The rapid development of vaccines amidst the COVID-19 pandemic is generally seen as a tremendous and unprecedented scientific breakthrough that will contribute to building herd immunity and decreasing caseloads across the United States. While the effectiveness of the vaccines may be high, there are also questions and hesitancy, including from healthcare workers. There are ongoing discussions by the Biden administration on whether COVID-19 vaccination should be mandatory for healthcare workers, and some countries have already put mandates in place (Amante). Currently, the U.S. government offers CDC guidelines that strongly encourage and place priority on healthcare workers to get vaccinated, and while employers technically can mandate vaccinations, most choose not to due to potential legal risks (Boyle). This paper will argue that governments should not mandate COVID-19 vaccinations for healthcare workers, leaving it up to personal choice due to the formation of natural immunity, potential dangers of new vaccines, and the need to respect individual liberties.
Immunity from a virus can be achieved in two ways – natural immunity when the body produces antibodies after an illness, and vaccine-induced immunity when the vaccine prompts the body to produce antibodies. Either way, the body naturally makes antibodies in response to the virus, usually taking several weeks to fully manufacture antibodies in a healthy person. This timeline remains the same regardless of natural exposure or vaccine-induced production. Those that have encountered COVID-19 and recover, develop natural immunity, which research is shown to have a long-lasting impact for at least 8 months, but potentially for years. Meanwhile, the issue with vaccine immunity is that it is unclear how long it lasts. While arguably it is safer to obtain immunity from a vaccine than taking the risk of encountering such a debilitating disease, COVID-19 is a highly virulent and rapidly-changing virus. Therefore, similar to influenza, it mutates, and a vaccine will be required each year, with some potential that it may not work due to the multiple variants in place (Aungst). The efficacy of vaccines may be high, but in all cases considered, natural immunity is more effective and long-lasting. It remains a question of choice for the individual, whether they are willing to take the safety risk.
Research by the National Institutes of Health indicates that in 95% of people who recovered from COVID-19, there are durable memories of the virus in the immune systems. Studies have shown a strong response after a natural infection, and long-term research indicated more B and T cells 6 months after symptom onset and afterward (Reynolds). Furthermore, while the chance of catching the virus is equal for all ages, young adults without underlying health conditions such as obesity, COPD, diabetes, or hypertension are at low risk of having complications. Studies show that in young adults aged 18-34 risks are relatively low, with only 21% needing hospitalization, and a 2.7% death rate, both rates associated with underlying or pre-existing conditions (Cunningham et al. 380)
Therefore, based on the evidence above, it can be argued that for healthy individuals who are not in at-risk categories, it may be just as appropriate to recover from the infection naturally as to receive a vaccine if an individual so desires. Due to the novelty of the vaccines discussed in the next section, the consideration of safety risk may be on the side of simply waiting and taking the chance with a natural infection for some individuals.
Vaccine Testing and Side-Effects
All existing COVID-19 vaccines in the U.S. have been approved for use by the FDA under Emergency Use Authorization (EUA). It is a specific clause that allows to rapidly approve vaccines, medications, or medical devices in cases of public health emergency instead of using the traditional full licensing method. To receive a full license, the substance requires long testing and monitoring prior to approval. Therefore, in the EUA process, the FDA relies solely on data provided by the vaccine manufacturers in their own independent trials including efficacy and side effects. The major vaccines approved to hold over a 95% efficacy rate in potentially stopping people from contracting COVID-19 (Boyle). While manufacturers and the CDC confidently say that the vaccines are safe, there are some understandable concerns even among healthcare workers.
First, the speed of development, trials, and subsequent authorization were extremely rapid. While understandably COVID-19 is an unprecedented public health crisis, and pharmaceutical companies had tremendous government support and financing, one cannot ultimately shift the scientific method and safety measures necessary for approval of vaccines and drugs, no matter how much money or research power is thrown at it. Even if development was possible quickly with previous vaccine research, the trials conducted were significantly shorter. Regardless of the efficacy, all vaccines have side effects in both the short- and long-term perspectives. While manufacturers do warn of short-term effects, the long-term effects are simply unknown, and cannot be known without the passage of time (“Adverse Effects of Vaccines”).
