Spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for front-line healthcare workers

Abstract

Seven COVID-19 vaccines are now being distributed and administered around the world (figure correct at the time of submission), with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity if properly implemented. Using the principle of least restrictive alternative, we have developed an intervention ladder for COVID-19 vaccination policies among healthcare workers. We argue that healthcare workers refusing vaccination without a medical reason should be temporarily redeployed and, if their refusal persists after the redeployment period, eventually suspended, in order to reduce the risk to their colleagues and patients. This ‘conditional’ policy is a compromise between entirely voluntary or entirely mandatory policies for healthcare workers, and is consistent with healthcare workers’ established professional, legal and ethical obligations to their patients and to society at large.

Attitudes towards Mandatory Occupational Vaccination and Intention to Get COVID-19 Vaccine during the First Pandemic Wave among Mongolian Healthcare Workers: A Cross-Sectional Survey

“…Responding to the immunization gap, Italian healthcare workers were the first in Europe to get mandated COVID-19 vaccination [ 38 ]. In Australia, Bradfield and Giubilini (2021) suggested a conditional COVID-19 vaccination policy for healthcare workers who refuse to receive the vaccine [ 39 ]. However, such discussion is not yet heard from developing countries, especially from Asia.…”

Ethical challenges experienced by care home staff during COVID-19 pandemic

“… 43 A stepwise approach was proposed by Ginbilini (2019) on the basis of the least restrictive principle, suggesting that vaccination mandates for healthcare providers should be preceded by non-coercive strategies, such as persuasion, nudging or providing incentives for vaccine uptake. 44 Providing balanced evidence-based information about the vaccine to clarify the myths and misconceptions underpinning vaccine hesitancy might also be helpful. 5 , 22 , 43 Redeploying staff to non-clinical duties, requiring them to take leave or suspending them from employment are other non-prescriptive alternatives to preserve healthcare providers’ right to choice regarding infection control measures.…”

“… 5 , 22 , 43 Redeploying staff to non-clinical duties, requiring them to take leave or suspending them from employment are other non-prescriptive alternatives to preserve healthcare providers’ right to choice regarding infection control measures. 44 Nevertheless, the right of healthcare providers to exercise autonomy should not breach their moral obligation of non-maleficence at the cost of public health. 44 …”

Waving away waivers: an obligation to contribute to ‘herd knowledge’ for data linkage research?

“…Many moral frameworks converge on the premise that coercive policies may justify curtailing individual freedoms in pursuit of anticipated social benefits (Department of Health, Education, and Welfare; National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 2014). Even small benefits may allow for interventions that are relatively costless (Childress et al, 2002), provided they are effective, necessary and proportionate (Bradfield and Giubilini, 2021). In this case, the re-use of data without consent is both necessary and effective in maximising participation to increase the size, power and potential benefits of large public datasets.…”

“…Third, the achievement of herd immunity has been used to justify mandatory vaccination, but not the forced vaccination of individuals against their will (Bradfield and Giubilini, 2021). On the contrary, I argue that the achievement of herd knowledge can be used to justify the analysis of collected information without any consent.…”