SHEA endorses mandatory flu vaccine for healthcare workers

Here is the position paper, and here is SHEA’s press release. We have blogged on this issue often, so you can read some of these posts here, here, here, here, here, here and here. More can be had by linking to related topics in our “labels” section to the right.

One of my posts makes reference to the conflict of interest issue. I know it is complicated. But in an ideal world, “official” position papers such as this would be written by those who have no financial ties to vaccine makers. This is not meant to sound snarky or holier-than-thou (I have my own industry ties, related to research funding). I also know that this means many future position papers and guidelines will be written by professionals who have a lower profile, since almost all opinion leaders have some conflicts in their area(s) of expertise.

I will make no further comment, though perhaps others who read this blog regularly (including one or more of the authors of the position paper) wish to comment!


  1. I've thought about this for a few days. I think conflicts are an important issue, of course. There is a gray area a bit in that this guideline doesn't endorse a specific brand of vaccine, just flu vaccine use. It could still enrich manufacturers in general, but not a specific one. If this was a UTI guideline that recommended a specific antibiotic and the authors received money from the manufacturer of that specific antibiotic, it would be a big conflict.

    It's a tricky issue since you would want experts writing these. Also, the world is conflicted. My mechanic is enriched when he recommends brakes for my car, but I don't know how to get around that since he's the expert...probably a bad example...

  2. Thanks, Eli!

    I agree that this differs in magnitude from potential COI related to treatment guidelines (e.g. the author of a CAP treatment guideline receiving financial support from makers of antibiotics commonly used to treat CAP). And I think it is highly unlikely that any of these authors were influenced by an industry relationship. But as you know, it is no longer demonstration of actual conflict that seems important--even the appearance of potential conflict is enough now to erode public confidence in professional guidance, scientific findings, etc. You need to look no further than the NY Times over the past several years to find many examples, and of course now we have many published recommendations about how to reduce potential COI.

    Reducing even the potential for COI in professional guidelines and recommendations means either a fundamentally different relationship between the professions and pharma going forward (which is happening, slowly), and/or a willingness to have guidelines and recommendations be written by professionals who have no substantive conflicts with industry.

    I think in some ways it would be refreshing to have a guideline written by 10 professionals who I've never heard of--a document that represents their own objective take on existing literature and clinical experience. It's an interesting thought experiment, actually--how would a pneumonia diagnosis and treatment guideline written by 10 lower-profile but experienced clinicians differ from the guidance we currently have?


  3. Here is what Wikipedia says about conflict of interest: "A conflict of interest (COI) occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other. A conflict of interest can only exist if a person or testimony is entrusted with some impartiality; a modicum of trust is necessary to create it. The presence of a conflict of interest is independent from the execution of impropriety."

    Dan talks about potential COI and the appearance of COI (as have I in previous posts), but according to the usage above, that is incorrect. If you are guideline author recommending a vaccine and have received money from a vaccine maker that IS a conflict of interest, not a potential COI or the appearance of COI.

    I think we have used the terms potential COI and appearance of COI to mean that the conflict didn't influence the individual's decision making.

    Other sources define COI differently, but I do agree that the conflict clearly exists in the case of the vaccine guideline. Whether it had impact is a different question. I do think it looks bad, and gives the anti-vaccine crowd ammunition.

    By the way, I think the guideline is based more on emotional arguments than real data, but I've blogged about that before and won't re-hash it here.


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