Art Caplan on New York State’s Mandate to Vaccinate against the Flu or Wear a Mask

Art Caplan has co-authored a new article, with Nirav R. Shah, published online today by JAMA. In “Managing the Human Toll Caused by Seasonal Influenza: New York State’s Mandate to Vaccinate or Mask,” Caplan and Shah discuss New York’s new mandate that health care personnel who have not been vaccinated against the flu must wear a mask during the coming flu season.

New York State and the nation as a whole experienced one of the worst influenza seasons in a decade during the winter of 2012-2013. In the peak week ending January 19, 2013, New York alone reported more than 5000 cases of laboratory-confirmed influenza, more than 1120 hospitalizations as a result of influenza, and 5 flu-related pediatric deaths. By the season’s end, more than 45 000 cases had been confirmed, more than 9500 people had been hospitalized, and 14 children had died.


The flu is especially threatening in health care settings such as hospitals, skilled nursing facilities, and nursing homes, where exposure to flu virus is heightened by ill patients and close and ongoing contact with infected health care professionals and staff. Public health officials have long urged health care personnel to get vaccinated. Even so, many do not.


The ability to minimize the transmission of the flu from health care personnel to patients in health care environments largely depends on high rates of vaccination among those providing care. Studies examining the vaccine’s preventive effects on patients and staff are limited but have been generally positive. Conversely, in New York State, high rates of vaccination coverage among patients in nursing homes has not been enough to prevent outbreaks in the face of low levels of staff vaccination.

Over the years, efforts to achieve high rates of flu vaccination through voluntary campaigns have failed to generate the requisite levels of participation to produce the maximal benefit for both patients and the health care workforce. Studies show rates of vaccination resulting from these campaigns in the 50% to 60% range. This has led to calls to mandate flu vaccination as a condition of employment in health care institutions.


The state of New York is implementing a first-of-its-kind mandate for the use of masks in all unvaccinated health care personnel, both staff and volunteer. The new regulation, which goes into effect with the 2013-2014 flu season, requires unvaccinated health care personnel in regulated settings to wear a surgical mask in areas where patients or residents may be present. These settings include hospitals, nursing homes, diagnostic and treatment centers, home care agencies, and hospices.

Read the full article here.

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