In September 2014, Saskatchewan became the second Canadian province to implement a so-called ‘immunize or mask’ policy as a strategy to combat the spread of seasonal influenza in health care facilities throughout the province. Seasonal influenza is a contagious respiratory infection for which certain populations, including those receiving care as in-patients or residents in health care facilities, are at heightened risk for serious complications. Although annual influenza immunization is recommended by public health officials as a preventative measure, routine uptake among health care workers remains relatively low. Saskatchewan data from last year suggests health care worker immunization rate was around 60%. Reluctance to vaccinate is often linked to the ongoing debate regarding vaccine effectiveness, particularly prevalent in years when vaccines poorly match prevalent flu strains, and concerns about potential adverse effects from the vaccine.
Saskatchewan’s new policy is framed as a patient safety initiative that also works to protect health care workers and their families from influenza. Led by the Ministry of Health, the policy was supported by each Regional Health Authority (RHA) in the province, as well as the Saskatchewan Cancer Agency (SCA), and is intended to be implemented by each of these organizations independently. Its goal is to reduce the transmission of influenza in RHA and SCA facilities throughout the province by improving immunization rates and/or increasing the use of masking during flu season. The policy requires employees, health care providers, visitors and contractors, among others, to either become immunized or wear a mask while in patient care locations. Patient care locations are defined as areas within health care facilities that are typically accessible to patients, residents or clients present to access care or services.
On its face, the policy aligns well with the Ministry of Health's commitments to patient-centered care and quality improvement. It promotes education and awareness regarding the risks of influenza and the importance of prevention, and draws on the professional obligations of health care providers to act in the best interests of their patients. Nonetheless, other jurisdictions' experiences with similar immunization policies suggests they can be controversial and sometimes raise objections from stakeholders including unions and non-unionized individuals working in the health sector. Sources of objection often focus on concerns about safety and efficacy of the vaccine, and on the perceived infringement of individual autonomy and privacy over health information, due to the associated stigma of masking and its potential revealing of immunization status. It is interesting to note that the Government of Saskatchewan announced in September 2015 that the policy will be voluntary for the 2015/2016 flu season, possibly in response to at least some of these concerns.