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DH director of immunisation tells nurses they have a 'duty' to have swine flu jab

The Department of Health’s director of immunisation Professor David Salisbury has said nurses have a responsibility to be vaccinated against swine flu, after a Nursing Times survey reveals one third of frontline nurses do not want the jab. 

Up to a third of frontline nurses are not currently planning to get immunised against swine flu when the vaccine becomes available later this year, a snapshot survey by Nursing Times reveals.

Top among the reasons for rejecting the vaccine are concerns about its safety, and a perception of the infection as ‘mild’, suggests the online survey of nearly 1,500 Nursing Times readers, of whom 91% describe themselves as frontline nurses.

The warning of frontline doubts about swine flu vaccination came as the Department of Health revealed its timetable for initial vaccination last week.

Overall 30% of survey respondents answered ‘no’ when asked if they would get immunised when the vaccine became available, compared with 37% who replied ‘yes’. A further 33% remained undecided and answered ‘maybe’.

Of those who said they would not get vaccinated, 60% said concern about the safety of the vaccine was the main reason. A further 31% of respondents said they did not consider the risks to their health from swine flu to be great enough, while 9% thought they would not be able to take time out of work to get immunised.

‘I would not be willing to put myself at risk of, as yet, unknown long-term effects to facilitate a short-term solution,’ said one respondent.

Another, who said they were yet to make up their mind over whether to have the vaccine, added: ‘I have had the seasonal flu vaccination three times and on each occasion was very poorly for several days afterwards. It can give you flu-like symptoms, which in my case were bad enough to put me in my bed.’

A further respondent said: ‘I have yet to be convinced there is a genuine health risk and it’s not just government propaganda.’

Speaking to Nursing Times in response to the survey results, Professor David Salisbury, the Department of Health’s director of immunisation, said it was unfortunate that nurses could ‘knowingly leave themselves at risk’.

‘They have a duty to themselves, they are at risk. They have a duty to their patients not to infect their patients and they have a duty to their families. I think you solve those responsibilities by being vaccinated,’ he said.

With regards to safety concerns about the vaccines, he added: ‘The evidence that we’ve had is sufficient to persuade the regulators that these are vaccines that will be licensed.’

Professor Salisbury’s comments follow a warning in July from chief medical officer for England Sir Liam Donaldson that swine flu could leave up to 12% of the NHS workforce on sick leave at any one time. The NHS Confederation also called on nurse managers to ensure that their staff were vaccinated, particularly those in the acute sector, in guidance published last month.

However the survey results suggest the threat of swine flu is unlikely to overcome reluctance of frontline nurses to get vaccinated. Only a third of survey respondents said they received the seasonal flu vaccine last winter.

Official statistics for the acute sector are even worse. Only around 13.5% of hospital nurses received seasonal flu vaccination last winter, according to the Department of Health’s report on flu vaccine uptake among healthcare workers in 2008–2009.

Some trusts – Newcastle upon Tyne Hospitals NHS Foundation Trust and Mid Staffordshire NHS Foundation Trust – vaccinated fewer than 3% of their nursing staff.   

The DH report said: ‘Overall influenza vaccine coverage for [healthcare workers] directly involved in patient care remains disappointingly low.’

Nursing Times understands that the Department of Health is in discussions with groups, including the RCN, on ways to ensure a high uptake of swine flu vaccine was high among frontline nurses.

Greta Thornbory, professional development director of the Association of Occupational Health Nurse Practitioners, said occupational health nurses would need to help frontline nurses make an educated judgement about the vaccine.

She said: ‘Occupational health nurses will have to be completely clued up about the evidence on the swine flu jab, so they can give up-to-date information to nurses and anyone else who might have the vaccine.

‘This advice should not just be verbal, occupational health staff should consider putting it in a leaflet. Putting this kind of advice on posters will not work,’ she added.

However, one survey respondent suggested pressure from occupational health nurses could have an adverse effect on uptake.

‘I think many nurses resent the pressure put on them by occupational health staff to have the seasonal flu vaccine, and this may influence their decision regarding the swine flu vaccine,’ the respondent said.

As widely reported last week, Sir Liam Donaldson also set out the government’s proposed timetable for vaccinating priority groups against swine flu, which includes frontline healthcare workers (see box).

Frontline nurses – working in primary care settings as well as acute settings – can expect to be offered vaccination in October, subject to the granting of licences by the European Medicines Agency.

A decision on licensing is expected from the EMEA at the end of September once versions of the vaccine have undergone multicentre trials – run by the University of Leicester and the Health Protection Agency – to assess immunity levels and identify any side-effects.  

