Should Coronavirus Vaccination Be Compulsory for Children’s and Young People’s Nurses?

ABSTRACT

Emeritus Professor Alan Glasper from the University of Southampton discusses the effort by numerous governments worldwide to make COVID-19 vaccination mandatory for all health care staff.

Introduction

Despite mankind’s tremendous scientific achievements over the first two decades of the 21st century including the roll-out of the internet across the world and major development in satellite technology, the arrival of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 attributable to the COVID-19 virus took the world by surprise. Regardless of modern medicine’s array of lifesaving treatments, this new novel coronavirus demonstrated man’s fallibility in being little more able to successfully treat coronavirus disease than its yesteryear counterparts during the Spanish Flu pandemic, which followed in the wake of World War I. Since the beginning of this global pandemic, the disease has caused some 5.5 million fatalities as of January 2022 (Our World in Data, n.d.).

Notwithstanding the development of highly effective vaccines, the death rate from SARS-CoV-2 continues unabated in many countries simply because large numbers of people are refusing to be immunized against the disease. Additionally, the new Omicron variant, which has its origins in South Africa, is causing concern around the world primarily because virologists now know that it has the ability to render less effectively the antibodies generated through two doses of the immunization vaccine.

Although in the 18th century, Jenner, the father of modern virology, was able to prove that immunization through vaccination was a successful method of preventing smallpox, objections to vaccines and immunization have periodically surfaced and especially so during this current pandemic. Jenner entitled the new method of disease prevention as vaccination, which stems from Vacca the Latin word for cow. This was in recognition of Blossom, the cow which Jenner used to source his vaccine for this first successful immunization of a child against smallpox (This Day in History, 2021).

Hollywood has always been fascinated by the specter of global pandemics. Several popular movies such as The Omega Man, I Am Legend, and World War Z have viscerally portrayed the effects of pandemics on contemporary society. In context, the movie I Am Legend, starring the actor Will Smith, is currently being highlighted by people who are labeled as anti-vaxxers to show the dangers of vaccination against COVID-19. In this movie, the origins of a dangerous disease are attributed to human beings being exposed to a genetically re-engineered strain of the measles virus that had been hailed as a cure for cancer. Anti-vaxxers are sincerely citing this movie as a reason not to get immunized against COVID-19, claiming that those that do risk becoming zombies. To reassure people, the writer of the movie script was forced to tweet that it was just a made-up story and not real (Heritage, 2021).

In context, many of the 18th century anti-vaxxers claimed that the smallpox vaccine would turn recipients of the vaccine into cows! Given the ongoing controversy as to the origins of COVID-19, which some link to a laboratory leak from the Wuhan Institute of Virology in China where bat coronaviruses were being studied, it is easy to see why fiction and fact become confused (Wade, 2021).

However, even before the first of the COVID-19 vaccines began rolling off the production line, some people, including well-known celebrities, were espousing misinformation about the new vaccines. Tragically, well-known public figures can have a strong influence on others, and some have been guilty of using public media platforms to air their own often-contentious personal views on health care, especially on the use of vaccines. For example, Jenny McCarthy, an American actress now better known as a judge on the musical competition show “The Masked Singer,” has fueled anti-vaccine propaganda through claims that her son’s autism symptoms had been caused following his MMR (measles, mumps, and rubella) vaccination (Shapiro, 2019).

When powerful people overtly or covertly promote the anti-vaccination movement, the harm they can potentially do is incalculable, especially to young children. Undoubtedly, the role of social media through the internet is one of the primary reasons for the recent strengthening of the anti-vaccination movement and its impact on public health generally. The anti-vaxxers believe, without evidence to support their views, that vaccines cause more harm than benefits to the health of the children and adults that are given them.

Much of contemporary anti-vaccine propaganda dates back to 1998 when the British surgeon and gastroenterologist Andrew Wakefield, now domiciled in the United States, began to claim that a relationship existed between bowel disease, autism, and the MMR vaccine. A paper he published in The Lancet and the media coverage it engendered fanned the fires of public fear and led to a dangerous decrease in MMR immunization to an all-time low of 79% by 2003.

Although this paper was later retracted by The Lancet and Wakefield was later struck off the medical register by the British General Medical Council for academic fraud including dishonesty and abuse of children, his grim legacy lives on. Despite his pariah status in the world of medicine, Wakefield is still a prominent anti-vaccine campaigner, and he has acquired the support of former President Donald Trump, who himself has spoken openly about the link between MMR and autism. Trump’s catastrophic handling of the COVID-19 pandemic in the United States reveals that as many as 40% of COVID-19-related deaths could have been prevented (Lee, 2021).

Do unvaccinated children’s nurses pose a danger to their patients?

John Stuart Mill, the British philosopher, was very influential in promoting the rights of the individual in a liberal democracy. His “harm principle” states that people should be free to act, however, they wish as long as their actions do not cause harm to someone else (Holtug, 2002).

Furthermore, Florence Nightingale, the founder of modern nursing, reminds nurses that “the very first requirement in a hospital is that it should do the sick no harm” (Nightingale, 1860). Few would disagree with Florence Nightingale. A modern interpretation would be “the first rule of health-care delivery is that the nurse should first do the patient no harm.” Although healthy children appear to have been spared the worst effects of COVID-19, this does not mean that children suffering from long-term conditions are immune to its acute respiratory syndrome pathology.

Important to the discussion is that some patients actually developed SARS-CoV-2 and subsequently died while being treated by staff in health-care facilities; thus, the facilities failed the harm principle. Perhaps in response to this, the Equality and Human Rights Commission of the United Kingdom have agreed to uphold mandatory COVID immunization for all frontline health workers in addition to care home staff.

