A Minnesota healthcare firm dismissed 50 employees for refusing to get flu vaccinations. Experts say this is a safety issue and should be required in other professions.

Would you be willing to risk your job by refusing to get the flu shot?

About 50 workers from Essentia Health in Minnesota were.

And they have been fired.

The workers reportedly refused to get flu vaccinations under a new policy for the health system that covers 15 hospitals and 75 clinics.

Essentia Health says most workers complied with the request for mandatory flu shots, but a small fraction still refused and failed to meet Essentia’s medical or religious criteria for exemptions.

Some unions have objected to the policy and the firing of the workers, but Essentia executives argue it is in the interest of patient safety.

They’re not alone.

Dr. Timothy Williamson, vice president of quality and safety at the University of Kansas Health Systems, says Essentia’s move is reasonable.

“Health systems implement mandatory vaccination policies to help keep patients safe. If there is a mandatory process in place to keep patients safe that employees refuse to follow, thereby placing patients at risk, then it seems within the right of the health system to not have those employees work there any longer,” Williamson told Healthline.

“To draw a parallel example; if a surgeon refused to wash his or her hands before surgery, they would similarly be fired for placing patients at risk by failure to comply with important infection prevention procedures,” he added.

The terminations occurred as the United States is bracing for what experts say could be a devastating flu season.

The Centers for Disease Control and Prevention (CDC) have announced that more than 7,000 cases of influenza have been reported so far this flu season.

That’s double the number during the same period last year.

CDC officials recommend that all healthcare workers in the United States be annually vaccinated against influenza.

This includes doctors and nurses as well as support staff such as housekeeping and clerical workers who may not be directly interacting with patients.

The CDC says those support workers could potentially transfer infections to healthcare workers and patients.

Policies surrounding mandatory vaccination in healthcare systems vary between institutions but have become commonplace in recent times.

“The concept of mandating influenza vaccine for all healthcare employees has been gaining strength and acceptance in the United States over the last 10 years. It’s really quite common,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Tennessee, told Healthline

“Mandates have become rather widely accepted, but mandates come in various flavors. Essentia has among the more severe or harsh flavors,” he added.

At Schaffner’s medical center in Nashville, workers are educated about the importance of influenza vaccination and are offered the vaccination free of charge.

Like Essentia, the Vanderbilt University Medical Center has a small list of acceptable exemptions.

Those seeking an exemption must submit an application to a committee that reviews their request.

“The substantial majority of the requests for exemptions that we have received are not valid exemptions from a medical point of view… we do not permit religious or personal belief exemptions. You have to have a valid medical reason if you’re a healthcare worker not to be vaccinated,” Schaffner said.

About 95 percent of employees who are denied exemptions at Schaffner’s medical center eventually agree to vaccinations.

Those who refuse are required to wear masks during influenza season.

“We regard our healthcare team here as a healthcare army as it were. When you’re in the military they don’t ask you whether you want to be vaccinated, they say ‘line up, roll up your sleeve, move on out’ because it’s for unit solidarity and function, and that’s the way we perceive it here,” Schaffner said.

In the Army, mandatory flu shots are commonplace.

Dr. Lee Norman, chief medical officer at the University of Kansas Hospital and a surgeon in the 35th Infantry Division of Task Force Spartan, says getting a flu shot is part of the job.

“We just did 11,000 mandatory flu shots in the last 10 days with my infantry division. Believe me, they have no ‘opt out’ choice unless there are medical contraindications. To my knowledge, we didn’t have any exemption requests,” Norman told Healthline.

“I don’t abide by the ‘free choice’ argument. To me it is as ridiculous as requesting an exemption for stopping at stop signs, obeying speed limits, and wearing seat belts,” he added.

Norman argues mandatory flu shots shouldn’t just be for those working in medical centers or hospitals.

He says they should also be for employees of nursing homes, long-term care facilities, dialysis centers, ambulatory clinics, child care centers, and adult day care centers.

“I see this as a question about ‘mitigating risk, in a reasonable manner,” he explained. “And for the same reason: this is a vulnerable population of influenza-prone individuals.”

Mandatory flu shots, he says, also play a role in maintaining public safety.

“We don’t want a wholesale exodus from the workplace by police, firefighters, military, and the like. We should all be vaccinated as well,” he said.

Schaffner concedes the flu shot isn’t perfect, but he argues getting vaccinated makes a world of difference.

As for the Essentia employees, he says getting vaccinated is part of their job.

“Once they become a healthcare worker it is their professional and ethical obligation to first do no harm, and being vaccinated is part of that,” he said.