The American way is to do as we please. But when it comes to transmission of disease, obviously things aren’t quite so simple. So should healthcare workers be required to get annual flu vaccines?

Despite today’s mainstream acceptance of the value of vaccines, for as long as there has been vaccination, there have been calls for mandatory vaccination, as well as resistance to any such practice.

One such debate that rages today is whether healthcare workers should be required to get flu vaccines. Proponents say it’s an easy way to help protect some of the most vulnerable sectors of the population, while others argue that any such requirement impinges on individual freedom.

Since 2010, the Centers for Disease Control (CDC) has recommended annual flu vaccination for “everyone 6 months of age and older,” especially “high-risk groups and their contacts and caregivers.” Among those groups the CDC includes “[h]ealth care personnel in inpatient and outpatient care settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.” These recommendations, the CDC says, “may be considered by state and other Federal agencies when making or enforcing laws” and are based on “findings of a recent CDC review of related published literature indicate that influenza vaccination of health care personnel can enhance patient safety.”

Although the CDC is not a policymaking organization and the federal government has passed no pertinent legislation, three states—Alabama, Colorado, and New Hampshire—do have laws that, to one degree or another, impose flu vaccination requirements on healthcare workers. Individual hospitals, however, are free to create and enforce such policies—and many do, including the world-renowned Johns Hopkins Health System, which employs over 25,000 people. It’s a move advocated by a wide range of medical organizations, including the American College of Physicians, the American Academy of Family Physicians, the National Association of County and City Health Officials, and the Infectious Diseases Society of America. While the American Medical Association is a little more roundabout in their endorsement of such a policy, they do say that “physicians have an obligation to [… a]ccept immunization absent a recognized medical, religious, or philosophical reason to not be immunized.”

Every Star Trek fan knows the gist of the argument in favor of such a requirement: The needs of the many outweigh the needs of the few. It’s an idea that predates Mr. Spock by centuries, going back at least as far as 1780’s An Introduction to the Principles of Morals and Legislation, where Jeremy Bentham introduced his ethico-philosophical principle of utilitarianism:

By the principle of utility is meant that principle which approves or disapproves of every action whatsoever according to the tendency it appears to have to augment or diminish the happiness of the party whose interest is in question: or, what is the same thing in other words to promote or to oppose that happiness. I say of every action whatsoever, and therefore not only of every action of a private individual, but of every measure of government.

If we go along with Bentham, if healthcare workers being immunized against the flu reduces the rate of patient infection, then it’s simply too bad for those workers who don’t want to be vaccinated: the needs of the many outweigh the needs (or wants) of the few. “It is in the highest tradition of the healing professions to set aside our own self-interests and preferences in the moral imperative to best protect and care for our patients,” says the Mayo Clinic’s Gregory A. Poland, “even if it means accepting some level of self-harm (real or imagined).”

But that’s not typically the American way. For better or for worse, Americans tend to prize their personal freedom more highly than the common good. Our Constitution, after all, is pretty quiet on the subject of individual obligations but explicitly enumerates a bunch of things the government may not do to you. And although employers are a different kettle of fish legally, the feeling is the same: No-one should tell me what to do with my own body.

There is, however, a more specific argument against mandatory flu vaccination. The utilitarian argument in favor of such policies is based on the premise that such practices reduce the rate of infection—but that is a point of contention. One of the organizations that has studied this question is Cochrane, an independent, nonprofit network of researchers, professionals, patients, and caregivers with a stated mission “to promote evidence-informed health decision-making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence.” From a 2015 review of five separate studies into the question of whether “vaccinating healthcare workers against influenza reduces the risk of older individuals in long-term care institutions (LTCIs) acquiring influenza infections from healthcare workers,” Cochrane found no reasonable evidence to support the practice, even though it “probably ha[s] a small effect on [reducing] lower respiratory tract infection.”

Balancing the common good against issues of individual self-determination and the fact that all vaccinations entail some (usually infinitesimal) degree of risk can be tricky business. Based on the available evidence, it is not certain that the mandating flu vaccination for healthcare workers makes an appreciable difference to patients. Then again, it almost certainly can’t hurt.

About the Author:

Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.

His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. For more information: greggorymoore.com