Ethics of mandatory vaccination for healthcare workers

Abstract

Healthcare workers (HCWs) are at increased risk of contracting infections at work and further transmitting them to colleagues and patients. Immune HCWs would be protected themselves and act as a barrier against the spread of infections and maintain healthcare delivery during outbreaks, but vaccine uptake rates in HCWs have often been low. In order to achieve adequate immunisation rates in HCWs, mandatory vaccination policies are occasionally implemented by healthcare authorities, but such policies have raised considerable controversy. Here we review the background of this debate, analyse arguments for and against mandatory vaccination policies, and consider the principles and virtues of clinical, professional, institutional and public health ethics. We conclude that there is a moral imperative for HCWs to be immune and for healthcare institutions to ensure HCW vaccination, in particular for those working in settings with high-risk groups of patients. If voluntary uptake of vaccination by HCWs is not optimal, patients' welfare, public health and also the HCW's own health interests should outweigh concerns about individual autonomy: fair mandatory vaccination policies for HCWs might be acceptable. Differences in diseases, patient and HCW groups at risk and available vaccines should be taken into consideration when adopting the optimal policy.

Influenza Immunization for All Health Care Personnel: Keep It Mandatory

“…Mandating influenza vaccine for all HCP nationwide is ethical, just, and necessary. [7][8][9] For the prevention and control of influenza, we must continue to put the health and safety of the patient first. …”

“…6 Mandating influenza vaccine for all HCP is ethical, just, and necessary. [7][8][9] Because individuals are embedded in societies and populations, their risk of illness cannot be considered in isolation from the disease risk of the population to which they belong. 10 Employees of health care institutions are obligated to honor the requirement of causing no harm and to act in the best interests of the health of their patients.…”

Vaccination of healthcare workers: A review

“…The main principles that have been invoked are autonomy, beneficence, non-maleficience, fairness and virtue ethics. 211 The main levels at which ethical decisions must be made are individual, 212 institutional 213 and governmental. 214 Judging HCW vaccination by any ethical standard requires good assessment of empirical and theoretical evidence of each vaccine's benefits and risks, the lack of which is the most common cause of opposition to vaccination by individual HCWs.…”

“…When benefits are low to moderate and risks are negligible, which is actually the case with most vaccines, all frameworks would recommend active educational campaigns and a mandate for alternative infection control measures for unvaccinated professionals. All frameworks could accomodate a mandatory vaccination policy with termination of employment for offenders, 211 but it should be preceded by a successful educational campaign for most of them, and a general consensus should be reached before the implementation of a mandate. 215,216 This is especially true when considering that a mandate without a consensus can lead to a serious backlash against vaccines in general.…”

Vaccine or Mask Policy: One Epidemiologists Opinion on the Ethics of this Healthcare Policy

“…Health care workers are at a far greater risk of contracting and spreading infectious disease. According to Galanakis,6 the gulf between the desired levels of vaccination coverage is so low for voluntary vaccination, as to make mandatory vaccination both reasonable and necessary. While some may feel that vaccination is a personal liberty decision, and that a mask may suffice in place of immunization, the question must be asked if the healthcare worker indeed has the best interest of the patient in mind.…”