Another Side of the Measles Discussion: Can Employers Require Vaccination?

February 4th, 2015

By CHHS Research Assistant Mona Qureshi

The year 2000 was supposed to mark the end of measles in the United States; however, in 2014 measles came back with a vengeance. From 2001 to 2013 measles cases in the US hovered around 200 cases annually, but in 2014 they spiked to 644 reported cases, largely traced to a group of unvaccinated Amish volunteers who visited the Philippines during a measles outbreak. Only one month into 2015, more than 100 cases have been reported with most stemming from an outbreak this past December at the California amusement park Disneyland.

Measles is a respiratory disease with a 90% transmission rate. Complications from measles include pneumonia, encephalitis, and even death. The MMR (measles, mumps, rubella) vaccine is 95% effective with the first dose, but some people won’t have the antibody response necessary even after two doses for full vaccine efficacy. A confluence of factors including vaccine efficacy, overseas travel by either an unvaccinated American or foreign tourist who carries the infection to the US, and refusal to vaccinate has resulted in the measles resurgence.

During the latest outbreak, five Disneyland employees were infected with measles. Amusement parks such as Disneyland consist of confined spaces where hundreds of people from all over the world gather daily. This much exposure puts employees at risk of contracting a variety of diseases, from the common cold to measles. Legally, employers cannot force employees to get vaccinated, and there are religious, medical and philosophical exemptions for those who refuse vaccines. Employers often offer annual flu shots, but that offer carries liability for the employer in case an employee becomes ill from the vaccine. This leaves amusement park employees in a precarious position with high levels of exposure but limited protection.

Hospitals deal with this issue all the time; their employees are constantly at risk for various infections. State legislatures around the country have devised laws for healthcare workers to reduce patient to caregiver transmission (and vice versa) and ensuring hospitals have healthy staff. There are two types of laws: offer laws and ensure laws. Offer laws require hospitals to provide employees with the chance to be vaccinated, but it is an optional vaccination that is suggested by state law. Whereas ensure laws require that the hospitals ensure that their employees are vaccinated, and it is a mandatory vaccination that must be administered to the health care worker.

In California, hospitals have offer laws for the MMR vaccine; in contrast Maryland hospitals have ensure laws that require the MMR vaccine for hospital employees. Under ensure laws, a healthcare employer can fire a healthcare worker if they are not in compliance, as the vaccination is tied to the job’s function and is mandated by law.

While we cannot expect state legislatures to impose the same standard on non-healthcare sector employers in the coming year, the recent measles outbreak proves to be a tricky issue for similar environments like an amusement park. As an employer they cannot force vaccination, and if they do offer them they carry the risk of liability should anyone have an adverse reaction to the vaccine. So while the legislature catches up with the latest issues in employer liability, the best protection moving forward is heeding President Obama’s suggestion and getting you and your family vaccinated.

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