Literature Review: Ethics of Mandatory Vaccination for Healthcare Workers

Ethics of Mandatory Vaccination for Healthcare Workers

Gur-Arie et al. (2021) wrote a commentary about the ethical issues regarding mandatory Covid-19 vaccination of healthcare personnel. The sample population includes all frontline workers (physicians, assistants, laboratory technicians, students in residency, etc.) who have directly and indirectly been around Covid-19 patients and have faced staff and resource shortages throughout the pandemic (p.1). The variables within the research are vaccine hesitancy among healthcare personnel (HCP) based on concerns of efficacy and perceived low risk of infection among personnel not working with Covid-19 patients. Their variables supporting mandatory vaccination for HCP include the principle of ‘do no harm’ and the duty of care involved with the healthcare industry (pp. 1-2). For the purpose of this Literature Review, it will focus on the ethical principle of healthcare which is ‘do no harm’. The main question of Gur-Arie et al.’s research is whether to mandate vaccinations for healthcare workers and how to implement it without a breach of ethics (pp. 1-2).

Policy should attempt to draw on current evidence, […] 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. (Gur-Arie et al., 2021, p. 2)

The above quotation outlines the different methods available to institutions when considering how best to implement policies to protect the individuals affected by their decisions, whether students in a university or staff in a hospital. However, any methodology chosen should be adequately measured against the risks associated with the phenomenon the institution wants to protect their staff or students against—in the case of the current pandemic, Covid-19 and the risks associated with receiving and not receiving a vaccine against it. However, the greatest benefit from vaccines comes from a significant sum of the population receiving their immunization and maintaining that significant percentage (Herd Immunity) — a feat where hesitancies would have to be put aside for the greater good of public health (Giubilini, 2021, pp. 6-7).

Gur-Arie et al. (2021) argue the principle of ‘do no harm’ as “one of the key justifications for requiring HCP to be vaccinated or show immunity against other documented occupational threats such as hepatitis B, measles, mumps, rubella, diphtheria and pertussis31” (p. 3). The researchers’ point of ‘vaccines worked before, so keep vaccinating’ has objective support based on most of the aforementioned conditions significantly decreasing in frequency after their vaccines were developed and distributed. Debates on ethics suggest less intrusive methods for reducing transmission before implementing a vaccine mandate, such as increased personal protective equipment (PPE) (p. 3). However, a central characteristic of the pandemic has been the resource shortages experienced and the exposure to improper systemic protections, such as a lack of ventilation within healthcare facilities. Gur-Arie et al. argue that the “failed institutional responsibility to assist HCP in the fulfillment of their duties to ‘do no harm’ weakens appeals to such duties in the justification of vaccine mandates” (p. 3).

Gur-Arie et al. (2021) conclude that although a vaccine mandate for healthcare workers may be seen as an end-all-be-all for increasing vaccination rates, it does not equitably weigh all the associated ethical concerns (p. 4). Instead, they suggest that institutions start developing vaccine campaigns based on education to promote voluntary vaccinations, as most individuals prefer to make their own informed decisions. By facilitating vaccine-related conversation, institutions can hear healthcare personnel’s ethics concerns and their firsthand experience of a public health crisis (p. 4). Open communication around vaccination can lead to a similar approach with other private, public, and government-run institutions, which prioritizes education over coercion. This review was included within the research study because it highlights the importance of educating affected individuals on the reasoning behind instituting mandatory vaccination. Individuals are more likely to agree with something if given a valid purpose behind it because it makes the regulation less daunting and more reasonable.