seasonal influenza vaccine , for example . Given the consensus prioritization of HCP to get vaccinated against COVID-19 , should vaccination of HCP be mandatory ?”
The case for and against mandating COVID-19 vaccination of healthcare personnel seems to swing on what many point to as the professional responsibility of the medical profession to “ first , do no harm ,” invoking the Hippocratic Oath when calling for healthcare professionals to set aside personal convictions to uphold patient safety above all else .
As Habib and Penan ( 2021 ) explain , “ Two widely accepted principles of Hippocratic medicine guide these duties : promoting the wellbeing of one ’ s patients and doing no harm to one ’ s patients . Taking an available vaccine for a communicable disease reduces the likelihood of healthcare workers transmitting that communicable disease to their patients , thereby reducing the likelihood of harming a patient . Under this framework , it can be argued that healthcare workers have a duty to their patients to take all reasonable steps to protect their patients from harm that could be caused by the healthcare worker , such as by transmitting a communicable disease for which a vaccine exists . However , the Hippocratic Oath is also based on principles of autonomy and is centered on the individual worker ’ s duty to patients , so the idea of a mandatory vaccine that elevates this moral imperative to a mandate , irrespective of the individual autonomy of the healthcare worker and the specifics of the environment the healthcare worker works in or the patients the worker serves , may go beyond the bounds of the Hippocratic Oath framework .”
They add , “ It is worth noting that not all healthcare workers take a Hippocratic Oath — it is primarily a physician-focused oath . Nursing and other allied health programs often include an oath of some kind , such as the Nightingale Oath , which includes the same types of ethical obligations to care for and protect patients . However , large swaths of individuals who are considered healthcare workers for vaccination purposes based on the nature of their jobs , such as those cleaning hospital rooms and serving food to patients in cafeterias , take no such oath and are not bound by professional licensure or culture to traditional notions of Hippocratic duties .”
As Gur-Arie , et al . ( 2021 ) observe , “ Mandatory vaccination of HCP might arguably involve justifiable limitations on HCP autonomy to ensure the fulfilment of certain professional responsibilities . On the one hand , HCP regularly work with and treat vulnerable populations , including older and immunocompromised individuals , heightening the importance of infection prevention including via uptake of safe and effective vaccines where these prevent transmission to patients . On the other hand , some HCP hold negative attitudes toward vaccines that contribute to low vaccine uptake . These negative attitudes seem to remain among HCP regarding COVID-19 vaccines . Research suggests additional concerns among HCP specifically regarding : COVID-19 vaccines ( including insufficient safety and efficacy data and long-term side effects ) and breakdowns of trust between HCP and institutions ( due to inadequate personal protective equipment and concerns that getting vaccinated against COVID-19 will
Ethical debate on vaccine mandates consistently suggests that unless all other reasonable means have failed ( or are likely to fail ) to increase vaccine uptake and / or reduce disease transmission by other means to an acceptable level , mandates should not be implemented .” be linked to requirements to work with COVID-19 patients ).”
The researchers continue , “ There has been a recent increase in seasonal influenza vaccination mandates for HCP based on their obligation to ‘ do no harm ,’ professional duty to prioritize patients ’ interests (‘ duty to care ’), and perceived obligation to set a good example for the public . Some or all of this logic may be adopted as the justification for mandating COVID-19 vaccines to HCP once they become available . Nevertheless , there are important questions surrounding the basis of HCP ’ s commitment to ‘ do no harm ’ and the duty to care in the context of getting vaccinated against COVID-19 .”
What we have seen from the medical societies and any entity pushing hard for mandatory vaccination over personal freedom of choice as an American as guaranteed by the U . S . Constitution , is the prima facie case to mandate COVID-19 vaccination for healthcare workers based on their duty to protect patients , and a prime justification for requiring these workers to be vaccinated or show immunity against other infectious threats such as hepatitis B , measles , mumps , rubella , diphtheria and pertussis . But , as Gur-Arie , et al . ( 2021 ) state , “ Nevertheless , appeals to HCP ’ s commitment to do no harm when mandating COVID-19 vaccines are weakened by considering the systemic failures of many healthcare systems to protect HCP and patients from healthcare-associated infections in the first place .”
Gur-Arie , et al . ( 2021 ) emphasize that , “ Public health should arguably strive to implement the least restrictive intervention when possible , yet vaccine mandates are the most restrictive , intrusive form of vaccine policy . Ethical debate on vaccine mandates consistently suggests that unless all other reasonable means have failed ( or are likely to fail ) to increase vaccine uptake and / or reduce disease transmission by other means to an acceptable level , mandates should not be implemented . This requires institutions to consider whether they have pursued all possible interventions and support mechanisms for preventing infection even without a vaccine intervention .”
Rachel Gur-Arie , PhD , MS , the Hecht-Levi Postdoctoral Fellow in Ethics and Infectious Disease at the Berman Institute of Bioethics at Johns Hopkins University , acknowledges how last-resort policies like mandates stymie dialogue between healthcare facility leadership and its vaccine-hesitant employees , and preclude softer mandates , first .
“ I personally do not know if Houston Methodist implemented any educational campaigns or additional measures aimed at reducing the burden of a vaccination before implementing a mandate ,” Gur-Arie says . This would be a more ethical approach to a vaccine mandate . In retrospect with today ’ s knowledge , I think that taking a strict vaccine-mandate and purposefully excluding natural immunity would constitute a mandate based on incomplete scientific evidence . However , hindsight is 20 / 20 and this is subject to change , like anything regarding COVID-19 . It is important to remember that consensus regarding natural immunity resulting from recovering from COVID-19 is still iffy . I personally agree that natural immunity should fulfill a vaccine mandate , though many institutions and scientists disagree currently .”