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A nurse at one of Charlotte's hospitals called me recently to complain about the pressure on health care workers to get vaccinated against the H1N1 flu.
Neither Carolinas HealthCare System nor Novant Health, which owns Presbyterian Healthcare, is requiring employees to get vaccinated.
But both are strongly encouraging it to protect patients as well as employees, who will be needed to work if lots of people get sick with flu complications.
Federal health officials recommend vaccinations for all health care workers, but they know this is a hard sell. Nationally, only about 40 percent of health care workers get vaccinated in a typical flu season.
That may change this year. At Mecklenburg County's emergency medical service, 29 percent of employees get flu shots in a typical year. But this fall, officials say 45 percent of 400 employees have voluntarily received the seasonal flu vaccine so far.
Presbyterian officials say they'll require workers who don't get the H1N1 vaccine to wear masks when dealing with patients. The nurse who called thought that would unfairly identify people who decide not to get the vaccine.
It's an ethical question that many people are facing as the swine flu pandemic, which started in the spring, blends into the regular flu season and we wait to see whether things will get worse.
Opponents of forced vaccinations are pushing back. Hundreds of people showed up at a recent rally in Albany, N.Y., to protest New York's plan to require all state employees to get both the seasonal and H1N1 vaccines.
In a recent column, Art Caplan, the widely quoted medical ethicist at the University of Pennsylvania, weighed in with his opinion of the opposition: "Enough already." Anyone who has regular contact with patients "ought to be required to get a flu shot or find another line of work," Caplan wrote.
What do you think?
What's in it?
Many people who don't plan to get the H1N1 vaccine are concerned about its ingredients.
Like seasonal flu shots, some H1N1 vaccine contains a mercury-based preservative, thimerosal. But you can request a vaccine without it.
GlaxoSmithKline, for example, uses thimerosal in multiple-dose vials of vaccine but also makes single-dose vials without it.
Others have worried about the presence of squalene, an adjuvant, or compound used to enhance a vaccine's ability to elicit a desired immune response.
No H1N1 vaccine distributed in the United States contains squalene or any other adjuvant, according to officials from the U.S. Centers for Disease Control and Prevention.
Some European countries are using vaccine with adjuvants, and the CDC has bought some adjuvants, separately, for possible use in an emergency if the virus were to mutate.
But current U.S. vaccine, approved by the Food and Drug Administration, does not contain any. For more information, check out www.cdc.gov.
What's up, doc?
With all the misinformation about vaccines going around, you'd think medical doctors would get their stories straight.
Last week, a colleague told me that his wife's doctor cautioned her that seasonal flu vaccine wouldn't last all season if she got it too early.
"If a person takes the seasonal flu shot right now, they should be well-protected for when we get into the actual flu season," said Dr. Stephen Keener, medical director of the Mecklenburg County Health Department. The effect lasts about six months.
It's also OK to wait until November or December for seasonal vaccinations. Seasonal flu usually peaks in January or February.
