Ethicists call for ‘soft’ mandatory vaccine policy for healthcare workers

This article was first published on the 12th of May, 2021.

There are currently seven COVID-19 vaccines being administered globally, with demand outstripping supply. In most countries, priority is given to frontline healthcare workers: not only because they face heightened exposure risks, but because they could pass the virus on to their charges.

But not all healthcare workers are willing to be vaccinated, which presents national health systems with a confounding ethical problem – do they make vaccinations mandatory, imposing on the freedoms of their employees? Or do they keep them optional, and put patients’ lives at risk? 

According to the authors of a new paper in the British Medical Journal’s Journal of Medical Ethics, the most ethical solution is to make healthcare workers’ job roles conditional on receiving the COVID-19 vaccine – a form of ‘soft’ coercive mandatory vaccination policy.

The ‘conditional’ policy proposed would mean that healthcare workers who refuse the vaccine could be temporarily redeployed to home work or to places where they don’t come into contact with patients, or barred from certain settings like tearooms (where masks aren’t worn, making them hotspots for transmission). In more extreme cases, persistent refusal could result in temporary suspension. 

There are a number of reasons why some healthcare workers refuse the COVID-19 vaccine, including concerns around safety and efficacy, a preference for ‘natural’ physiological immunity acquired by exposure to the disease rather than the vaccine, distrust of the government, and beliefs about autonomy and personal freedom.

“If as a frontline healthcare worker you’re not prepared to be immunised, then probably the most appropriate ethical solution is for those frontline healthcare workers to be redeployed to other areas of the hospital where they wouldn’t come into contact directly with patients, or at the very least not come into direct contact with the most vulnerable patients,” says co-author Owen Bradfield, from the University of Melbourne’s School of Population and Global Health.

The authors argue that while frontline healthcare workers can choose between vaccination and their jobs, sick patients cannot choose whether or not to get sick – nor whether the person caring for them is vaccinated or not. With this in mind, they argue that sick patients treated by unvaccinated healthcare workers have a greater restriction of choice than healthcare workers forced to choose between vaccination and their jobs. 

“From an ethical perspective, what matters is that the collective benefits outweigh the risks, and that there is some limit to the kind of risks that can be imposed for the sake of those collective benefits,” the authors write.

But mandatory vaccines are a contentious issue. In March and April 2021, the UK press reported that that Prime Minister Boris Johnson was considering a mandatory vaccination policy for NHS staff. Unison, a union that represents about 100,000 NHS staff, spoke out against mandatory vaccinations, calling them “sinister” and “counterproductive,” and argued that uptake would be increased more by information and education than by coercion.

The authors point out that many healthcare services already enforce mandatory vaccination policies for Influenza, as well as mandatory hygiene policies – like hand-washing – that are punishable if not followed. They say that coercive approaches to flu vaccination uptake have been proven to reduce serious illness.

The authors also note, however, that overly coercive regulation might undermine relationships between healthcare workers and their employers, and promote anxiety and resentment among a sector of workers who already experience disproportionate mental health issues as a consequence of their jobs.

There are also cultural and ethnic dimensions to any proposed mandatory vaccination policy, because not only does COVID-19 disproportionately affect ethnic minorities, but ethnic minorities make up a significant proportion of the corpus of frontline healthcare workers. 

The authors argue this should be addressed through “information and trust campaigns,” to address hesitancy that stems from cultural differences.

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