COVID-19 vaccine mandate for healthcare workers in the United States: a social justice policy

ABSTRACT

Introduction

Vaccination is the most effective strategy to mitigating COVID-19 and restoring societal function. As the pandemic evolves with no certainty of a herd immunity threshold, universal vaccination of at-risk populations is desirable. However, vaccine hesitancy threatens the return to normalcy, and healthcare workers (HCWs) must embrace their ambassadorial role of shoring up vaccine confidence. Unfortunately, voluntary vaccination has been suboptimal among HCWs in the United States, a priority group for whom immunization is essential for maintaining health system capacity and the safety of high-risk patients in their care. Consequently, some health systems have implemented mandates to improve compliance.

Areas covered

This article discusses the ethical and practical considerations of mandatory COVID-19 vaccination policies for HCWs utilizing some components of the World Health Organization’s framework and the unique context of a pandemic with evolving infection dynamics.

Expert opinion

COVID-19 vaccine mandates for universal immunization of HCWs raise ethical and practical debates about their appropriateness, especially when the vaccines are pending full approval in most jurisdictions. Given the superiority of the vaccines to safety and testing protocols and their favorable safety profile, we encourage health systems to adopt vaccination mandates through participatory processes that address the concerns of stakeholders.

KEYWORDS:

• COVID-19
• health personnel
• mandatory program
• public health
• vaccination

Abbreviations

COVID-19, Coronavirus disease-2019; EUA, Emergency Use Authorization; FDA, Food and Drug Administration; HCW, Healthcare worker; U.S., United States.

Article highlights

• COVID-19 vaccines approved for emergency use in the United States are safe and highly effective. They remain the best strategy to mitigate the pandemic and restore normalcy, with very few alternatives.

• With the emergence of more virulent coronavirus variants and significant vaccine hesitancy in several sections of the public, universal immunization of at-risk populations is the desired endpoint for public health agencies.

• Healthcare systems and personnel have the fiduciary, professional, and ethical duties to preserve the frontline workforce and minimize the risk of care-associated infections by vaccinating against COVID-19.

• Despite the free and sufficient supply of the vaccines to HCWs in the United States, voluntary vaccination has been subpar, prompting health systems to adopt mandatory vaccination policies with repercussions for non-exempted non-compliers.

• Mandating vaccines that are pending full approval from the Food and Drug Administration through a Biological Licenses Application raises ethical and legal debates about the appropriateness of such policies.

• The benefits of mandating the COVID-19 vaccines approved for emergency authorization far outweigh the minimal potential risks, and health systems are encouraged to adopt mandatory policies for COVID-19 vaccination.

Declaration of interest

K Nasir is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.