bitching from one angry feline
Take your mandatory flu vaccination and shove it (in your arm, not mine)
JUICY FUN !- SLASHING AND BURNING THE CNA'S MANDATORY VACCINATION FOR NURSES POLICY!
The following is a rebuttal addressed to the CNA regarding their flawed position statement on Mandatory Influenza Immunization for Nurses. This paper is not expected to sway the minds of the deluded CNA . I have forwarded it however to nursing and public employee unions in hope to illustrate the paucity of evidence to support this unfair practice so that you may help your members fight this initiative during next years “flu” madness. It is long, but each argument you will face in your fight is covered. If you read nothing else PLEASE read chapter 7 page 54-60 of the CIDRAP report to CDC regarding how vaccine recommendations for healthcare workers have been promulgated at http://www.cidrap.umn.edu/cidrap/files/80/ccivi report.pdf This is a vital piece of information as it critically examines the poor studies that your hospital, and our government, is using to endorse forced vaccination. Any study not covered by CIDRAP is addressed in Abramson's review: http://www.hindawi.com/journals/ijfm/2012/205464/
To the board of the CNA:
I had to control my laughter when I read the CNA patting themselves on the back for their support of mandatory vaccination of healthcare workers. The CNA drags out poor old Florence Nightingale and insists she would be "proud" of their position. As a reformer, a statistician with keen analytical skills, Ms Nightingale would certainly not be "proud". In fact, she would more likely be horrified to see dewy eyed influenza vaccination committees, armed with sanctimonious consensus and no facts, dictating the rights of the individual; all tucked neatly under the blanket of "the greater good", so that anyone who questions it is painted as a reckless fool. She would be gravely disappointed to see the alleged representative body of nursing, the CNA, dutifully accepting the verbatim orders of vertical powers without critical evaluation of influenza statistics and quality literature, all at the expense of human rights which she fought vigorously to uphold
Blue Italics indicate CNA's position paper or ethics statement
CNA Position Paper on Mandatory Vaccination of Nurses:
CNA recognizes that influenza is a serious illness that affects certain populations disproportionately. Vulnerable groups, such as infants, seniors, pregnant women and those with chronic illnesses, are at higher risk of experiencing complications from influenza.
CNA supports annual influenza immunization as the most effective method of preventing influenza and its complications.
A study in February 2013 Clinical Infectious Diseases found, there was no evidence that vaccination prevented household transmission once influenza was introduced; adults were at particular risk despite vaccination and shockingly, annual vaccination was found to leave participants at “SUBSTANTIALLY HIGHER”risk to contract influenza(1)
Treanor and Szilagyi's editorial to this study says this:
"Given the many persistent questions about flu vaccine efficacy, it may be time to rethink the view that randomized trials are unethical, the two commentators suggest. "Given that the effectiveness of the vaccine is unclear, [that] the subjects in such studies are typically at extremely low risk of serious disease, and that effective antiviral therapy is available, perhaps [the ethics] should be reconsidered...”
The CDC assures effectiveness of the flu vaccine for “about a year” However, new studies from Eurosurveillance found that the flu vaccine's efficacy quickly waned and protected at 0% at the end of 3 months. Kelly from CIDRAP hints at the follies of faith based evidence when he praises the new studies: "It's never easy to publish something that doesn't fit with the things we like to say. It shows scientific integrity and a passion for the best data." (2,3,4)
The CIDRAP report to CDC illustrates that the 4 common studies to support healthcare vaccination are dramatically flawed(5). Abramson's meticulous dissection of the poor quality studies to support mandated health care worker vaccination concludes this“ The arguments for uniform healthcare worker influenza vaccination are not supported by existing literature.”(6)
Gardam and Lemieux from the Infection Prevention and Control Unit at Toronto's UHN:
'We are uncomfortable taking the next step of compelling vaccination given the considerable limitations of the current vaccine." The team also acknowledge that the research on the effectiveness of flu vaccines comes amid exaggerations of flu deaths from models that are promoted by public health officials and publicized by media (covered on page 7)
Ulrich Kiel, is the director of the WHO collaborating centre for epidemiology and prevention of cardiovascular and other chronic diseases at the university of Münster. Dr Kiel provided testimony at the Hearing on “The handling of the H1N1 pandemic: more transparency needed?” Dr Kiel starts his talk with: “Ladies and gentlemen, we are presently witnessing a gigantic mis-allocation of resources in public health.” He quotes Neustadt and Fineberg who concluded in “The Epidemic That Never Was” that we have:
- Overconfidence by specialists in theories extrapolated from meagre evidence •
-Conviction fuelled by a conjunction of some preexisting personal agendas •
-Premature commitment to deciding more than had to be decided •
-Failure to address uncertainties in such a way as to prepare for reconsideration •
-Insufficient questioning of scientific logic and of implementation prospects (7)
Obviously, those lessons have not been learned by the CNA or our public health policy makers regarding influenza and angst driven pandemic programs. To date, arguments in favour of HCW influenza vaccination are not supported by credible literature.
