Mandatory Flu Shots

Influenza (flu) is a highly contagious acute viral infection of the respiratory tract that is spread through droplet transmission. Flu has a short incubation period and on average symptoms will start around two days after exposure to the virus. Symptoms of flu include: fever, headaches, sore throat, muscle aches, joint pain, gastrointestinal symptoms and exhaustion. A person may be contagious about a day before they experience any symptoms, and may remain contagious for around 5 to 7 days after symptoms have started.

Flu kills. In 2017 the World Health Organization increased it’s estimate about the number of deaths that can be attributed to seasonal flu. It now suggests that between 290,000 to 650,000 deaths globally each year may be caused by flu (World Health Organization, 2019). This data is now only based on those who die of respiratory illness and flu, now discounting deaths of other causes (including cardiovascular) alongside flu. Influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. Rates of infection from seasonal influenza are highest among children, but the risks for complications, hospitalizations, and deaths are higher among adults ages 65 years and older, children younger than 5 years, and people of any age who have medical conditions that place them at increased risk for complications from influenza (Immunization Action Coalition, 2019). Socio-economic effects of flu also include missed days at school and work.

In the early 1930s it was discovered that influenza was the cause of a virus rather than bacterial infection. It was a few years later in 1936 that the first neutralized antibodies generated by infection by human influenza virus were isolated (Barberis et al, 2016). The first system for the surveillance of circulating influenza virus strains in several countries worldwide was created in 1952 by the World Health Organization (WHO). Monitoring of the different strains of flu by the World Health Organization still continues to this day, and the composition of the flu vaccine is determined by the most prevalent strains of flu from the previous year’s data (Barberis et al, 2016). Vaccination can be provided through injection (inactivated virus) or nasal spray (live virus but weakened), and some are cultured using eggs and others using cells. It is important to note that the flu vaccination does not provide resistance against all types of flu, so contracting the illness is still possible if the person comes into contact with a different viral strain. Flu vaccination is widely considered safe for the majority of the population, and is promoted by governments around the world and the World Health Organization, however there is actually little publicised evidence of the long term side effects.

Delivering healthcare in a safe environment, and protecting patients from harm are at the forefront of healthcare delivery. So too is maintaining a healthy workforce, ensuring maximum resources are available to deal with the increased seasonal patient demand. With this in mind, some healthcare delivery organizations in the US have made the decision to make vaccination against influenza mandatory for their employees, including nurses. Despite the already mandatory vaccination against Hepatitis B for healthcare workers, there are concerns that removing worker’s choice about receiving the flu vaccination is taking an unethical and unnecessary approach.

Healthcare workers may be allowed to refuse the flu shot on rare religious or medical grounds, and an appeal would need to be made. However there have been cases recently in the US where nurses have been fired by their organization for refusing to have the flu shot for reasons ranging from concerns over miscarriage risk to not wanting to accept chemicals into the body. Other sanctions that have been given for nurses who have refused to have the flu shot have included being forced to wear a face mask to deliver patient care. Some nurses are suing their previous employers after being fired for upholding their right to decline the flu shot.

Ultimately it is your right to choose what you put into your body, however so long as the organization is not violating human and civil rights laws, they are currently allowed to terminate your employment if flu vaccination is a mandatory policy. As mandatory vaccination becomes more popular then there is likely to be more cases like these in the headlines.  


Barberis, I; Myles, p; Ault, SK; Bragazzi, NL; and Martini, M (2016). History and evolution of influenza control through vaccination: from the first monovalent vaccine to universal vaccines. Available at:

Immunization Action Coalition (2019). Ask the Experts: Influenza. Available at:

World Health Organization (2019). Estimate of Respiratory Deaths due to Seasonal Influenza 290,000 to 650,000 Annually. Available at:

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