Don't stop at a COVID vaccine mandate; flu shots should be required, too

Is it time to have flu vaccination mandates? We certainly think so. As two emergency medicine physicians whose young careers have been defined by the race to develop lifesaving vaccines to thwart a pandemic, we can both attest to the importance of vaccinations. With flu season well underway, we believe that the annual flu vaccine deserves the same level of focus as the coronavirus pandemic.

This past year has caused a huge shift in the way that governments, companies and even private citizens think about vaccinations. Thanks to the ongoing COVID-19 pandemic, there is an increasing realization that our decision to get vaccinated, or not, has wide ranging effects beyond our personal health. Getting vaccinated is ultimately a personal decision, and we would never suggest otherwise. However, employers and municipalities can certainly require flu vaccinations in order to engage in certain activities. The most striking example has been New York City, which has enacted sweeping COVID vaccination mandates for its residents to enter many public spaces.

Even before the coronavirus pandemic, flu season was a time of dread for those of us who worked in health care. Flu season, for us, is always defined by a rush of patients with "flulike symptoms." Often, these symptoms are mild and will get better with bed rest and fluids. Still, some of our patients, despite our best efforts, will succumb to the flu and die.

Admittedly, not as many will die of the flu as have died from COVID, and some may wonder if it is worth mandating vaccination against a less deadly pathogen. Yet the risks the flu poses are not insignificant. Every year, the Centers for Disease Control and Prevention estimates that the flu leads to approximately 700,000 hospitalizations and over 50,000 deaths. While 50,000 may seem insignificant when compared to the over 800,000 Americans who have died from COVID, for those who lose a child or parent to the flu, one death is too many. Despite this, only about half of Americans get a flu vaccine every year.

The best thing that we can do to protect our patients from the flu is to encourage them to get vaccinated. Every year, the flu vaccine is created to offer protection against that year’s strain. And it works exceedingly well. The flu vaccine reduces the risk of complications and death from the flu by 50 to 80%. No other therapy that we could offer our patients does as well at protecting our patients.

Would a flu vaccine mandate be better received than the COVID vaccine mandate? We do not kid ourselves that it would. But there are precedents for flu shot mandates in nursing homes and hospitals. In fact, we, as doctors, are required by our hospitals to get a flu vaccine every year.

Mandates for COVID vaccines have been met with anger and vitriol from some, but we also see high compliance where they’ve been enacted on college campuses, in public schools, and in the federal government and military. A flu mandate would undoubtedly be met with resistance but also lead to greater vaccination rates. Science should not be decided by the loudest voice, and the science on the flu vaccine is unquestionable: It works, and it saves lives — and it’s been shown to do so year after year.

The logic underlying COVID vaccination mandates is that the benefits of vaccination provide a public health good beyond the boost to an individual’s immunity. Having more people vaccinated protects not just them from COVID but also helps protect some of the most vulnerable members of society. The same logic is true for flu vaccines.

The COVID-19 pandemic, and the race to vaccinate the population, has cast a spotlight on vaccination methods in general — who should be vaccinated, how often and for what reason. As such, we need to consider the yearly influenza vaccine with more weight. Just like the COVID-19 vaccine, it is a cornerstone in preventive health and mitigating health complications for the majority of the populations. Beyond that, it keeps people from seeing us while we are at work. A mandate for the influenza vaccine would bolster the health of all Americans, something that all of us, regardless of where we work, should approve of.

Gregory Jasani is an adjunct clinical instructor of emergency medicine at the University of Maryland School of Medicine. Shruti Gujaran is an emergency medicine resident physician at Temple University Hospital.