Experts Disagree on COVID-19 Vaccine Mandates for Health Care Providers

Professional organizations have called for COVID-19 vaccination to be mandated for all health care providers (HCPs), and some mandates for HCPs have already been put in place.^1,2,3

However, some experts have expressed hesitancy about mandating vaccines for HCPs.^4,5

Given that cancer is known to be a significant predictor of serious illness and death from COVID-19,^6,7,8 should vaccines be required for HCPs who care for cancer patients?

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Writing in the Journal of Medical Ethics, Julian Savulescu, PhD, a professor of philosophy at the University of Oxford in England, argued that a few criteria determine whether vaccine mandates are ethically justified.⁹

One of the criteria — the threat to public health — is greater among more vulnerable patients, as the level of threat is proportional to the vulnerability of the population. In cancer care, the patients’ high risk of mortality from COVID-19 may indicate that this criterion is fulfilled.

In a head-to-head debate published in The BMJ, Michael Parker, PhD, professor of bioethics at the University of Oxford, argued that COVID-19 vaccination should be mandated for all HCPs.⁴

“Patient safety is ultimately the responsibility of health and social care institutions,” Dr Parker wrote. “With regard to employment practice, these institutions have a duty to employ only workers whose presence would not place patients at unnecessary risk.”

“If hospital chefs refuse to comply with new safe food preparation guidance, they have no good reason to expect to continue to be employed,” he added. “So too in frontline health care roles, staff are rightly required to modify their practice in the light of evidence about patient safety.”

On the other side of the debate, Michael Ussher, PhD, and coauthors argued that mandatory vaccination is “not necessary, acceptable, or the most effective way to achieve high uptake, and it raises serious ethical issues about freedom of choice.”⁴

“Although it can be argued that freedom of choice does not trump protecting patients and care home residents, mandatory vaccination could be counterproductive,” Dr Ussher and coauthors wrote.

The authors did express the view that HCPs have a duty of care to be vaccinated against SARS-CoV-2. However, the authors advocated educating vaccine-hesitant HCPs rather than mandating vaccines.

“In principle, applying the argument in The BMJ, we would say that it is good to understand the reasons for vaccine hesitancy, and a mandate would be the last resort,” said Dr Ussher, a professor of behavioral medicine at St George’s University of London in England.

Reasons for vaccine hesitancy are diverse and complex, but new research suggests that an individual’s previous experiences with vaccines against influenza may affect the likelihood of hesitancy.¹⁰ The study suggests that nurses may be more likely than physicians to refuse COVID-19 vaccination. This may be particularly problematic in the cancer setting, given the high frequency of patient contact with nurses.

Other recent publications have detailed potential drawbacks of widespread vaccine mandates, particularly given the number of unknowns involved with COVID-19, in terms of the populations affected, the vaccines’ approval status, and the changing biological characteristics of the virus itself.^5,11

The authors of a viewpoint published in JAMA argued that “limited vaccine mandates with public support, in special high-risk or high-value settings, and with longer-term safety data can be part of a comprehensive package of interventions to return society to pre-pandemic life.”⁵

The lead author of that viewpoint, Laurence O. Gostin, JD, said he is now of the opinion that vaccine mandates are necessary for HCPs.

“I now believe the COVID crisis is so dire that we should mandate vaccines in all health and long-term care settings,” said Mr Gostin, a professor of global health law at Georgetown University in Washington, DC.

Disclosures: Mr Gostin and Dr Ussher reported having no relevant conflicts of interest.

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