This week the Chief Medical Officer Sir Liam Donaldson announced the commencement of the swine flu vaccination programme in the UK. Although voluntary, the CMO and the DH have urged healthcare workers to take up the offer of vaccination. A joint statement in support of the programme from key organisations and stakeholders, including the British Medical Association, encourages staff to take up both the H1N1 and the seasonal flu jab, but also recognises that the decision is a personal matter and that health workers have the right to refuse vaccination.

By contrast, in New York this August, the State Health Commissioner, Richard Daines, announced that vaccination with approved influenza vaccines, including swine flu, would be mandatory for health care workers. Those who refused to comply with the mandate by 30 November could be fined as a result. However, the Centres for Disease Control and Prevention (CDC) does not advise mandatory vaccination for influenza and no other state or city has tried to enforce such a rule. It is unsurprising therefore that the regulation has been controversial. Last Friday, in response to a lawsuit filed against the state by three nurses who claim the regulations violate their civil rights, a judge has suspended the enforcement of the mandate until the lawsuit, in conjunction with two others, is heard at the end of the month.

Defending the regulations in an open letter to New York health workers in September, Daines argued that the safety of patients should be their overriding concern and patient welfare was best served by high rates of staff immunity to influenza, unachievable through a voluntary programme. Daines argued that the vaccines had been tested to the same methods and standards that govern all healthcare practice and challenged healthcare workers to show confidence in these standards. In response to the temporary restraining order imposed by the judge, the state health department announced that it would fight the lawsuits and seek to enforce the regulations.

Given the differences between the UK and New York, how far do you think the freedoms of individual health professionals should give way to the public good?

Hi Martin,

It's interesting that the GMC's guidance on doctors looking after their own health states that doctors should protect patients, colleagues and themselves 'by being immunised against common serious communicable diseases where vaccines are available' (para 78 of Good Medical Practice). It doesn't make such vaccination mandatory. The BMA's position is also opposed to mandatory vaccination for health professionals.

Can you imagine any circumstances that might arise in which it would be reasonable to call for mandatory vaccination in the UK?

Ellie