Another issue, from the perspective of a healthcare worker, is the use of medical staff as the first recipients of the vaccine. It is being advertised as a manner of protection for the brave frontline workers, but ultimately it is a trial by all means. That is, if volunteer trials conducted by manufacturers encompassed several thousand people, once the vaccine is available to frontline workers, the sample expands by tens of millions. It is unknown how the vaccine will affect different populations, ages, racial groups, pre-existing conditions, other conditions (pregnancy, etc), and the multitude of factors that could not have all been considered in trials.
Essentially, because of these highly volatile and experimental factors, mandatory vaccinations by the government or employers for healthcare workers should not be implemented. It should be a personal choice of each individual after evaluating the known information and risks based on their own beliefs as well as an understanding of their body. Even if an individual decides to wait for vaccination, it does not make them an ‘anti-vaxxer’ – but reflects their own choice and respect for their body because while manufacturers and the FDA have taken all precautions necessary, there are concrete risks that cannot be fully declared safe until years of research and monitoring into the future.
Individual Liberties and Ethics
Most governments or organizations defend mandates for vaccination under the precautionary principle, suggesting that in the context of public health, perfect evidence may be difficult to prove, but the ethos of public health indicates that risk-mitigating measures must be taken even with restriction of individual freedoms (Flood et al.). In 1905, the landmark Supreme Court case Jacobson v. Massachusetts found that compelling vaccination by state governments was legal and a reasonable exercise of the government’s police power that does not violate the Fourteenth Amendment (Malone and Hinman 271). However, this applied to well-established pox vaccines for children that had decades of testing. As described in the previous section, the COVID-19 vaccines are new and by all means, still experimental. Referring to the AMA code of medical ethics, “no person may be used as a subject in research against his or her will” – it is unethical to mandate a vaccine where long-term risks will not be identified for years, as well as violating an individual’s autonomy (“Informed Consent in Research”).
Arguably, true liberty does not exist as proven by the 1905 case, as it would result in anarchy. However, many legal experts believe that mandatory vaccination, even in non-pandemic times is an overreach of the state’s power. The Supreme Court decision is over a century old and has not been revisited despite significant differences in the status quo of society and medicine. In the midst of a rapidly developing pandemic, the state exercising police power in this manner sets a dangerous precedent in violation of the due process of law (even it is legally allowed). Also, it can be argued that healthcare workers are citizens just as everyone else, regardless of their status or profession. Therefore, they should be afforded the same type of choice as would other citizens, especially adults. So, unless there is a nationwide federal vaccination mandate for all populations that have been upheld in court, medical personnel have the same right of individual choice. Currently, because the vaccines were authorized under the Emergency Use Authorization (EUA) clause rather than a full FDA approval process that takes years, neither the government nor employers should be able to legally mandate vaccinations (Siri).
One of the primary arguments for mandatory vaccination of healthcare workers is their role in the interaction with and care for individuals, who are infected with COVID-19 as well as other illnesses. As frontline workers, it is expected that all safety precautions are taken to protect not just the medical worker but the patients as well. Unvaccinated workers may be healthy and not experience many or any symptoms, but serve as carriers of infection that would be passed to patients with vulnerabilities in health. The latest CDC data suggests that people that are vaccinated also do not carry and cannot spread the virus (Rosa-Aquino). In the context of COVID-19, where response measures have led to outbreaks in long-term care and retirement homes, while other areas see significant disparities in care – it is arguably the ethical duty of healthcare workers to vaccinate. Mandatory vaccination of healthcare workers protects them directly and allows them to remain healthy enough to work, protects the populations that they treat, and sets a social example for the vaccination of the general public to avoid vaccine hesitancy (Flood et al.).
In response to this argument, the issues discussed earlier in the paper remain relevant. However, some concerns can be addressed and mitigated through other means. The issue of public safety that may arise in cases of healthcare workers not wanting to be vaccinated can be resolved through practical and logistical methods. The first consideration is that healthcare workers utilize many layers of protection to prevent the spread of the virus, particularly when working with vulnerable populations. This ranges from wearing personal protective equipment (PPE) to thoroughly sanitizing hands and surfaces in-between patients. Furthermore, healthcare workers usually undergo frequent and regular COVID-19 testing. If anyone demonstrates potential symptoms or a positive test, the individual self-isolates until a negative result, while those who have been in contact with the infected individual are tested more frequently. In extreme cases, healthcare workers that do not vaccinate can be rotated off duty and on schedule to work in more isolated environments or with less vulnerable populations. In other words, the COVID-19 vaccine is arguably the last line of defense and protection, meant to potentially ensure safety but not in any way a primary guarantee that a patient would not contract the virus because the healthcare worker is vaccinated.