It is CNA’s position that all registered nurses (RNs) should receive the influenza vaccine annually to protect themselves, their families and those in their care, with the exception of RNs for whom influenza immunization is contraindicated.
“No reliable date can be found on influenza rates in HCWs (or their families) or comparisons to the general population. The argument that HCWs are at higher risk of infection because of their proximity to infected patients is theoretical. A contrary argument is that RN’s as health care professionals,are indeed more aware of the danger and take more precautions against infection, such as keeping a distance from others, access to and trained use of N95’s, presence of trained cleaning staff, hand washing, and industrial HEPA/HVAC filters and ventilation.” (5)
CNA recommends that annual influenza immunization of RNs be part of a comprehensive workplace and patient- safety strategy. Front-line RNs must be included in the planning, implementation and evaluation of such programs.
Front line nurses have been offered no choice in this matter. It has been an autocratic process that has seen the position of front line nurses disrespected and disregarded. Nurses are seen as part of the problem, not part of the solution.
CNA believes that policies that place immunization as a condition of service should be introduced if health-care worker influenza immunization coverage levels are not protective of patients, and reasonable efforts have been undertaken with education and enhancing accessibility to immunization.
You have no evidence to prove what “coverage levels” are protective to patients. You cite one study in your reference list (Benet) that claims 35% coverage may be accurate..then others are 90%. This again, is an illustration of the arbitrary, assumptive action of policy makers who are not guided by science. The Kiwanis Nursing home in Sussex New Brunswick was closed from an influenza outbreak for 2 months this year. They had a staff and resident vaccination rate of over 80% ( Be assured situation will be repeated all over the country this year as the facts start coming out)
CNA considers mandatory immunization policies by employers to be congruent with the Code of Ethics for Registered Nurses in Canada and the obligation to act in the public interest, as noted in CNA’s Objects.
Really? Don't not think the dictum “do not harm” allows you implement policy based on good intent, not evidence. Lets examine the CNA code of ethics further. I assume you are referring to this statement:
During a natural or human-made disaster, including a communicable disease outbreak, nurses have a duty to provide care using appropriate safety precautions. See Appendix D.
However, the CNA Code of Ethics in Appendix D also states:
Nurses have a right to receive truthful and complete information so that they can fulfil their duty to provide care. Also, Employers are expected to provide RNs with information that is thorough, current and accessible.
We cannot fulfil our duty to care operating in a blind spot of evidence. The CNA, the NACI ( National Advisory Committee on Immunization) and the ACIP (Advisory Committee on Immunization Practices) are well aware of the quality contrary evidence to this initiative. Yet, In keeping with endemic publication bias on this topic, studies and statistics are cherry picked for “proof” . ( We will examine each of the studies later) How “truthful and complete” is the information provided, when credible sources like the Cochrane Collective review of vaccination of health care workers, are censored and manipulated to serve vaccination campaigns? Never once are we provided with important and unambiguous conclusion of that review: “We conclude there is no evidence that vaccinating HCWs prevents influenza in elderly patients in long term care facilities.” ( please see the end of this document for the manipulation of the Cochrane review by our leading health officials)
The next sentence in Appendix D of the CNA Code of Ethics states: They (nurses) must also be supported in meeting their own health needs.