Nurses who opt to have the vaccine can expect to be given one of two products, both of which will require two jabs roughly three weeks apart.

The majority of swine flu vaccine will be the adjuvant version manufactured by GlaxoSmithKline, which contains 4mcg of antigen. The second type, manufactured by Baxter, is a whole virus vaccine containing 7.5mcg of antigen. 

Readers' comments (14)

  • I have the flu jab every year and was planning to have the swine flu - working in general practice where all the sickies come. However, I will be rethinking after reading about the potential neurological side effects. This will also affect the advice I give my patients. perhaps there needs to be up-front information on potential side effects.... what does everyone else think?

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  • i was not aware that as a health care worker I would be offered the flu vacine but know I know and on reading the above article I did a search about the flu vacine and have found the information very confusing! My main concern is why should we consent to have a vaccine when the US and UK government have absolved the manufacturers from liablity of side effects as they rush to get this vacine on the market.

    As health care workers we strive to provide evidence based care, we are taught to question research and custom practices to enhance the care that we give. However, all I see at this juncture is a potential large subject group and a large amount of bias (money to be made), with no concern for the side effects. Until then I don't consider my consent to be informed or valid.

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  • Martin Gray

    Sorry but I'm not going to be dictated to over what goes into MY body. To use the term' a duty of care' I find quite offensive, even insulting! We all know where our duty of care lies Professor Salisbury, and we are all quite capable of making our own formed decisions after looking at the evidence presented. Patients also have a duty of care NOT to attend surgeries and hospital A&E departments when they are unwell with flu-like symptoms.

    I wonder what the government would do should a higher percentage of the health care force be off work because they HAD the vaccination?

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  • Ever since swine flu got into the media headlines I was suspicious about the way people were driven into panic. Remeber the anticipated "up to 65,000 dead" ?
    The pharma industry made huge profits out of all this by selling enormous amounts of Tamiflu and no doubt hoped for even more money out of a quickly developed vaccine. You can,t help but wonder if the industry has taken direct influence on the government and the media to fuel this panic. And now that case numbers are dropping nurses are pressured to get a risky vaccination (so at least some of the costly stuff gets sold) ? NO, THANK YOU !

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  • Taking the articles point that only 13.5% of nursing staff receive the seasonal flu vaccination last year (DoH 2008 - 2009 stats).

    I am not aware that the health service was crippled in 2008 - 2009 by excessive staff absence due to seasonal flu even though the vaccination rate was so low.

    Based on current figures vA(H1N1) is less infectious than seasonal flu (although mildly more serious when acquired). Therefore if 30% of nursing staff are immunised we have a situation in which we have over double the seasonal flu immunisation level for a virus that is less infectious. This strongly suggests that even less staff will be infected than in last years seasonal flu epidemic and we weill therefore not have a significantly larger problem with absence than we did at that time.

    Of course if the virus mutates into something more virulant then we will be in trouble, but there is no reason to believe the vaccine would be effective in that situation either.

    As to whether, in a theoretical worse situation, staff have a duty of care to be immunised I am undecided. Morally society generally feels that we have the final say regarding medical interventions on our own bodies. However if the evidence becomes so large that individuals rejecting it are deemed irrational then we should move. My compromise? The nursing councils or colleges should make the decision for their members, the government should not.

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  • Are you Prof. David Salisbury and all your family going to have this swine flu vaccination I wonder? After all you also have a 'duty of care' to your work colleagues and your family!!! I am sick and very tired of listening to the government constantly telling our wonderful NHS staff what they should and should not be doing, and playing on the 'duty of care' label repeatedly. Come down from your perch and mingle with the rest of society and then you might all realise what actually makes the world go round!

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  • I would like to bring to your attention the work carried out by Jefferson et al a meta analysis on the efficacy of influenza vaccines.
    Link :-
    Jefferson T, Rivetti D, Rivetti A, Rudin M, Di Pietrantonj C, Demicheli V. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005;366:1165-74.[CrossRef][Web of Science][Medline]
    Which is self evident in terms of community acquired viral infection. i.e. there appeared to be some minimal effect in community acquired infection but little to justify mass vaccination.

