Should Marin County Require Health Workers to Get the Flu Vaccine?

San Anselmo doctor Matthew Willis became the county’s public health officer in mid-November, at the dawn of the flu season.

Though influenza has yet to leave a major mark in Marin in 2012, it has arrived early nationally, according to the Centers for Disease Control and Prevention. One of the myriad ways Bay Area counties are hoping to combat the flu this winter is by requiring medical staffers to get vaccinated or wear a surgical mask on the job, hoping to prevent health care workers from spreading the flu to patients.

Health officials in San Francisco, Alameda, Contra Costa, Santa Clara and Sonoma counties are mandating vaccination or masks for health workers this year, and a number of other counties around California are doing the same.

Willis said he is considering joining those counties next year in mandating vaccinations.

“I’m a strong proponent of mandatory vaccinations for healthcare workers,” Willis said. “It’s part of what we all agree to when we sign up to be working in a healthcare facility. Actively infecting a patient is not acceptable.”

But having assumed his new post just five weeks ago, Willis said he isn’t likely to deal with a possible mandate this flu season, particularly because Marin’s nearly 65 percent vaccination rate among health workers is in line with the national average and above the 60 percent of those working in California hospitals, according to the most recent data available from the California Department of Public Health.

Also, two of Marin’s three major hospitals – Marin General and Novato Community – have implemented vaccination mandates for their staff in 2012, Willis said. CDC data indicates that health worker vaccination mandates incite a 95 percent vaccination rate.

As a result of those factors, Willis said he plans to wait until next year to explore a countywide vaccination mandate for health workers.

“It is my responsibility to control the spread of communicable disease,” he said. “That carries into domains where evidence-based measures are not being applied. Our numbers are good right absent of me doing anything yet. But we would certainly consider it for next year.”

There remains some question about how county public health officers can enforce vaccination mandates. According to the Bay Citizen, Bay Area county health officers contend that they have few resources to enforce new mandates, “leaving it up to the discretion of hospitals, nursing homes, dialysis centers and other health care facilities to make sure their staffs are vaccinated.”

Willis, 47, said that while there is precedent to issue a vaccination mandate, he buffeted by the positive data in Marin right now and he’ll revisit the issue in 2013.

In the interim, Willis said he is focusing on an even more acute issue – vaccination rates among workers at skilled nursing facilities, or nursing homes certified to participate and be reimbursed by Medicare.

“That’s where you have older and more frail patients who don’t have the strongest of immune systems, and staffing structures are such that the internal tracking mechanisms on vaccinations are not as strong as they are in hospitals,” Willis said.

The Centers for Disease Control indicate that vaccination rates for workers at those facilities is just 55 percent.

“It’s a setting in which the population is more vulnerable and the staff is less vaccinated,” Willis said.

To address that concern, the county is sending letters to each of the 13 skilled nursing facilities in Marin – including the likes of The Redwoods in Mill Valley, the Rafael in San Rafael and the Tamalpais in Greenbrae – to seek data on clients taken to emergency rooms with flu-like symptoms from nursing facilities. Letters have been sent out this week seeking that data.

In September, Gov. Jerry Brown vetoed a bill that would have required California clinics and health facilities to achieve a 90 percent or higher flu vaccination rate by mid-2015, saying he was confident that local governments and health facilities could raise vaccination rates without a new state law.

Willis said that county health officials are also discussing a regional mandate for health workers.

“Counties are artificial boundaries – viruses by no means adhere to them,” he said. "But here in Marin, we need to have a countywide conversation on this topic in the calm of the summertime."