How is a forced vaccination supporting us in meeting our health needs? We forfeit our rights to choice and assume risks for a virus that is not properly tracked and submit to a vaccine that has been scientifically illustrated to provide negligible patient benefit. Health is not isolated to a physical entity. Health is compromised of mental, spiritual and emotional needs. Forced vaccination that causes moral and emotional conflict due to opposing philosophical, professional or religious beliefs is the antithesis of “supportive health needs”
The CNA code of Ethics also says:
assist in developing a fair way to settle conflicts or disputes regarding work exemptions or exemptions from the prophylaxis or vaccination of staff
Again, reconciling forced vaccination with fairness is mind boggling.
Public Health Lawyer Wendy Mariner says this about forced vaccination programs: “The public will support reasonable public health interventions if they trust public health officials to make sensible recommendations that are based on science and where the public is treated as part of the solution instead of the problem. Public health programs that are based on force are a relic of the 19th century; 21st-century public health depends on good science, good communication, and trust in public health officials to tell the truth. In each of these spheres, constitutional rights are the ally rather than the enemy of public health. Preserving the public’s health in the 21st century requires preserving respect for personal liberty.” (8)
The Code of Ethics also advocates: Promoting and respecting informed decision making
Ethically we are bound to ensure that we are honest about the veracity and quality of evidence. We are bound to disseminate evidence based medicine NOT popular opinion. An ethical nurse values transparency to ensure trust is established and maintained in the decision making process.
Maintaing Privacy and confidentiality
Nurses recognize the importance of privacy and confidentiality and safeguard personal, family and community information obtained in the context of a professional relationship.
A nurse who is bound to a standard of privacy for their community would acknowledge that submitting to stickers, wearing shaming masks or being forced for reveal personal health information, religious affiliations or philosophical mores contravenes ethics, privacy and confidentiality.
CNA believes that RNs must be well-informed of the risks of the disease to themselves, their families and those they care for, as well as of the benefits and risks of immunization.
Registered Nurses are well aware of the dangers of influenza. A Registered Nurse is also aware that there are a plethora of other diseases that are regularly confused with influenza. We agree that RN’s must be well informed about risks and benefits of immunization that is the very reason this protest exists before you.
“Today more than 500 infectious diseases are known to occur in humans, yet in the United States, public health officials recommend routine childhood or adult vaccinations for only 17 of these diseases. And, for only one of these diseases is there a recommendation for universal annual vaccination: namely, influenza. In a recent review in the CDC’s Morbidity and Mortality Weekly Report (MMWR), 15 vaccines were highlighted for their significant role in reducing morbidity in the last 60 years. Of note, the influenza vaccine was not one of these, despite accounting for 26% of the citations in the review" ( see reference 6 Osterholm's CIDRAP report chapter 7 page 51)
CNA urges nursing education programs to discuss the science of vaccines, including safety and efficacy, as well as ethical issues surrounding the immunization of RNs and nursing students.
We absolutely welcome a reciprocal discussion performed in transparent manner to demonstrate efficacy of this vaccine in valid studies.
Regarding safety, we would like an explanation as to why the ACIP's minutes recognized they had no safety data for repeated annual injections and yet , HCW's are expected to be forced to submit to yearly injections (6) We are told the vaccine is safe, however clearly there are certain immune systems that do not respond favourably to the vaccine. Herein lies the problem with credibility and trust. We know for a fact we have been provided with censored efficacy and statistical data on influenza. Why would we trust that you are transparent regarding the accuracy in which you track adverse reactions, especially autoimmune reactions with late or subacute onset? Most importantly, The 2010 Cochrane review on vaccines for preventing influenza in healthy adults concluded that, “Although serious harm from vaccination may be rare it cannot be ignored and conclude that the results of their literature review discourage the utilization of vaccination against influenza in healthy adults as a routine measure.”
