Study Shows Israeli Nurses Distrust State Directive on Vaccinations

Nurses say they feel frustrated with their employer, the Health Ministry, and prefer to make decisions independently.

The Health Ministry has launched an initiative for nurses in well-baby clinics to get inoculated against whooping cough after a study showed many were ignoring the ministry's directives to do so. Many nurses in the study expressed a lack of trust in the ministry's guidelines on vaccination.

The study, led by Prof. Orna Baron from the University of Haifa's School of Public Health, was commissioned after 20 doctors and nurses from the maternity ward at Rambam Medical Center, Haifa, got whooping cough in summer 2010. Following the epidemic the Health Ministry instructed Haifa doctors and nurses to be inoculated against the disease, but three months later only 2 percent of the nurses had done so.

Twenty-five nurses from well-baby clinics in the Haifa district, 10 of whom had a degree in nursing, participated in the study, aimed at determining the reasons for the nurses' reluctance to be inoculated.

The results of the study, published in the monthly journal Vaccine, reveal that one of two main reasons was their lack of trust in their employer, the Health Ministry - the body in charge of directives concerning vaccinations. The lack of trust seemed to be related to the ministry's guidelines to be inoculated against swine flu a year earlier, when the ministry purchased vaccinations for all Israelis, before it transpired that the virus did not cause a widespread fatal epidemic.

"It caused a drastic change in our trust," said one nurse, while another added: "Now I realize that I used to be inoculated without even thinking, just because someone 'up there' decided I should."

The nurses who took part in the study said they felt frustrated with the ministry. One expressed the sentiment that the ministry doesn't respect them as human beings. In 2009, during the swine flu panic, "we were threatened, and received endless e-mails enquiring whether we were already inoculated, and if not, why not," one nurse recalled.

When the directive to be inoculated against whooping cough was published, many nurses insisted they had the right to make up their minds independently.

One nurse asked: "If one nurse caught whooping cough in the hospital, why should all the nurses be inoculated? Is this Soviet Russia here? In principle, I won't be inoculated this year."

The nurses were also embittered by the partial information they said they received concerning the vaccines they were supposed to get. "We can't be brainwashed. They expect us to forget what they told us three months ago [concerning the swine flu vaccination]," one said.

'Laboratory animals'

The second main reason for the nurses' reluctance was a refusal to serve as role models for the general public. "What I do and my beliefs as a private person are completely irrelevant to my profession," said one nurse.

Other factors explaining the very limited response to the guidelines were fear of the vaccine's adverse effects - despite the fact that nurses administer the whooping cough vaccine habitually. Some nurses feared they would be infected by the vaccine, and others said the vaccine's benefits weren't worth the risks. Others believed the disease was not really dangerous.

Several nurses said they felt they were being used as "laboratory animals" for both vaccines.

"The phenomenon of health workers who do not trust the directives issued by the health authorities is not exclusive to Israel," said Prof. Shmuel Rishpon, head of the Haifa District Health Office and chairman of the Health Ministry's advisory committee for vaccines and infectious diseases, who helped conduct the study.

"It can be seen in many developed countries, and was already expressed in the low number of doctors and nurses who agreed to be inoculated against pandemic flu. In this study, the reasons for the nurses' reluctance to receive the vaccine was based on their insistence to reach an independent decision concerning their health. This will replace the previous automatic agreement to act according to governmental directives in general and the Health Ministry's directives in particular."

"These findings are consistent with previous studies that identified the new approach of young people - examining and considering government directives instead of automatically accepting them as gospel," Rishpon added. "Other reasons reveal that the nurses lack appropriate information [concerning the vaccines]."

As a result of the study, the Health Ministry has launched a new initiative to inoculate nurses against whooping cough, and so far some 43 percent of nurses in well-baby clinics in the Haifa district have indeed been inoculated. The initiative will soon be rolled out across the country.

In the United States, only 20 percent of health workers have agreed to be vaccinated against whooping cough.

The whooping cough vaccine is part of Israel's national vaccine program and is administered as part of the DTaP vaccine against diphtheria, tetanus and pertussis (whooping cough) at the ages of 2 months, 4 months, 6 months and at the ages of 7 and 13.

Between 2004 and 2006 the number of whooping cough patients in Israel has multiplied by 14 in comparison to between 1996 and 1998, particularly among babies and young children.

In 2011, 2,259 people were diagnosed with the disease - a rise of 84 percent in comparison to 2010. In the first four months of 2012, there were 751 cases of whooping cough - a rise of 83 percent compared with the first four months of 2011.