Mandatory flu vaccination for medical staff: a physician's objection

Dear readers,

Below is a letter from one of my dearest friends to his hospital administration.  This year, the administration has mandated Influenza vaccination.  Short of a few accepted exemptions, it is a requirement for continued medical staff participation by physicians or employment by other staff.

Those who do not receive it must wear a mask while working for the entire duration of the flu season, as well as a badge stating that they did not receive the vaccination.

It has become an issue of great contention among staff, but has been largely dismissed as of insufficient concern to the administrative staff.  Another facility near his has excused its staff from this requirement on moral grounds.  Most others are requiring the vaccine.

Whatever you believe, or do not believe, about vaccines in general or Influenza vaccine in particular, My friend, emergency physician Dr.Doug McGuff, makes a reasoned, sound and scientific argument against the requirement.

Hardly the rant of an uninformed individual, Dr. McGuff is without question one of the most intelligent and articulate people I am honored to call friend.  In addition, he is an author and nationally recognized fitness expert.

His websites are, as follows, with links to his recent McGraw Hill publication, Body by Science:

As physicians are slowly, but surely, edged into employment positions, as we find ourselves forced by government and various regulatory bodies to do whatever we are told, as we move from professional to commodity, it would be wise for us to ask, ‘how much more?’  First a flu vaccine, easy enough.  But at what point will our freedom, our judgment, be compromised past the breaking point?

Read Dr. McGuff’s outstanding response to his hospital administration and consider the situation for yourself.  And pass it on.  He gives you permission to do so.


To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family.  Unfortunately, I do not qualify for any of the exemptions allowed by our facility.  Since I am not religious, I have no religious objections, I am not allergic, and I have never had Guillane-Barre as a result of a flu vaccine.  My objection to the vaccine is based on rational evidence and moral indignation.

From the standpoint of rational evidence, I was amused that Dr. Eric Kasowski (of the CDC’s influenza division) in his  position paper “Healthcare Workers Must Be Vaccinated Against Influenza” cited no research papers.  This is very unusual given that this is a document directed at health care professionals.  No papers were cited to support this statement because there are no such papers.  The gold standard for evidence-based decision making in health care comes from The Cochrane Collaboration.  This group of experts makes recommendations on all aspects of medicine and science based on a pooling of the best research studies and with a strict avoidance of all commercial or coercive interests.

In their paper titled “Vaccines to prevent influenza in healthy adults” the Cochrane group concluded “In average conditions 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalized or working days lost but caused one case of Guillane-Barre syndrome for every one million vaccinations.  Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration.  Our results may be an optimistic estimate because company-sponsored influenza vaccine trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.”  This is hardly compelling evidence.

In the Cochrane paper “Influenza vaccination for healthcare workers who work with the elderly” found “that vaccinating healthcare workers who look after the elderly in long-term care facilities did not show any effect on the specific outcomes of interest, namely laboratory-proven influenza, pneumonia or deaths from pneumonia.”  Thus, even in the most high-risk health care population and scenario, there is NO evidence that influenza vaccination protects patients.  In fact, vaccination may actually increase risk because the health care provider, feeling that they are protected by the vaccine, may be less likely to carry out the behaviors that do protect patients.  In their paper “Physical interventions to interrupt or reduce the spread of respiratory viruses” The Cochrane group reviewed 67 studies and found that simple measures such as hand washing, and simple masks were effective in reducing viral (including influenza) transmission.  Further , they “found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks”.   Thus there is NO evidence that not taking a vaccine poses any risks to patients and thus the requirements to wear an arm band (similar to a Star of David or Scarlet Letter) is exposed for what it really is…a way of shaming non-compliers.  In fact, evidence would suggest that it is the vaccinated that are less likely to carry out the behaviors that do work, and it is perhaps they who should wear the arm band.  Furthermore, individuals who are coerced to take a treatment are more likely to experience adverse reactions due to the nocebo effect, which is like a placebo effect but with negative effects.  Such nocebo reactions would likely result in more days lost than days lost due to influenza contracted because of a lack of vaccination.

I would now like to address my moral objections to this requirement.  Let me preface my statement by saying that if the organization had simply been honest and stated that they were requesting employees be vaccinated because less than 90% compliance would be met by a financial penalty from our government payers at a time when the hospital was already under financial stress, I would have been first in line to get my vaccine.  Every day I make personal sacrifices in order to support the financial interests of the hospital in which I work.  I continue to work in an ER that is severely understaffed relative to its workload.  Every shift I arrange for serial ER visits and rechecks of non-paying patients with pyelonephritis, PID, cellulitis, MRSA abscesses, pneumonia, etc rather than having them admitted where they would cost the hospital even greater lost revenues.  This is done at great personal expense (and medico-legal risk) to myself and my group.  I say this to demonstrate that I would do almost anything to help the hospital’s bottom line, and I believe that is true of almost anyone in the organization.  But rather than banking on this goodwill from the employees and staff, the institution chose to frame this as a patient care issue.  Worst of all, it portrayed the providers of healthcare as some sort of danger to the patients that the hospital cares for, as if we were potential vectors of disease should we not comply with this mandate; essentially painting as a threat those that provide care under a real threat of contagion, violence, stress, litigation, government fines and circadian disruption.  This was all done with overwhelming evidence to the contrary.

