Influenza is a significant public health concern. According to the Centers for Disease Control and Prevention, the 2017-2018 flu season, which took off in November, was categorized as high severity. There was a record rate of hospitalizations, and the flu was the deadliest in four decades, also claiming more pediatric lives — 183 — than ever before. Alarmingly, 80 percent of the children who died did not receive a flu vaccination, which is the best way to prevent the flu and is recommended for everyone 6 months of age and older.
Since 1984, the Advisory Committee on Immunization Practices (ACIP) has recommended annual influenza vaccinations all health workers who have patient contact, though some organizations and individuals view a mandate as an encroachment on an individual's civil rights, and vaccination rates remain at suboptimal levels, though they are improving. Roughly 64 percent of health workers received a flu vaccination during the early 2014-2015 season, according to the Centers for Disease Control, compared with 63 percent a year earlier. By the end of those two seasons, the percentages increased 9 to 12 points.
Obligatory vaccination is not a new concept. In 1905, in Jacobson v. Massachusetts, the U.S. Supreme Court ruled that states have the power to mandate vaccination if it is necessary for public health or safety of the people. From a public health perspective mandating flu vaccinations is sound policy, as key criteria are met: There is clear medical value from the intervention to the individual and those he or she comes into contact with, and vaccination is considered the only preventive option to the flu.
Mandatory vaccination of children is even more controversial than that of adults. Information from state health departments demonstrates that only Connecticut, New Jersey, Ohio and Rhode Island have a mandatory policy that all children in daycare facilities must be vaccinated annually with the influenza vaccine. This past summer, New York City was granted the authority to mandate vaccinations for all children attending child care or school-based programs.
Considering children are at greater risk of serious illness from the flu, mandatory vaccination is justified. Most often children introduce the virus to the household, and vaccination would promote herd immunity and limit widespread illness in the community. Younger children generally have inferior responses to inactivated vaccines, as compared with healthy adults, and children under 9 years of age are recommended to receive two doses the first year that they receive the influenza vaccine. Of the 183 children who died last year from the flu, 58 would still be alive today if they had been vaccinated, according to last year’s vaccine effective rate.
While vaccination rates have improved, we must come together to decrease flu mortality and meet the U.S. Department of Health and Human Services Healthy People 2020 objective of 90 percent vaccination rates. From a public health viewpoint, we are obligated to work to mitigate the number of residents affected by the flu in our state and city. An increase in flu vaccinations is associated with reduced hospital admissions and overall patient morbidity and mortality, resulting in cost decrease and a lessened burden on an already overburdened health care system. Additionally, with a healthier workforce there has been less absenteeism and arguably greater productivity.
Public health officials should support organizations that require flu vaccination among health care personnel and urge others to follow suit. The health care policy implementation has demonstrated success, which should be used to model and expand vaccination to other vulnerable populations.
The state of Maryland should consider the implementation of a mandatory flu vaccination policy for all children in child care and school programs. Mandatory influenza immunization is the best-known prevention strategy and is an ethical practice. Mandatory vaccination of children should be a priority because one child dying from the flu is one too many.
Dr. Marissa Khajavi is a preventive medicine fellow at the University of Maryland Medical System and is pursuing an MPH in epidemiology at the University of Maryland School of Medicine. Her email is MKhajavi@som.umaryland.edu.