Am J Public Health.  2011 Feb;101(2):212-6. doi: 10.2105/AJPH.2009.190751.
Vaccinating health care workers against influenza: the ethical and legal rationale for a mandate.
Ottenberg AL ,  Wu JT ,  Poland GA ,  Jacobson RM ,  Koenig BA ,  Tilburt JC .

Bioethics Research Program, Mayo Clinic, Rochester, MN 55905, USA. ottenberg.abigale@mayo.edu 

Abstract
Despite improvements in clinician education, symptom awareness, and respiratory precautions, influenza vaccination rates for health care workers have remained unacceptably low for more than three decades, adversely affecting patient safety. When public health is jeopardized, and a safe, low-cost, and effective method to achieve patient safety exists, health care organizations and public health authorities have a responsibility to take action and change the status quo. Mandatory influenza vaccination for health care workers is supported not only by scientific data but also by ethical principles and legal precedent. The recent influenza pandemic provides an opportunity for policymakers to reconsider the benefits of mandating influenza vaccination for health care workers, including building public trust, enhancing patient safety, and strengthening the health care workforce. 

Acknowledgments
Abigale L. Ottenberg, Joel T. Wu, Barbara A. Koenig, and Jon C. Tilburt have no disclosures. Gregory A. Poland has offered consultative advice on novel influenza vaccine development to Merck & Co., Inc., Avianax, Theraclone Sciences (formally Spaltudaq Corporation), MedImmune LLC, Liquidia Technologies, Inc., Novavax, Sanofi Pasteur, and PAXVAX, Inc. Robert M. Jacobson serves as the Principal Investigator on a Pfizer-funded study ex- amining PCV 13 in adults, which involves, in part, adult receipt of the influenza vaccine.