    Moreover there is the matter of a so called outbreak of a swine flu ( containing Hsw1N1 type) virus in 1976 (Influenza A/New Jersey/76) at Fort Dix in America

    Swine Influenza A Outbreak, Fort Dix, New Jersey, 1976
    Joel C. Gaydos,* Franklin H. Top, Jr,† Richard A. Hodder,‡ and Philip K. Russell§1
    *Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; †MedImmune, Incorporated, Gaithersburg, Maryland, USA; ‡Northeast Center for Special Care, Lake Katrine, New York, USA; and §Albert B. Sabin Vaccine Institute, New Canaan, Connecticut, USA

    where 13 soldiers were found to have developed a flu like virus and one poor chap who was made to leave his sick bed to undertake a forced route march consequently died. Intensive investigation followed and showed that this particular strain had been confined within the camp however a mass vaccination programme was insigated with a vaccine that had been rushed through the developemnt process, and which resulted in over 500 cases of Guillon Barre syndrome of which 30 people died.

    Needless to say I will not be exposing myself to something which has yet to show real evidence of safety and efficacy, neither would I be prepared to give it to patients until they have been fully educated re its risks and benefits in order to make an informed choice, as I hold my duty of care to my patients ( in terms of do no harm !! ) as core to my practice

    Further link to info :-

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  • Over the last decade or more we in the nursing and medical professions have been told that all nursing and medical care should be evidenced- based. Until such time as the swine flu vaccine has been through such trials or is proven to be effective I will not be having the vaccine.
    Out of interest why have only nursing staff been singled out? Surely doctors are just as likely to be in the front line?

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  • I can only agree with the above comments - evidence-based is how we work, and evidence-based is how I will decide on what interventions I agree to for myself!
    I AM asthmatic, I do have the seasonal flu vaccine each year, but so far will not be partaking of the swine flu vaccine - back to paragraph one...
    I have not yet seen sufficient information for me to be able to aid 'informed consent' for my patients - perhaps risk groups I can justify but certainly not the whole population!
    I will NOT be 'told' by some professor that I owe it to my patients to be immunised! What if I'm the one of many...? who have Guillain-Barre syndrome and I'm then off sick for weeks or months - how will that benefit my patients?
    So - the jury's still out for me. Awaiting evidence based information not somebody trying to TELL me what to do....

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  • I can only agree with the above comments - evidence-based is how we work, and evidence-based is how I will decide on what interventions I agree to for myself!
    I AM asthmatic, I do have the seasonal flu vaccine each year, but so far will not be partaking of the swine flu vaccine - back to paragraph one...
    I have not yet seen sufficient information for me to be able to aid 'informed consent' for my patients - perhaps risk groups I can justify but certainly not the whole population!
    I will NOT be 'told' by some professor that I owe it to my patients to be immunised! What if I'm the one of many...? who have Guillain-Barre syndrome and I'm then off sick for weeks or months - how will that benefit my patients?
    So - the jury's still out for me. Awaiting evidence based information not somebody trying to TELL me what to do....

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  • Normally I have a seasonal flu vaccination for 2 reasons - to protect myself and to protect my patients because I care mostly for elderly patients. Nevertheless, I'm not sure that I will agree to having the swine flu vaccination. For a start, as a reciever of the vaccine, I become a "patient" and therefore expect an evidence base of efficency and safety before I consent to having it. I wouldn't volunteer to part of a drug trial, so why should I have it forced upon me by my employer?

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  • I will not be having the swine flu vaccine and both my husband and myself have discussed whether or not our youngest son receives this vaccine and our decision is that he will be opted out of this at school should it be offered. I do not want my son to be a guinea pig, nor am I assured that this vaccine is not being "rushed through", I will also not be forced into having this vaccine. Many people that I have heard of as being diagnosed with swine flu via the flu helpline on turning up to get their Tamilflu have not even had a temperature let alone any of the many symptons that would indicate it, how much has this cost the NHS in terms of available budget. The figures for the number of people diagnosed is not going to be anywhere near accurate in these circumstances therefore how are we to believe these figures.

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  • To state that as nurses we have a "duty of care" is correct, but to suggest that it should be compulsory for us to have the vaccine is rediculous, we, just like everybody else should be able to decide what chemicals etc should be put into our bodies. An information pack stating all the possible neorological effects should be compiled and nurses should have a choice.

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  • I agree with most of the above comments, I disagree with the sentiment 'we should be able to decide...' we ARE able to decide as intelligent individuals because it is our inherent right to do so. I will not be bullied, blackmailed or guilt-tripped into anything I am not comfortable with or do not have enough information about in order to make an informed and intelligent decision nevermind a caring decision in relation either to myself or anyone else. Employers do not have the right to make anyone have any vaccines or medication regardless of the profession concerned. When I see the professors, doctors and drug company employees happy to take one in the arm as voluntary guinea pigs in the duty, passion and dedication of their profession I will review my suspicions

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