The issue of vaccinations and the flu vaccination in particular has been on our agenda over the past few months, as it has been for the sector.  In 2015, despite improved uptake of the flu vaccination amongst DHB employees, one DHB (Waikato) has still taken a punitive approach to non vaccinated staff, insisting they wear masks when in direct patient contact or risk suspension and disciplinary procedures.

We felt at this time it might be appropriate to discuss the role of NZNO in this matter. Amongst our membership we have the full spectrum from those passionately in favor of vaccinations, to those equally against.  So should the union even have a view and if so on what basis?

So starting with the right not to be vaccinated – we all have that right.  Being injected against our will is assault, pure and simple.  In addition, when in receipt of healthcare, everyone is covered by the HDC Code of (patient) Rights.  This provides for the right to informed consent and the right to say “no”.  It also provides for the right to be treated with respect.  Given one role of NZNO is the legal protection of member’s rights, enforcing the right not to be vaccinated goes without question.

The issue of vaccination largely comes down to an individual view (I do or do not wish to be vaccinated because I…) or a collective one.  On the latter, there is both a public health good derived from vaccinations and an employment one. The former relates to the reduced spread of disease and therefore harm, especially amongst those in our communities who are most vulnerable, and the latter, lack of staff to treat the sick due to staff themselves being sick. And yes for the DHBs fewer sick days and so less cost, is attractive.

Evidence confirms that whilst not a perfect remedy, vaccination is the best mechanism we have to prevent the spread of disease and the human toll that disease represents. Herd immunity, where vaccination rates are high enough to stem the spread of disease and therefore protect a community, is the goal.

The flu vaccine is not 100% effective. Each year the vaccine must be reconstituted to capture the new strains of flu that emerge.  The flu virus is a nasty little beast that genetically morphs from year to year, hence its success as an organism!  As impressive as this may be, lets not forget, it also kills. Regardless of your view on vaccination, this virus is not the common cold we can all expect to suffer most years.  It is a serious and life threatening virus that has caused millions to die.

When the unions and DHBs (in the forum known as NBAG) collectively came together to investigate the issue what became clear was that a positive, educative and supportive approach to the issue of vaccinations was far more successful than punitive, threatening or negative.  If the overall motivation is community good through protection from disease, having people “on board” is going to more effective than the resistance a negative approach inevitably engenders.  This is not so much about vaccinations per se, but about how we approach the issue.

Acknowledging that employees can’t be required to be vaccinated, what about the DHBs ability to decide what to do with the non vaccinated staff?  In fairness NBAG didn’t even go there (at that time).  We agreed a positive and constructive approach was better and looked (amongst other things) to whether the unions had a role in leadership on this issue, thereby in effect avoiding a negative reaction that some DHBs might have in the face of non vaccination. The answer was yes: better to keep members out of trouble whilst recognising everyone has rights.

NBAG put out guidelines to the DHBs supporting a positive and educative approach, rather than punitive. And the unions agreed to support engagement with members on this issue.

So far so good. Unions avoided the punitive and inevitably adversarial approach DHBs might take against members: DHBs got our support on the vaccination process.

Interestingly, for all the concerns expressed by the DHBs, the uptake of vaccination by management was no different from the rest of the staff, confirming that we are dealing with a wider and more intrinsic issue than superficial review might suggest.

So why did Waikato DHB ignore NBAG advice and fail to engage with us on the issue?

Well Waikato DHB has an already evidenced poor culture when it comes to employee engagement, so probably no surprises there. It is sad, but this DHB continues to have a poor attitude towards their own employees on a number of fronts, including bullying.  And again, regardless of their personal views about vaccination, members have been almost universally concerned at how Waikato DHB is handling this matter.

We have made an application to the Employment Relations Authority to test the DHB’s policy on the basis of a failure to adequately consult prior to implementation. Not only is the issue of ignoring considered national advice on the matter concerning, a whole lot of other issues have arisen that, had proper consultation occurred, would probably have been worked through.  And these issues do need to be resolved, including:

• What is “direct patient contact”?
• How effective is mask wearing, including how often we need to change masks to be effective?
• What of the effect on patient – staff communication through a mask?
• Distribution of personal health information (vaccination status is health information).
• What of patient and visitor vaccination status? Visitors can equally spread the virus (remembering the flu is communicable up to 14 days prior to symptoms emerging) so what is the point of just concentrating on staff?
• If the patient is vaccinated, should the staff member have to wear a mask?
• If such a public health issue, consistent application of measures are surely required? If that means short staffed areas being left without staff and services interrupted as a result, what is the balance between non vaccinated staff on duty and no service?

We could go on….  Waikato DHB’s approach is also causing resistance amongst staff, and could be self defeating. It is also exacerbating a prevalent negative culture in this DHB which is corrosive, damaging to staff and in need of change all issues of concern to us and our members.

So in summary:  Why are we involved?

• Because members have rights and we are tasked legally with preserving those rights.
• Because we also have a role to play in avoiding conflict and progressing matters on an evidence based and reasonable basis.
• Because Union leadership is evidenced as being instrumental in assisting with positive change on issues such as this (and our own experience supports this).
• Because at the end of the day our members want what is in the interests of not just themselves but their patients and communities. However as with most things in health, this is a more complex issue than a superficial glance might suggest, and we need to do the best we can to get it right.