Illinois Tightens Flu Shot Requirements For Health Workers. But Who’s Enforcing It?

A new Illinois statute aims to boost flu shot rates among healthcare workers by making it harder for employees to decline the vaccine.

Lawmakers say this is important in light of last year’s flu season that killed more people than car crashes and drug overdoses. But some on the frontlines of public health worry that a law that’s not enforced will have little effect.

More than half of all states in the U.S.—including Indiana, Ohio and Missouri—have laws regarding flu shots for healthcare workers. The laws vary in what they require, and can apply to employees at hospitals, long-term care facilities, or both.

Breaking Down Illinois’s New Law

Illinois law now essentially requires flu shots for employees at more than 3,000 state-licensed hospital and health care facilities, including long-term care facilities. There are only a few exemptions.

Under the public health department’s new rules, all facilities must offer the influenza vaccine to employees and only allow someone to decline if they have a religious objection or “some sort of medical problem that would be complicated by getting the vaccine,” says Democratic state Sen. Bill Cunningham of Chicago, one of the law’s lead sponsors.

Health workers who have already received the flu shot can also decline their employer’s offer. But "moral reluctance" or philosophical objections are no longer valid reasons to refuse the flu shot. 

Cunningham says the old law “basically allowed for employees to use just their personal convictions as a legitimate reason to deny an influenza vaccine."

That lack of clarity in the law created conflict between some hospitals that wanted everyone vaccinated and employees who didn’t want to get the flu shot, Cunningham says.

He says healthcare facilities can now take disciplinary action against anyone who declines the vaccine without a medical or religious exemption. That could mean getting suspended or even fired.

“I don’t think any hospital wants to get to that point,” Cunningham says. “I think [employers] feel like having the law clarified will help them avoid those kinds of conflicts.”

Why Require The Flu Shot

These stricter flu shot requirements are important in light of last year’s deadly flu season, says Dr. Nirav Shah, who directs the Illinois Department of Public Health.

An estimated 80,000 people across the U.S. died of flu-related illnesses during the 2017-18 flu season, according to the director of the Centers for Disease Control and Prevention in a recent interview with the Associated Press.

Among those who died, 181 were children. An additional 900,000 people were hospitalized with flu-related illnesses, according to the CDC. Those most susceptible to serious complications from influenza include young children, pregnant women, people with certain medical conditions and adults 65 and older.

Credit: CDC / MORBIDITY AND MORTALITY WEEKLY REPORT VOL. 67 NO. 38

The CDC recommends everyone 6 months and older get vaccinated against the flu by the end of October. Flu season in the U.S. runs from October through May.

“Healthcare workers are at ground zero,” says Shah, whose agency licenses health facilities across the state. “They are often coming into contact with other individuals who might have the flu and then could potentially transmit it to another patient.”

The goal is to stop that spread, and the new law will help achieve that goal by limiting the reasons health workers can decline the flu shot, Shah says.

Lack Of Enforcement

Some on the frontlines of public health worry the law won’t live up to its purpose since it lacks enforcement.

No one is required to track whether health care facilities are doing what’s now required of them. That worries Julie Pryde, who leads the Champaign-Urbana Public Health Department.

“Look at something as simple as a speed limit sign,” Pryde says. “If [they] know that there’s nobody checking up... people aren’t going to follow it.”

Shah says his agency conducts regular facilities inspections, and checking up on flu shot programs could be a part of that.

But Pryde says the law would be more effective if it allowed public health officials at the state level to work with local departments like hers to do more thorough enforcement.

“Unvaccinated workers pose a significant health risk to the vulnerable populations if they get the flu,” Pryde says. But when those employees are vaccinated, they “form a ring of protection.”

A Snapshot Of Flu Shot Rates

Danny Chun, a spokesman for the Illinois Health and Hospital Association, notes that flu shot rates for hospital workers are pretty high nationwide: 92 percent, according to the CDC.

“Hospitals and healthcare workers are very aware of the risks and dangers of the influenza season,” Chun says.

But for employees at long-term care facilities, including nursing homes, the nationwide flu shot rate is much lower, at 67 percent.

Side Effects reached out to several hospitals and long-term care facilities throughout Champaign-Urbana to find out how some places are handling the new law.

At Carle Foundation Hospital and OSF Healthcare, flu shots are offered to all employees, according to hospital spokespeople. Medical and religious exemptions are allowed, and both hospitals' vaccination rates track with the national average for hospital workers, at around 90 percent.

Spokespeople for Swann Special Care Center, a nursing care program for children with severe intellectual disabilities, and Heartland Health Care Center-Champaign, say they require all employees get flu shots unless they have a religious or medical exemption. 

The Champaign County Nursing Home declined to answer questions.

Pryde says she wants to see the state follow up to ensure all facilities require flu shots of their employees in accordance with state law.

“If people see this law in the news, they’re going to assume that their loved ones are being protected, when in fact, it may not be,” Pryde says.

What The Future Could Bring

Shah says his agency has already done what the law requires: write the new rules and notify facilities about them.

“The implementation and execution of this program is really left, now, to the facilities,” Shah says.

State Sen. Cunningham says he doesn’t anticipate compliance with the new rules will be an issue. It was a hospital system in Chicago, after all, that reached out to initiate the stricter legal language regarding flu vaccines for health workers.

Plus, he says, the state’s public health department has the legal authority to take action against any facility that doesn’t comply. Cunningham says the legislature is also open to further amending the law, if needed.

But Pryde’s question remains: If no one’s checking, how will people really know health care workers are getting the flu shot?

Editor's clarification: A previous version of this story stated Clark-Lindsay retirement community encourages but does not require employees to get the flu shot. Clark-Lindsay is a senior living community, not a long-term care facility. It's not affected by this new law and therefore Side Effects has removed this reference from the story.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Follow Christine on Twitter: @CTHerman