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With the recent Ebola virus outbreak, we are reminded of how quickly deadly viruses can spread. In fact, the World Health Organization (WHO) recently declared the virus’ outbreak to be a “public health emergency of international concern.” When the swine flu hit in 2009, the WHO declared a similar state of emergency. The deadly Ebola epidemic serves as a real reminder that influenza season (or as it’s more commonly referred to, the “flu”) is around the corner, and that, if as brutal as past years, fatalities could be seen in large numbers.

Unlike Ebola, the flu can be prevented, or at least curtailed, by a seasonal flu vaccine. Each year, researchers identify the season’s most prevalent influenza strands and vaccine manufacturers create a vaccine to help prevent the spread of the virus. With this year’s flu season fast approaching, individuals and the healthcare community are sure to debate whether a flu vaccine should be mandatory for healthcare workers. Some in the industry argue that each person should have autonomy over his or her body and decide for themselves whether to receive the flu vaccine. Others take the position that virtually all healthcare workers should be required to receive the vaccine, especially those healthcare workers who come into close contact with highly vulnerable patients, such as the elderly or immunocompromised. Those advocating for more widespread vaccination often support their position by pointing out that even seemingly healthy individuals can carry and pass the virus before symptoms present, without knowing they’re infected.

Although Pennsylvania, like many other states,1 has not made flu vaccination mandatory for all healthcare workers, certain Pennsylvania hospitals have adopted policies requiring that all employees receive the vaccine.2 Conversely, other states, such as New Hampshire, have enacted legislation expressly requiring employers to vaccinate all consenting employees.3 Yet another approach to combat the spread of the flu has been adopted by Rhode Island; hospitals are required to ensure that healthcare workers either receive the flu vaccination or wear a surgical face mask during each encounter with a patient.4

Like states that have addressed the issue, entities that have mandated flu vaccination have done so in a variety of different ways. For example, some mandatory vaccination policies apply only to nurses, while others apply to any individual who provides services to patients. Furthermore, some policies require non-vaccinated individuals to wear a surgical mask or colored dot on his or her badge, while others do not draw attention to non-vaccinated workers in any way. Although these policies differ in some respects, almost all contain an exemption provision that allows certain individuals to avoid receiving otherwise mandatory vaccinations. Most mandatory vaccination policies include exemptions for medical contraindications and religious reasons, but such exemptions must be requested by a certain date and frequently must also be approved by the employer. Moreover, an exemption for religious reasons must usually be supported by a sincerely held religious belief.

If a healthcare entity chooses to implement a mandatory flu vaccination policy, it should consider certain issues. For instance, will the policy apply to all workers or just a certain subset of workers? Will the policy apply only to employees or affiliated individuals as well? Will the policy allow for individuals to receive an exemption? If so, what procedures will be followed to consider and grant exemptions? If an individual receives an exemption and does not receive the vaccine, will such individual be required to wear a surgical mask during patient encounters or take some other precautionary measure? Finally, if an individual does not comply with the policy, what consequences will follow?

The hotly debated issue of mandatory vaccinations will continue to receive attention as this year’s flu season approaches. In fact, as the world continues to focus on the tragic Ebola outbreak, the debate over mandatory vaccination may become more pronounced than ever. Healthcare providers that choose to implement mandatory flu vaccine policies must be prepared to educate employees and patients alike as the vaccination debate continues. To do so, it is important that providers review applicable state laws and regulations that address this issue, if any, and consider the pros and cons of implementing a mandatory vaccination policy.

1A list state-by-state comparison of influenza vaccination requirements is available on the Centers for Disease Control and Prevention website at:
2See Influenza Vaccination Honor Roll: Honorees with Influenza Vaccination Mandates, available at:
3N.H. Rev. Stat. Ann. § 151:9-b(IV).
431-1 R.I. Code R. 22:3.5.4; 31-1 R.I. Code R. 22:5.4