Registered nurse Orlyn Grace, left, administers a COVID-19 booster vaccination to Jeanie Merriman, right, at a COVID-19 vaccination clinic on April 6, 2022, in San Rafael, California. (Justin Sullivan/Getty Images)
A form letter from two of Louisiana’s top health officials ostensibly provides health care workers with a way to get around an employer’s flu vaccine requirements.
And even anti-vax proponents have acknowledged the document might not carry much weight.
The letter from Surgeon General Dr. Ralph Abraham and his top deputy, Dr. Wyche Coleman III, has circulated online over the past week, though there’s no mention of it on the Louisiana Department of Health (LDH) website.
A health department spokesperson has not responded to requests for more information about the letter and Abraham’s reasons for making it available.
Physicians can fill in the blanks to personalize the would-be permission slip written on LDH letterhead that includes the names of Gov. Jeff Landry and Health Secretary Michael Harrington on top.
“Please allow this letter to serve as an exemption from your hospital’s influenza vaccination requirement for Dr. ____,” the letter starts. The doctors state that evidence doesn’t prove the flu vaccine is effective at preventing “infection, transmission, hospitalization, or death … and represents little more than a guess” in combating the upcoming flu season’s predominant strain.
“Where there is risk there must be choice,” the letter continues. “In the case of Dr. ____, risks of influenza vaccination outweigh benefits, and there should be no further coercion to comply.”
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Abraham makes no mention of specific flu vaccine risks in his letter. The most common side effects, according to the Centers for Disease Control and Prevention, include injection site soreness, muscle aches and fever. More serious complications are extremely rare.
The message Abraham’s letter conveys concerns Jennifer Herricks, who holds a Ph.D. in microbiology and molecular genetics. She’s also the founder of Louisiana Families for Vaccines, a group that combats medical misinformation and falling vaccine rates.
“If there are certain health care workers who do choose to use this form … then it’s scary to think about people who are in the hospital, who are vulnerable, who could get exposed,” Herricks said.
Doctors and Infectious disease experts acknowledge that, in some years, flu vaccines are a best “guess” at what a particular strain will be, meaning there a vaccine cannot promise 100% protection against preventing the flu. But they still stand behind its real world effectiveness.
“We typically don’t know the effectiveness of the vaccine until we really get into flu season, and we can see what types of viruses actually end up circulating in the population,” said Dr. Kate Kirley, a family physician and the American Medical Association’s director of chronic disease prevention.
“It typically falls somewhere between 40% and 60% effectiveness,” she said for the AMA’s What Doctors Wish Patients Knew series. “Even when the vaccine is only 30% effective at preventing flu, that is still very meaningful and crucial for preventing hospitalizations and deaths.”
Kirley’s words are similar to language on the LDH website that actually encourages the public to be vaccinated against the flu. Both counter the viewpoints of Abraham and Coleman as stated in their opt-out letter.
“Everyone six (6) months of age and older should get a flu shot by the end of October, though getting one anytime during flu season is still beneficial,” the LDH website reads. “It will help reduce your chances of getting and spreading the flu. You can also help care for a loved one who may be at high risk of contracting the flu by helping make sure he or she gets a flu shot, too.”
There’s data to back up those claims. For the 2022–23 flu season, the CDC estimates people vaccinated for the flu in the U.S. prevented 6 million flu-related illnesses, 2.9 million medical visits, 65,000 hospitalizations and 3,700 deaths.
Abraham makes another dubious claim in his letter.
“Conclusive evidence has not shown masks to be effective against transmission of respiratory viruses,” he writes, linking to a scientific study to support his claim. The study’s authors evaluated dozens of randomized controlled trials from around the world to determine that “wearing masks in the community probably makes little or no difference to the outcome” of flu-like and COVID-related illnesses.
Herricks questioned Abraham’s reliance on research without including greater context.
“A single study doesn’t prove or disprove anything,” she said. “They’re always considered within the full body of knowledge.”
The surgeon general’s take clashes with science that went into evaluating what should go into this year’ flu vaccine. Each year’s dose typically includes protection against multiple strains of the flu, but the U.S. Food and Drug Administration decided that influenza type B wasn’t needed for this season, NPR reported.
The reason: There hasn’t been a case of influenza B since spring 2020, which scientists attribute to widespread social distancing and masking at the onset of the COVID-19 pandemic. In simple terms, those measures cause the strain to go extinct, according to Dr. Rebecca Wurtz, an infectious disease physician and epidemiologist at the University of Minnesota School of Public Health.
And there’s also the question of whether the Abraham-Coleman letter will hold any weight if a health care facility decides to part ways with an employee who decides to defy a vaccine requirement. The Louisiana Supreme Court upheld the Ochsner Health System’s COVID-19 vaccination requirement after some of its employees challenged it.
In 2022, the U.S. Supreme Court blocked a federal rule that would have allowed businesses with more than 100 employees to require COVID vaccines or weekly testing for those who refused the shot. But justices made an exception for the Centers for Medicare and Medicaid Services that allows health care facilities to have vaccine mandates.
The Illuminator’s questions to Louisiana’s three largest hospital owner-operators — Ochsner Health System, LCMC Health and the Franiscan Missionaries of Our Lady Health System — about their flu vaccine policy have gone unanswered.
Health Freedom Louisiana, a group that supports efforts to end vaccine mandates, has circulated Abraham’s “incredible” letter and offered to send the public copies customized with their name.
“There are no guarantees that the hospital will honor this letter,” the group stated in a recent Substack email, which also said people who get flu shots “are more likely to get the flu with repeated annual doses.” While the vaccine might cause minor flu-like symptoms as a side effect, medical experts – including the Mayo Clinic – say annual flu shots do not increase the likelihood of contracting the virus.
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Abraham’s letter is reminiscent of steps Landry took in 2021 when he was attorney general. In an email to employees in his agency, he suggested strategies for students to get out of a mask mandate then-Gov. John Bel Edwards would put in place for K-12 schools just hours later. The governor’s order came during a surge in COVID-19 cases, with higher numbers among students, from the Delta variant of the virus.
“Louisiana law offers broad and robust protections for students’ and parents’ religious and philosophical objections to certain state public health policies,” Landry wrote to his staff. “I support your religious liberties and right to conscientiously object.”
At the time, public health experts said the biggest reason behind the emergence and severity of the Delta variant was low vaccination rates. Herrick and others fear a broader anti-vax mindset could lead to a reemergence of largely eradicated diseases such as measles, mumps and pertussis.
It appears Abraham would rather repeat history than learn from it.