity.


These are all valid concerns, and they can be addressed by the public health community:

  • Health care employers need to do the best they can to protect the health of their patients, and the government already has certain mandatory vaccination powers.
  • In many states the government has mandates for hospital inpatients that are similar to the proposed health care worker mandates, and these measures are likely to work even better in tandem.
  • According to the CDC, “hundreds of millions of Americans have safely received seasonal flu vaccines.”
  • Most states that require healthcare workers to be vaccinated mandate that the vaccine be offered to the employee for free.
  • Influenza vaccines are not always effective, but they are significantly better than nothing, and mandatory vaccination for health care workers greatly increases vaccine uptake.
  • By choosing to vaccinate you decrease the risk of spreading influenza to those around you, some of whom cannot be vaccinated due to legitimate medical concerns, a term public health officials call herd immunity.

These are not comprehensive responses, but they do cover a lot of the concerns I’ve seen on this topic. It’s important that we, as the public health community, continue to address the concerns of the population, and to stay on our talking points. Simply passing a law mandating influenza vaccination may work in the short term, but convincing people of its merits will better ensure the law is not simply repealed in a storm of backlash later on.

This blog was prepared by Chris Walker, J.D., Staff Attorney at the Network for Public Health Law -- Northern Region at the William Mitchell College of Law.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this blog do not represent those of the Robert Wood Johnson Foundation.

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