But even if it were true that healthcare workers were transmitting flu to patients and that vaccination could prevent this from happening, forcing a professional to do even that which is beneficial is profoundly immoral.  Values can only exist when there is freedom of choice.  As philosopher Harry Binswanger recently observed; “You cannot achieve anyone’s good by force, because values are objective.  Values only exist if they are judged by the acting party as beneficial to him.  No one can be forced to make a rational judgement.  The only effect of the force is the destruction of the alleged beneficiary (and everyone else).”  This was probably expressed best by the philosopher Ayn Rand who stated: “A value which one is forced to accept at the price of surrendering one’s mind, is not a value to anyone; the forcibly mindless can neither judge nor choose nor value.  An attempt to achieve the good by force is like an attempt to provide a man with a picture gallery at the price of cutting out his eyes.”  So even if there were a benefit to be had from flu vaccination, it would be wrong to force us to have it.  It is even worse when it is done with evidence to the contrary.

I will therefore submit for flu vaccination on or before November 1, 2012; but please be aware that I am doing so under compulsion and the threat of losing my means of earning a living.


Doug McGuff, MD, FACEP


41 thoughts on “Mandatory flu vaccination for medical staff: a physician's objection

  1. As an employee of an organization which also mandated the flu shot this year your words were exceptional. Likewise to your institution, our noncompliant must wear masks we purchase (even those with no patient contact), an indicator on our badge we weren’t vaccinated, as well as receive a written performance warning and stripped of our merit increases for the following year. We were allowed to opt out for the same reasons…withstanding a review board agreed you were religious enough or medically adverse enough to qualify for the exception. I, not qualifying for any of the exemptions, was stuck between standing on moral ground and succumbing to corporate pressures to secure stability for my family. It was compounded by the fact that as a member of management I had to repeat the mantra and charge my coworkers be vaccinated as well. The term “just drink the Kool-Aid” became a coping mechanism. I consulted a family friend, who is an attorney, and found out as I thought I could battle this if I really wanted to but at what price? And in the end what would I be left with? Most likely career suicide and no happiness over my victory because the cost was too great. At the heart of it all I relish in the challenge of my job, I believe in what our ministry is about, and I have worked so hard to ensure its livelihood for years to come that I drank that Kool-Aid. Only it wasn’t the sweet Kool-Aid we sold for $0.25 as a kid at the end of our driveway, it was the bitter Kool-Aid you started making before you realized you were out of sugar. Your well pinned letter put that sugar back in my Kool-Aid and I thank you for that.

  2. What a great letter by Dr. McGruff. I too work in a hospital that mandated flu vaccination as a condition of employment this year. No option to wear a mask only get the shot or get out. The greatest indignation of the entire thing was that once I grudgingly agreed to the shot they handed me a “consent” form. How exactly is this considered consent when there is a penalty for saying no. Under my hospital’s excellent example I guess using a weapon as a threat to coerce another individual into a sex act is considered consensual. In the space on the “consent” form under the signature line I wrote in large letters “under duress.”

  3. Great letter Dr. McGruff, fortunately I do not work at a hospital that mandates flu shots, however if that were the case, I would probably be leaving that place of employment because two years ago I did get my flu vaccine, and as a result of poor technique and needle size, I got a joint injection!!! and as a result that that, my left arm has terrible sharp shooting pain radiating down to my hand and I’ve developed DeQuervin’s tendonitis also as a result. Lots of money and time spent only to find out that there’s nothing that can be done! So I continue to work daily (ER physician), with a painful left arm/shoulder and very, very painful thumb, that requiring me to wear a brace.

    I will never get a flu shot.

    So I would suggests that you and anyone else, get the flu shot in the thigh!

  4. I am being pressured to give the flu vaccine to my children (3 years old and 11 months) at the price of my husband’s job. Not only does their receiving the shot have no impact on his work, but they are at low risk as they stay at home with me and are breastfed. I am incredibly frustrated at this situation and wonder what other objectionable things I would allow before drawing the line…

  5. just found out tonight that my wifes work is making her get the flu shot. im pretty upset about this. what the hell has happened to this country.

  6. I am not a medical professional. But I would love to chime in on this topic to hear everyone’s thoughts. I am just some guy, no medical training at all. I have never had a flu shot. I have had the flu under 10 times in my entire life (and in fact I can’t remember the last time I even had the flu). I am 37 years old.

    So here is my query: Suppose you “just drink the kool-aid” as one said. And you coerce others to do so as well. And doing this to secure your jobs and by extension your financial lifestyles. Should anything negative ever occur to the people you coerced as a result of the vaccine, like GBS or something else, is this not the price of your kool-aid? Your income paid for on the backs of the ones that became sick under your knowing and consent?

    When I enter a hospital, there is a certain trust and expectation that the medical staff has MY interest in mind and not their own at the expense of mine. So to read about so many “just drinking the kool-aid” and coercing others to do so for the sake of an income is very disturbing to me and frankly weakens that trust and expectation.

    I understand that medical staff are encouraged or required to swear some form of oath with some form of the following points:
    * THE HEALTH OF MY PATIENT will be my first consideration
    * I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat

    So just drinking the kool-aid and coercing others to do so (even with evidence of possible harm to those who do) does seem to violate this oath and my trust.

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