Focus on voluntary efforts is paying off.

Story Highlights

• Hundreds of health care workers have already been fired for not getting a flu shot.
• A 2005 study found no correlation between an increase in vaccine use and a decrease in deaths.
• There just isn't enough medical justification for firing a health care worker for refusing a flu shot.

When you decide not to get a flu shot, the risk is that you or someone near you will get sick. But for health care workers, the price is increasingly a pink slip. Hundreds have already been fired.

In October, Rhode Island became the first state to mandate the immunizations for all health care workers with direct patient contact. Earlier in 2012, Colorado's Board of Health voted that all hospitals, nursing homes and health facilities across the state achieve at least a 90% vaccination rate for workers by 2015.

In Ohio, TriHealth offered its employees flu shots and has now fired more than 150 for non-compliance. Last week, in Indiana, eight health workers from another company were fired. Even accountants have lost their jobs as the mandates have spread from a couple of hospitals in 2005 to more than 400 today.

Such goals seem admirable at a time when the flu season is off to its earliest start since 2003-04, but these mandates might have done more to boot doctors and nurses from their jobs than to protect people's health.

Education, not orders

For one thing, encouraging people to act in the right way on their own is a more powerful and lasting solution than coercion. And education efforts are working. A recent survey by the Centers for Disease Control and Prevention found that about two-thirds of health care workers and more than 85% of physicians are receiving the yearly vaccine, and that the number is on the rise.

This isn't to say that mandatory vaccines don't have their place, just that mandates should be reserved for situations where a vaccine can play a major role in fighting back a clear public health risk. In the case of seasonal flu, neither the risk of the disease nor the benefit of the vaccine is big enough to warrant forcing health care workers to receive it.

The right targets

Measles, another highly contagious and deadly virus, is another p[oint of reference: Vaccination of health care workers is recommended by the CDC but not mandatory. The chances of a health care worker carrying measles isn't high enough to warrant mandatory vaccine. Instead, mandates are targeted on the most vulnerable population: children. According to the World Health Organization, increased measles vaccination resulted in a three-fourths drop in measles deaths between 2000 and 2010, when 85% of the world's children received one dose of the vaccine by age 1, up from 72% in 2000.

For the flu, the evidence is not nearly so powerful. Studies of Japan, where flu vaccination of schoolchildren was largely mandatory from 1962 to 1987, did show that more than 37,000 deaths were likely prevented. But here in the U.S., a 2005 National Institute of Allergy and Infectious Diseases study found no correlation between an increase in vaccine use over 20 years and a decrease in deaths.

We are not in the midst of a deadly pandemic where a vaccine could be the only line of defense against instant death. Because the yearly flu vaccine is generally only 60% effective against the prevailing strains, taking it should be advised, not mandated, even in a bad season.

There just isn't enough medical justification for firing a health care worker for refusing a flu shot.

Marc Siegel is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, as well as a member of USA TODAY's Board of Contributors.

In addition to its own editorials, USA TODAY publishes diverse opinions from outside writers, including our Board of Contributors.

Marc Siegel is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, as well as a member of USA TODAY's Board of Contributors.

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