-A discussion of ethics is laughable when your paper endorses forced vaccination.
Most patients are not tested routinely for influenza, making it difficult to assess the true burden of influenza in terms of incidence
Yes, it is and this statement destroys your credibility. Data without context is misleading and unacceptable. We are supposed to TRUST that the presenting pathogen is influenza despite the fact that only 10-20% of the cases of ILI are actually caused by the influenza virus. This is called “faith-based medicine.” The healthcare system and the media have fuelled vaccine campaigns by perpetuating the falsehood that “the flu” incorporates all seasonal ills general, most symptoms of the “flu” are not caused by influenza virus, but by a variety of non influenza viruses, bacteria, other infectious organisms, or even noninfectious conditions. Shoddy influenza quick tests with massive error margins are performed in doctors office instead of reliable virology culture confirmed tests. The knee jerk influenza response is dangerous. A 24 year old mother died in Hamilton Ontario this year after being sent home with “influenza” after 3 visits to an Emergency Room. She later died of bacterial meningitis. Still, the paper mused about whether or not she had her flu shot.
The dissemination of false perceptions about influenza will only serve to erode public confidence that will lead to less vaccine uptake and less confidence in future recommendations.
If the CNA were to make true initiatives with public health, why not campaign to demand accurate tracking of seasonal viruses with RT-PCR and/or culture-confirmed outcomes.
The Public Health Agency of Canada estimates that, in a given year, between 2,000 and 8,000 Canadians die of influenza and its complications, depending on the severity of the influenza season.3 Yearly, there may be up to 20,000 hospitalizations related to influenza,
Again, has the CNA critically examined how this astounding number is derived? You've just admitted influenza is not routinely tested How do you profess to know accurate mortality of morbidity rates?
“In fact, there were only 300 deaths per year across Canada where physicians actually documented “influenza” as a cause of death between 2000 and 2008....The 2009 H1n1 proposed “pandemic” mandated that all samples be properly laboratory confirmed by culture. The final death count in 2009? 428 – a number closer to the proposed seasonal average of 300 rather then the “2000-8000” estimated by computer models which are a statistical guess.. Public Health Canada uses these flawed models to derive the 2000-8000 number. One model counts all respiratory and circulatory deaths — that's death from heart and lung failure — as flu deaths. At the lower end of that model they count the number of deaths officially listed as "influenza" on the death certificate, plus all deaths from pneumonia — even though not all pneumonia is caused by flu. Another model assumes that every extra death that happens in the winter is a flu death. Winter deaths (minus) summer deaths = death by flu virus. That includes winter deaths from slippery sidewalks, snowy roads, freezing temperatures, plus all the winter heart failure, lung failure and deaths from cancer.
“For proof of how models keep changing their estimates, look back at Canada's flu files. More than a decade ago, flu was estimated to kill about 500 to 1,500 Canadians every year. But in 2003 Health Canada changed models, and the estimates jumped to "700 to 2,500 per annum." The 2,500 deaths at the upper end of that range quickly became the lower end, when an even newer model was tried in 2007, pushing the upper limit to 8,000 based on the severe flu seasons of 1997 to 1999.” (9)
The truth is we have no idea how many people die of influenza every year. It might be 300 it might be 10,000. The only reality is that scaring people appears to justify evidence free policies.
In February 2013, US CDC has released a new report about an “alarming” increase in superbugs in hospitals including Klebsiella pneumoniae, a pathogen that killed at least seven patients at a federal research hospital in Bethesda, Md (7) . With limited resources, should infections inarguably acquired in hospitals concern the CNA?
If the CNA were innovators, they would use their voice to address the true menace inflicted upon those entering hospitals of antibiotic resistant infections like C Diff and MRSA. They would push for campaigns to bring in a scientific model to collect information about mortality and morbidity that truly reflects the burden of influenza.
Annual immunization is the most effective method of preventing influenza and its complications.
