Leading ethicists argue in a long essay published online in the Journal of Medical Ethics that while mandating the flu vaccine for healthcare workers is ethical, the same cannot be true for the COVID-19 vaccine.
Unlike the COVID-19 vaccine, the flu vaccine is safe and has few adverse effects, it reduces the risk of infection, and it reduces staff shortages and “presenteeism,” according to the researchers.
Furthermore, healthcare staff have a professional responsibility to protect patients from a virus that is especially dangerous to the elderly, who are overrepresented among hospital patients. The authors say that these obligations are more important than limits on personal freedom.
In light of the pandemic’s effects on infection control and the steps taken by different countries to get people to trust vaccines, the authors compare the ethical reasons for making healthcare workers get vaccinated against COVID-19 and seasonal flu.
A vaccine mandate for healthcare personnel would be in line with current professional responsibilities, which are based on avoiding patient damage. However, not all professional obligations are also legal obligations.
According to the authors, additional ethical criteria are needed to justify such a policy. These include the benefits and drawbacks of vaccines, as well as the availability of less restrictive alternatives that provide similar health benefits.
Several nations, including France, Italy, some US states, several Canadian provinces, and Australia, required COVID-19 vaccination for healthcare workers during the crisis.
The UK government considered doing the same, but decided against it due to concerns about job losses and perceived overreach in light of the discovery of the milder Omicron strain.
It did, however, advise on requiring the seasonal flu vaccine for healthcare professionals, as one out of every four do not receive the vaccine.
Every year, flu kills more than 11,000 people in England alone, with the number rising to more than 22,000 in 2017-18.
During the 2018–2019 flu season, data from London University College hospitals suggests that 15% of inpatients with flu contracted the infection while in the hospital (nosocomial infection).
During some flu seasons, substantial numbers of unvaccinated employees become ill, causing shortages or ‘presenteeism,’ in which infected employees continue to work, increasing the risk of infection spreading to patients and coworkers.
“Vaccine mandates are typically controversial as they entail limitations of individual liberties for the sake of the collective good,” the authors note.
“However, when it comes to [healthcare workers], liberty-based counter-arguments are more difficult to apply. Quite simply, [healthcare workers] have an ethical and professional obligation not to harm patients, or to minimise the risk of harm to patients, which other people do not have ,” they say.
“It is already commonly accepted that [healthcare workers] should take on at least some additional health risk for the sake of their patients…”
The question isn’t whether this is justified, but rather how much additional risk is justified by contractual and professional obligations,” they say.
COVID-19 vaccines are linked to a minor risk of blood clots and myocarditis (inflammation of the heart muscle), and considering the low risk of serious illness from COVID-19 among younger employees, the cons may outweigh the benefits, they say.
Neither do the current COVID-19 vaccinations appear to be very successful at preventing transmission, and the protection they provide against symptoms only lasts a few months.
Furthermore, due to changes in the circulating form of the virus, high vaccination uptake in individuals at highest risk, high rates of natural immunity, and an expanding number of treatments becoming accessible, the severity of COVID-19 sickness has decreased, according to the scientists.
They point out that these concerns do not apply to the seasonal flu vaccination, which has been in use for decades and has a well-established safety profile with few and relatively minor adverse effects.
Increased flu vaccination uptake reduces the risk of injury to patients, not just by lowering the risk of infection, but also by lowering the risk of staff shortages caused by illness. According to the authors, research suggests that mandatory flu vaccinations improve vaccination rates more than less stringent measures.
However, the question of how much compulsion is ethically permissible remains unanswered. “One way to strike a balance between individual freedom and patients’ interests is to make vaccination a condition of entry into the profession rather than mandating those already employed,” they write, “and adopt a conditional mandate if at all possible for those already in the profession.”
“Ultimately, there is an ethical balance to be drawn between protecting patients (including their own right to not acquire serious but preventable nosocomial infections) and coercing some healthcare professionals into having a vaccine that they would prefer not to receive.”
“For reasons that we have given above, the balance of risks and benefits suggests that an influenza vaccine mandate, but not a COVID-19 mandate, would currently be ethically proportionate,” they conclude.
“Mandates should be introduced on a disease-specific and vaccine-specific basis,” they caution.
“The problem must be a significant one; the vaccines must be safe and effective at preventing illness and/or transmission; mandatory measures must be superior to less coercive alternatives, and the costs in loss of liberty and risk to health professionals must be proportionate in professional terms to the benefits to patients.”
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