ican Medical Association . In the Joint Statement in Support of COVID-19 Vaccine Mandates for All Workers in Health and Long-Term Care , Emanuel stated , “ Due to the recent COVID-19 surge and the availability of safe and effective vaccines , our healthcare organizations and societies advocate that all healthcare and long-term care employers require their workers to receive the COVID-19 vaccine . This is the logical fulfillment of the ethical commitment of all healthcare workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being .”
“ As we move toward full FDA approval of the currently available vaccines , all healthcare workers should get vaccinated for their own health , and to protect their colleagues , families , residents of long-term care facilities and patients . This is especially necessary to protect those who are vulnerable , including unvaccinated children and the immunocompromised . Indeed , therefore many healthcare and long-term care organizations already require vaccinations for influenza , hepatitis B , and pertussis . We call for all healthcare and long-term care employers to require their employees to be vaccinated against COVID-19 . We stand with the growing number of experts and institutions that support the requirement for universal vaccination of health workers . While we recognize some workers cannot be vaccinated because of identified medical reasons and should be exempted from a mandate , they constitute a small minority of all workers . Employers should consider any applicable state laws on a case-by-case basis .” Existing COVID-19 vaccine mandates have proven effective . Simultaneously , we recognize the historical mistrust of healthcare institutions , including among many in our own healthcare workforce . We must continue to address workers ’ concerns , engage with marginalized populations , and work with trusted messengers to improve vaccine acceptance .
Exploring COVID-19 Vaccine Policy Options
Acknowledging COVID-19 vaccine hesitancy among healthcare personnel ( HCP ), Gur-Arie , et al . ( 2021 ) note , “ Potential contributors to COVID-19 vaccine hesitancy among HCP include safety concerns , doubts about effectiveness ( in terms of individual protection and / or reduction of transmission ), and perceived low risks of infection among HCP who do not treat patients with COVID-19 . Similar factors contribute to vaccine hesitancy toward seasonal influenza vaccination among HCP , which has been a documented challenge in raising seasonal influenza vaccine uptake among HCP in some settings for decades , despite established evidence of safety and effectiveness .”
The researchers continue , “ The pandemic emergency has exacerbated shortages in healthcare staffing and resources , heightening the importance of protecting HCP . Vaccinating HCP against COVID-19 first could therefore help to maximize the benefit of a limited resource , assuming that vaccinated HCP continue to care for patients , including those infected with COVID-19 . Vaccinated HCP may also impose less risk of disease transmission to patients , as documented in other infectious disease contexts including influenza and hepatitis B . All of these justifications are arguably related to HCP ’ s professional commitment to protect patients .”
Gur-Arie , et al . ( 2021 ) say that the ethical acceptability of vaccination policies depends on many factors including disease severity , vaccine effectiveness , safety and target population ( s ), as well as social , cultural and political considerations . They state that , “ Policy should attempt to draw on current evidence , attempt to manage residual uncertainties , and prepare for future developments . On one end of the vaccine policy spectrum are less restrictive options — opt-in , voluntary recommendations , and so on — while on the other end , there are more restrictive options — compulsory mandates backed with legal and financial penalties , with non-compliance potentially resulting in imprisonment . The current emergency arguably leaves little room for low vaccine uptake if we wish to reap the maximum benefits of vaccination , assuming adequate safety and effectiveness . Yet , vaccine hesitancy and logistical challenges pose significant threats to vaccine uptake generally and among HCP .”
They continue , “ Vaccine mandates , though the most intrusive form of vaccine policy , have been shown to yield high vaccine uptake among HCP . For this reason , there has been heightened interest in mandating COVID-19 vaccines , once available . Public health ethics principles suggest that mandatory vaccination policies in adults should usually be the ‘ last resort .’ … Historically , mandatory vaccination policies have been more widely accepted in emergency situations due to outbreaks that posed an imminent threat due to consistent low vaccine uptake resulting from voluntary policies , especially in healthcare and educational settings .”
Writing nearly seven months before the Biden Administration ’ s vaccine mandate , Gur-Arie , et al . ( 2021 ) recognize that , “ It is important to distinguish between government-implemented vaccine mandates and employer-mandated vaccine mandates … Institution-level mandates can be characterized by healthcare settings that mandate influenza vaccination of HCP when legally , politically and culturally permissible . The line between government-mandated and institution-mandated vaccine policies may be blurred when centralized national healthcare systems are in place and healthcare institutions are essentially extensions of government . As a result , ethical arguments for or against COVID-19 vaccine mandates should be sensitive to the policy level at which they are being implemented . On this note , while relevant precedents for mandating COVID-19 vaccination may exist , there might be more uncertainty regarding long-term effectiveness ( including regarding prevention of transmission ) and safety of COVID-19 vaccines than the
Public health ethics principles suggest that mandatory vaccination policies in adults should usually be the ‘ last resort .’ … Historically , mandatory vaccination policies have been more widely accepted in emergency situations due to outbreaks that posed an imminent threat due to consistent low vaccine uptake resulting from voluntary policies , especially in healthcare and educational settings .”
www . healthcarehygienemagazine . com • october 2021
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