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It doesn't apply to me
Cross-talk
It doesn’t apply to me In September 1969, while in Exeter attending the annual meeting of the British Association for the Advancement of Science, the immunologist Sir Peter Medawar suffered a near-fatal stroke. Then aged 54, he was at the height of his powers. A professor at 32, a Fellow of the Royal Society at 34, and a Nobel laureate at 45, he was later the Director of the National Institute for Medical Research in London. Yet he also had undiagnosed hypertension. Telling me this some years later, he said could not remember, at the time of the incident, when he had last had his blood pressure taken. Although he did not use the words “it didn’t apply to me”, the implication was clear. We all take health risks, scientific or medical backgrounds notwithstanding. I have eaten food very likely to be carrying enteric pathogens, and even imbibed toxic quantities of ethanol (long ago, of course). In 2009, the obituary of a grossly obese scientific colleague mentioned his repeated rejections of doctors’ advice to lose weight. Risky behaviours of this sort usually affects just one individual. But what of doctors and other health personnel who decline to be vaccinated against infections they might not only acquire themselves but also pass on to patients? There was disquieting news of this sort in the UK towards the end of 2009, with newspapers reporting the substantial proportion of National Health Service (NHS) staff apparently rejecting immunisation against pandemic H1N1 influenza. Successive pleas from the Department of Health and its Chief Medical Officer had seemingly fallen on many deaf ears. Hospital chief executives contacted by The Guardian (Oct 12, 2009) told the newspaper that they expected as few as 10–20% of their staff to get vaccinated. The hospital authorities could not fulfil Department of Health demands because protection was entirely voluntary. At around the same time, a poll by Nursing Times magazine suggested that the proportion of nurses who did not intend to have the jab had risen from 31% in August to 47%, and the proportion of those definitely intending to be immunised had fallen from 35% to 23%. Although these data are disturbing, there is further cause for concern in the outcome of a piece of research into what is known, or not known, about the immunisation status generally of health workers. Lorenzo Pezzoli at the Health Protection Agency (HPA) in London and co-workers sent out questionnaires on this matter to 162 NHS foundation and acute (hospital) trusts in England, only 104 (64·2%) of which replied. The answers, published in Epidemiology and
www.thelancet.com/infection Vol 10 March 2010
Infection (2010; 138: 45–52), show that of the responding trusts only 66·4% recorded staff eligible for immunisations and 68·2% recorded staff they had immunised. Whereas all of the responders offered hepatitis B, tuberculosis, measlesmumps-rubella, and influenza vaccines, 13·5% did not offer tetanus-diphtheria-polio vaccine and 0·9% did not offer varicella vaccine. Generously stating that the response rate to their enquiries was “satisfactory”, Pezzoli and his colleagues conclude that “setting up a surveillance system to monitor vaccine uptake in healthcare workers is possible but would be challenging, given the variation in current systems”. Many will feel that this conclusion might have been expressed more robustly, especially since the HPA team began its work in view of incidents in which diseases, potentially preventable by immunisation, were transmitted among staff and their patients in English hospitals. Elsewhere in their paper, the investigators argue that a surveillance system is indeed needed. Pointing out that this “is confirmed by the fact that policies are reported to be in place to vaccinate [health-care workers] against seasonal influenza, but the yearly reported coverage is consistently very low”. There is something else I would like to know. Why do many health-care workers fail to protect themselves against pathogens they might acquire and transmit to patients? Forgetfulness? “It doesn’t apply to me”? Medical ignorance cannot be the explanation.
Bernard Dixon 130 Cornwall Road, Ruislip Manor, Middlesex, HA4 6AW, UK; [email protected]
145
It doesn’t apply to me In September 1969, while in Exeter attending the annual meeting of the British Association for the Advancement of Science, the immunologist Sir Peter Medawar suffered a near-fatal stroke. Then aged 54, he was at the height of his powers. A professor at 32, a Fellow of the Royal Society at 34, and a Nobel laureate at 45, he was later the Director of the National Institute for Medical Research in London. Yet he also had undiagnosed hypertension. Telling me this some years later, he said could not remember, at the time of the incident, when he had last had his blood pressure taken. Although he did not use the words “it didn’t apply to me”, the implication was clear. We all take health risks, scientific or medical backgrounds notwithstanding. I have eaten food very likely to be carrying enteric pathogens, and even imbibed toxic quantities of ethanol (long ago, of course). In 2009, the obituary of a grossly obese scientific colleague mentioned his repeated rejections of doctors’ advice to lose weight. Risky behaviours of this sort usually affects just one individual. But what of doctors and other health personnel who decline to be vaccinated against infections they might not only acquire themselves but also pass on to patients? There was disquieting news of this sort in the UK towards the end of 2009, with newspapers reporting the substantial proportion of National Health Service (NHS) staff apparently rejecting immunisation against pandemic H1N1 influenza. Successive pleas from the Department of Health and its Chief Medical Officer had seemingly fallen on many deaf ears. Hospital chief executives contacted by The Guardian (Oct 12, 2009) told the newspaper that they expected as few as 10–20% of their staff to get vaccinated. The hospital authorities could not fulfil Department of Health demands because protection was entirely voluntary. At around the same time, a poll by Nursing Times magazine suggested that the proportion of nurses who did not intend to have the jab had risen from 31% in August to 47%, and the proportion of those definitely intending to be immunised had fallen from 35% to 23%. Although these data are disturbing, there is further cause for concern in the outcome of a piece of research into what is known, or not known, about the immunisation status generally of health workers. Lorenzo Pezzoli at the Health Protection Agency (HPA) in London and co-workers sent out questionnaires on this matter to 162 NHS foundation and acute (hospital) trusts in England, only 104 (64·2%) of which replied. The answers, published in Epidemiology and
www.thelancet.com/infection Vol 10 March 2010
Infection (2010; 138: 45–52), show that of the responding trusts only 66·4% recorded staff eligible for immunisations and 68·2% recorded staff they had immunised. Whereas all of the responders offered hepatitis B, tuberculosis, measlesmumps-rubella, and influenza vaccines, 13·5% did not offer tetanus-diphtheria-polio vaccine and 0·9% did not offer varicella vaccine. Generously stating that the response rate to their enquiries was “satisfactory”, Pezzoli and his colleagues conclude that “setting up a surveillance system to monitor vaccine uptake in healthcare workers is possible but would be challenging, given the variation in current systems”. Many will feel that this conclusion might have been expressed more robustly, especially since the HPA team began its work in view of incidents in which diseases, potentially preventable by immunisation, were transmitted among staff and their patients in English hospitals. Elsewhere in their paper, the investigators argue that a surveillance system is indeed needed. Pointing out that this “is confirmed by the fact that policies are reported to be in place to vaccinate [health-care workers] against seasonal influenza, but the yearly reported coverage is consistently very low”. There is something else I would like to know. Why do many health-care workers fail to protect themselves against pathogens they might acquire and transmit to patients? Forgetfulness? “It doesn’t apply to me”? Medical ignorance cannot be the explanation.
Bernard Dixon 130 Cornwall Road, Ruislip Manor, Middlesex, HA4 6AW, UK; [email protected]
145