However, it is important to recognize that nursing staff who work directly in COVID-19 environments are themselves at an increased risk of contracting the infection from the patients they care for. In the United Kingdom, for example, it is believed that over 850 health-care workers died of SARS-CoV-2 between March and December 2020. Consequently, unimmunized health-care staff and especially those from discrete ethnic groups are themselves in danger of developing the disease, and importantly, some infected care staff may initially be clinically asymptomatic but continue to shed the virus, thus transmitting the disease to their patients.

Within Islam, there is suspicion of authority and worries about what is halal. However, there is also the perspective that the Koran instructs the faithful that protecting others is an obligation. Yet many Muslims have concerns that vaccines might be haram, or forbidden, because they contain pork. Sharia compliance, however, has been upheld, with the manufacturers of Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca vaccines claiming that the vaccines contain no animal derivatives, and this has been underpinned by the British Islamic Medical Association, the Assembly of Muslim Jurists of America, and the grand mufti of Saudi Arabia (Kadri, 2021).

Despite these assurances, many health-care staff within and without the Muslim community continue to have doubts about the safety and efficacy of COVID vaccines. In the United States, perhaps the most liberal of all the world’s democracies, vaccine resistance among conservative, evangelical, and rural Americans runs high, especially in counties that supported Donald Trump in the 2020 election.

Concerns about low levels of vaccination among care staff in the United Kingdom led to the Secretary of State for Health and Social Care announcing that compulsory COVID-19 vaccination was to be implemented. Importantly and despite the fact that the compulsory COVID vaccination rule comes into force for the UK health service in April 2022, many nurses are unwilling to get vaccinated. Hospital managers have concerns that implementing the mandatory immunization protocol may be responsible for causing the shutdown of entire hospital units caused by staff resigning in protest. In particular, fears that maternity units could be adversely affected have been raised. One English hospital, for example, is fearful that 40 midwives are not going to adhere to the mandatory COVID vaccine rule. Noncompliance on this scale would necessitate the closure of this hospital’s entire maternity unit (Campbell, 2021).

Which countries are implementing mandatory COVID-19 immunization for care staff?

In reaction to the emergence of the highly infectious Omicron COVID strain, governments in Europe and further afield have also been making vaccination mandatory for care staff, including governments in Australia, Britain, Croatia, Czech Republic, Finland, France, Germany, Greece, Hungary, Lebanon, New Zealand, Poland, and Russia. The US government’s attempts to make the vaccine compulsory have failed owing to numerous legal challenges to the proposed legislation.

The United States fiercely guards the freedom and rights of the individual citizen, and although attempts have been made to make the vaccine mandatory for health-care staff in a number of states, it should be recognized that previous attempts to do so have failed. For example, when the Houston Methodist Hospital tried to impose COVID-19 immunization, they were challenged by a large number of health-care staff. The staff had been instructed to get vaccinated by June 7, 2021, but a large body of them filed a lawsuit on May 28, 2021, against the hospital, claiming that the vaccines were not safe and demanding that there should be a temporary injunction against the hospital’s mandatory immunization policy (Hassan, 2021).

Almost 3 in 10 health-care employees in some American hospitals have indicated that they do not intend to get vaccinated against COVID-19. Similarly, Field (2009) discusses the failed attempt by New York State to implement mandatory immunization against influenza by hospital workers on the basis that no one is at greater risk of contracting contagious diseases or of spreading them than health-care workers. Those who work in care environments regularly encounter patients as an essential part of their jobs. Disease-causing organisms can easily spread from patients to health-care workers and then back to other patients on a hospital floor. However, the effort proved to be short-lived, and as in Huston, Texas, in 2021, a group of nurses sued and obtained a restraining order suspending enforcement of the law. In December 2021, a federal judge issued a preliminary injunction to block President Biden’s vaccine mandate for health-care workers. The president had required workers in hospitals and nursing homes to receive at least one vaccine shot by December 6, but 14 states, led by Louisiana, sued in opposition to the mandate (Paybarah & Abelson, 2021).

According to Limb (2021), care homes and health centers have suspended around 3,000 workers across France for failing to comply with mandatory vaccination. Compulsory vaccinations for health workers in the French Caribbean territories of Martinique and Guadeloupe have fueled resentment among the Islands’ populations, leading to violent protests and causing the French government to postpone the implementation of the vaccine mandate on these Islands (Reuters, 2021).

Although many countries have decided to make COVID-19 immunization mandatory for health-care staff, Italy was the first to actually legally implement this as a national policy (Paterlini, 2021).

Third and fourth waves of the disease are being reported in many parts of the world now, attributed to the Omicron variant. For example, in Moscow, where the virus appears to be spreading unabated, compulsory immunization against the disease has now been ordered for service-sector staff in an effort to slow the spread. This is predicated on evidence that suggests that COVID-19 vaccines also prevent those who become infected by the virus from infecting other people too!

Meanwhile, Greece has implemented plans to fine people over the age of 60 who refuse to be immunized against coronavirus 100 euros ($113) per month. Similarly, Austria is considering a fine of €7,200 ($8,158) for people who refuse vaccination.

It remains to be seen that what happens as mandatory vaccination programs are rolled out across the care industry in many countries, but the precedent that surgeons have to be vaccinated against hepatitis B before they can operate should be highlighted. Undoubtedly, if children’s nurses are vaccinated against coronavirus, this will help ensure that the most vulnerable children gain the greatest possible levels of protection against this infection. Furthermore, with its overriding philosophy of family-centered care, the children’s nursing workforce also needs to recognize that sick children may have vulnerable carers who will also be susceptible to the COVID-19 virus.