You have quoted Wilde et al for this reference. Had you critically examined Wilde's paper you would find: Wilde et al.  demonstrated high effectiveness of vaccinating hospital employees in preventing serologically defined influenza infection with 13.4% of control subjects and only 1.7% of vaccine recipients developing serologic evidence of influenza. However, this did not translate into clear clinical benefit—the small mean reductions in febrile respiratory disease (0.12 days) and absence from work (0.11 days) were far from reaching statistical significance. Also of most important note, serology confirmed influenza is well known to be an unreliable end point in any influenza study. RT-PCR and/or viral culture-confirmed outcomes are the evidentiary standard. This study was identified as being at risk of high bias by a cochrane evidence review. (5)
Influenza immunization programs focus on three groups: those at high risk of influenza-related complications, those capable of spreading influenza to individuals who are at high risk of complications and those who provide essential community services.
Due to the nature of their jobs, both in acute care and in the community, RNs are in contact with people who are at high risk of complications — children, seniors, pregnant women and people with low immunity or with chronic health conditions. Many nurses also provide essential services, and their absences due to illness compromise a facility’s ability to provide care.
The recommendation of vaccinating all adults for influenza is weak. The 2010 Cochrane review on vaccines for preventing influenza in healthy adults detected a statistically significant reduction in confirmed influenza cases, the size of which depended on the degree of vaccine matching to the circulating virus. However, the reviewers point out that the small overall average absolute difference of about 1% suggests that 100 adults would need to be vaccinated to prevent one case of influenza. The review showed that vaccine reduced time off work by an average of 0.13 days. This small effect was of borderline statistical significance (95% CI 0.00–0.25). Vaccination did not have a statistically significant effect on hospitalization or complications, and no evidence was found that vaccines prevent viral transmission. The last sentence is of the utmost significance to the healthcare worker argument in that even a perfect antigenic match does not guarantee an adequate antibody titre, nor does it ensure measurable antibody assure protection.
Influenza immunization of health-care workers (HCW) has been shown to decrease infection rates.
You cite Wilde again here, are you short on studies? Wilde does not support your position.
and a growing body of evidence demonstrates that HCW immunization can improve patient outcomes in health-care settings
Lets look at your “growing body” of studies, shall we?
( Carmen et al, 2000)- This 13 year old study, did not find an association between HCW vaccination and virological proof of patient infection, despite a good match between the vaccine and outbreak influenza variants. The authors did not find a statistically significant reduction in patient mortality associated with HCP vaccination, after adjusting for covariates. (5)
(Potter et al 1997) A 17 year old study. The authors concluded “we do not have any direct evidence that the reductions in rates of patient mortality and influenza-like illness that were associated with HCW vaccination were due to prevention of influenza.” (5)
Lemaitre: Flawed study design with inconclusive results and multiple confounders including more confusion between circulating viruses, namely influenza and RSV..See Abramson's Review at http://www.hindawi.com/journals/ijfm/2012/205464/ (6)
Haywood: Again, poorly conducted study with once again, no confirmed end point of influenza. Non blinded RN's Significant alterations in patients health characteristics between study years. See Abramson's critical review at http://www.hindawi.com/journals/ijfm/2012/205464/ (6)
No randomized controlled trial data exist for acute care;
Another credibility killer. Why not rephrase this to say, “ There is no gold standard evidence to support this policy in an acute care setting” Not a single study has been performed in the setting of primary care clinics where contact with patients is less intense.
However, observational studies have found lower immunization rates of HCWs to be associated with higher rates of laboratory-confirmed hospital-acquired influenza among patients.
Observational studies cannot form the foundation of a scientific argument! Even The flawed NACI ( National Advisory council on immunization) cautions against observational studies: “Increasingly, the need for caution has been expressed in the interpretation of observational studies that use non-specific clinical outcomes and that do not take into account differences in functional status or health-related behaviours” (10)
The CNA cites a hopelessly small observational study ( ie not an experimentally designed investigation) by Benet et al which consists of 55 people. They found: “The threshold that we reported was based on the distribution of HCW vaccination in our hospital. A proportion of vaccinated HCW of less than 35% seemed to have no effect on HAI ( hospital acquired infection) in patients, whereas a proportion of more than 35% could be considered, according to our data, as the minimal vaccination coverage with potential protective impact on hospital-acquired incident cases. Also, while a higher proportion of vaccinated HCW is expected, it has not been demonstrated that the concept of herd immunity, which needs large and closed populations, can be applied in acute-care settings with multiple different contacts.” A question, do you read the studies before you put them in your position statements?