Currently, the U.S. administers more than 2 million doses daily, and gradually more population groups and demographics are becoming eligible for vaccination. Nevertheless, vaccine hesitancy is prevalent among healthcare workers, with approximately 66% of workers in hospitals vaccinated, but only around 50% in doctor’s offices, nursing homes, and other outpatient facilities (Terry). Experts attribute the lower-than-expected vaccination rates to both being an information problem and a trust issue. This is partially due to the workforce being exploited during the pandemic. There is also a lack of information and the method/persons of delivering the information regarding vaccine safety (Grabowski). Mandatory vaccines in any context do not indicate forceful immunization, but rather consequences if an individual refuses to vaccinate, ranging from reduced pay and hours to leave without pay or outright termination. While mandating vaccinations for healthcare personnel will potentially maximize vaccine uptake, it will create significant breakdowns of trust between workers and institutions in an already fragile system. Furthermore, while ethical arguments may support mandating vaccinations for public health protection and care of patients, fulfilling these duties requires a safe and trusting work environment which would be effectively shattered in cases of mandates (Gur-Arie et al.).
In conclusion, the government mandating the COVID-19 vaccine for healthcare workers is wrong, even if they have the legal capacity to do so. The element of personal choice is based on individual freedoms that the bedrock of the U.S. democratic system is important to uphold, especially in times of crisis. The vaccines while potentially effective, are still in the early stages of implementation. It would be unethical to mandate participation when it is evident that not all factors are known. As noted in this paper, there are other means which can be utilized for the protection of healthcare workers, patients, and the general public. Meanwhile, the best means of reducing vaccine hesitancy is to maintain transparency, provide updated information, and demonstrate by example instead of attempting to force the issue in a highly sensitive time.
“Adverse Effects of Vaccines.” Institute of Medicine of the National Academices, Web.
Amante, Angelo. “Italy Makes COVID-19 Vaccine Mandatory for All Health Workers.” Reuters, 2021, Web.
Aungst, Christina. “How Long Does COVID-19 Immunity Last? – GoodRx.” The GoodRx Prescription Savings Blog, 2021, Web.
Boyle, Patrick. “COVID-19 Vaccines: Here’s What Health Care Workers Need to Know.” AAMC, 2020, Web.
Cunningham, Jonathan W., et al. “Clinical Outcomes in Young US Adults Hospitalized With COVID-19.” JAMA Internal Medicine, vol. 181, no. 3, 9 Sept. 2020, pp. 379–381.
Flood, Colleen, et al. “The Case for Mandatory Vaccination of Health Care Workers.” Hospital News, 2021, Web.
Grabowski, David C. “Why Wont Some Health Care Workers Get Vaccinated?” Harvard Health Blog, 2021, Web.
Gur-Arie, Rachel, et al. “No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel.” BMJ Global Health, vol. 6, no. 2, 2021.
“Informed Consent in Research.” American Medical Association, Web.
Malone, Kevin M., and Alan R. Hinman. ” Vaccination mandates: The Public Health Imperative and Individual Rights.” Law in Public Health Practice, edited by Richard A. Goodman et al. Oxford University Press, 2003, pp. 262-284.
Reynolds, Sharon. “Lasting Immunity Found after Recovery from COVID-19.” National Institutes of Health, 2021, Web.
Rosa-Aquino, Paola. “CDC Data Suggests Vaccinated Don’t Carry, Can’t Spread Virus.” Intelligencer, 2021, Web.
Siri, Aaron. “Employers Can’t Require Covid-19 Vaccination under an EUA.” STAT, 2021, Web.
Terry, Ken. “Nearly Half of Frontline Healthcare Workers Not Vaccinated: Survey.” Medscape, 2021, Web.