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Unvaccinated health workers are “unethical and appalling”—experts want mandates


A person gets a sticker after getting a Pfizer-BioNTech COVID-19 vaccine.
Enlarge / A person gets a sticker after getting a Pfizer-BioNTech COVID-19 vaccine.

Leading public health organizations and a growing number of independent health experts are coming together to push health care facilities to make COVID-19 vaccines mandatory for all health care workers. Some experts say such mandates are overdue and that failure for any health care worker to get vaccinated against the deadly pandemic coronavirus is both “unethical and appalling.”

On Tuesday, seven health organizations—including the Society for Healthcare Epidemiology of America, the Association for Professionals in Epidemiology and Infection, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society—published a consensus statement, saying that “COVID-19 vaccination should be a condition of employment for all healthcare personnel.”

Fully vaccinating health care workers have the advantage of protecting vulnerable patients, fellow health care workers, and the community overall, they write. And mandates are highly effective at getting high levels of vaccination among health care staff. For decades, many health care facilities have mandated seasonal flu vaccines to great success, they note. In the 2019-2020 flu season, health care facilities that mandated flu vaccines saw 94 percent of workers get vaccinated, while only 70 percent of health workers got vaccinated in facilities without mandates.

The statement, written by more than two dozen experts representing the organizations, is accompanied by guidelines for such mandates, all published in the journal Infection Control & Hospital Epidemiology. The authors also support COVID-19 vaccination for nonemployees working within health care facilities, such as students, contract workers, and volunteers.

Do no harm

As the consensus statement was published Tuesday, three doctors in Boston published a commentary in the Annals of Internal Medicine similarly laying out the case for COVID-19 vaccine mandates for health care workers. “We believe that there is an extra onus on health care workers to protect themselves from SARS-CoV-2 in order to protect patients.”

In an opinion piece published Wednesday in Stat, three health experts at the University of Pennsylvania went further, writing that it is “unethical and appalling” for health care workers to risk exposing patients to SARS-CoV-2 by remaining unvaccinated.

“No vulnerable, immunocompromised patient—older adults, cancer and transplant patients, individuals with HIV/AIDS, and others—trying to beat their disease should have to worry that the people caring for them may be asymptomatic carriers of Covid-19,” the opinion piece read.

“Vaxxed or axed”

The piece, titled “Vaxxed or axed: To protect patients, every health care worker must be vaccinated,” was written by Ezekiel Emanuel (the co-director of the Healthcare Transformation Institute at the University of Pennsylvania) as well as medical ethicists Patricia Hong and Matthew Guido.

They emphasize that vaccination is particularly critical in nursing homes, which have elderly residents who are highly vulnerable to COVID-19. Since the start of June, the writers note that there continues to be roughly 150 COVID-19 deaths per week among nursing home residents. Though nearly 80 percent of nursing home residents have already been vaccinated, only 55 percent of nursing home staff have been vaccinated nationwide.

In contrast, more than 96 percent of physicians reported being fully vaccinated against COVID-19 in a poll by the American Medical Association last month. Of the unvaccinated doctors, 45 percent said they planned to get vaccinated.

While elderly and immunocompromised patients are clearly at risk from unvaccinated health workers, other health experts expressed concern for children, most of whom are not yet eligible to receive a COVID-19 vaccine.

Children’s hospitals literally have a vast majority of their patients unvaccinated—and yet, most children’s hospitals that I’m aware of have not mandated this,” Ashish Jha, dean of Brown University’s School of Public Health, told the Washington Post. “That strikes me as particularly stunning. And I don’t understand that.”

Best course

Many experts suggest that health care facilities may be holding back on mandates for fear of generating controversy or even fears of facing legal challenges.

“None of these are valid excuses,” Dr. Emanuel and his co-authors write in Stat. “Leadership requires taking the moral road even when it isn’t popular. And medical ethics—backed by recent regulatory and court decisions—supports the mandate decision as the best course for the nation’s health.”

In May, the federal Equal Employment Opportunity Commission determined that employers can indeed mandate COVID-19 vaccination, given reasonable accommodations.

Recently, a group of 117 health care workers made headlines for protesting and suing a Houston-based Methodist hospital system for mandating COVID-19 vaccines. A federal judge swiftly dismissed the lawsuit, calling some of their arguments against the mandate “reprehensible.”

“Methodist is trying to do their business of saving lives without giving them the COVID-19 virus,” US District Judge Lynn Hughes wrote in a scathing dismissal order. “It is a choice made to keep staff, patients, and their families safer.”

In the end, the mandate at Methodist was highly successful, with about 97 percent of the hospital system’s 26,000 employees getting vaccinated. A vocal minority of just 153 workers lost their jobs for refusing to get vaccinated.



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