Recommendations for the immunization of HCWs against influenza have been made for over 20 years
Yes, and have you have never given pause to consider how these recommendations were promulgated? Not a SINGLE vaccine recommendation from 1958 – 2013 has been based on evidence. They have been solely opinion and authority based arising from the ACIP ( advisory council on immunization practices) (5)
From October 2005-2008, the ACIP minutes identified uncertainty among the committee on several issues around gaps in knowledge for expanding influenza vaccination recommendations. In October 2005, the gaps identified were: 1) vaccine effectiveness for those 65 and older 2) indirect benefits of vaccination of persons not at risk for complications ( ie nurses) 3)cost effectiveness of vaccine strategies and 4) SAFETY of repeated vaccination. (5)
A statement from the influenza working group minutes in June 2006 minutes says: “Several critical factors must be assessed before changing current recommendations and advancing toward a universal policy.” By 2011, there were no records in ACIP minutes that addressed the gaps in knowledge noted above.
The ACIP has not kept up with current evidence standards, i.e they continue to use studies that have serology as an end point ( an error that has been well known since 1959)
Shockingly , the ACIP prejudiciously selects these following 4 studies of “proof” that serve as the crux of their forced vaccination argument for healthcare workers. You will find these studies associated with most mandatory influenza programs:
In the first study, the authors did not find a statistically significant reduction in patient mortality associated with HCP vaccination, after adjusting for covariates. ( Carmen et al, 2000)
In the second study, the authors concluded that “we do not have any direct evidence that the reductions in rates of patient mortality and influenza-like illness that were associated with HCW vaccination were due to prevention of influenza.” (Potter et al 1997)
In the third study, vaccination did not reduce the episodes of self-reported respiratory infection or the number of days ill with a respiratory infection, but it did reduce the time employees were
unable to work because of a respiratory infection. (Saxen and Virtanen, 1999) this study was cautioned as being at high risk for bias by cochrane reviewers.
In the fourth study, Wilde et al.  demonstrated high effectiveness of vaccinating hospital employees in preventing serologically defined influenza infection with 13.4% of control subjects and only 1.7% of vaccine recipients developing serologic evidence of influenza. However, this did not translate into clear clinical benefit—the small mean reductions in febrile respiratory disease (0.12 days) and absence from work (0.11 days) were far from reaching statistical significance, This study design was described as being at high risk of bias by Cochrane reviewers.
Osterholm says "Since only two of the four studies cited provide some support for the ACIP statement, it is unclear how the quality of evidence in these studies received a category IA evidence grade." (5)
So, in the absence of evidence, they make it up! Just think, recommendations based on evidence that didn’t even support the initiative is what is navigating influenza vaccination programs at the highest levels in the USA! Canada, as the United States lap dog, is only too happy to indulge the same.
However, rates of immunization against seasonal influenza are as low as two per cent, with an average between 40-60 per cent
This is an insignificant statement as vaccination of HCW for influenza has never been proven to be an effective initiative.
The rationale for immunizing HCWs is that:
HCWs with influenza can be infectious at least one day before their initial signs and symptoms,
See below re masking and environment
and most HCWs will continue to work even when ill with influenza, particularly if the illness is mild.
The word “most” exists here for sheer drama and illustrates the emotional tone of these campaigns. The concept of “most” HCW’s “presenteeism” speaks more to institutional staffing shortages and badgering measures with “attendance management” programs. This has nothing to do with influenza vaccination.
Approximately 20 per cent of ill HCWs remain sub clinical yet are still infectious.
See below re masking and environment