As COVID-19 vaccines become increasingly available to all segments of our population, a real balance must be struck between personal choice and public safety. Nowhere is this issue more significant than in the healthcare community itself.
With rare exceptions, the vaccines have proved safe and effective in preventing symptomatic COVID as well as pre-symptomatic and asymptomatic transmission of the infection. Still, the prospect of vaccinations engenders great hesitancy and resistance in many quarters. For some, it is a distrust of any governmentally sponsored program. For others it is a deep-seated belief in personal freedom. Still others reject the science. Conspiracy theories, fertility concerns and suspicions as to potentially adverse long-term effects are difficult to overcome, even in the face of persuasive evidence to the contrary. While these tensions may disappoint vaccine advocates in the public health community, it is time to accept this reality. It may well be impossible to convince broad segments of our society as to the necessity, indeed the social responsibility, of vaccination, but the debate sharpens when considering the discrete population of healthcare workers.
Clearly, there is precedent to enforce vaccinations among these groups. Educational and healthcare institutions have long required vaccination and testing to prevent the spread of infectious diseases in their spheres. TB testing and vaccinations for measles, mumps, pertussis, and hepatitis are all prerequisites to employment in many schools and in all healthcare facilities. These are mandated by state laws. Many healthcare systems also require Influenza vaccinations for their work force even though those vaccines are not very efficacious.
Other institutions and businesses have begun to apply the same standards for COVID. Many public and private universities have announced vaccine mandates for their staff and students. Cruise lines, in accordance with a Centers for Disease Control and Prevention proposal, may be subject to a 95% vaccination rate among passengers and crew before their return to operations. This is occurring despite the lack of formal Food and Drug Administration approval, which will be forthcoming and will not really change much.
Healthcare settings present even greater challenges and risks than these other sectors. Hospital-acquired COVID has been present since the beginning of the epidemic and COVID clusters–among patients and staff–remain problematic in hospitals and outpatient facilities. The elderly, children, adults who have refused the vaccine and the immunosuppressed are among the most vulnerable patient populations. Hospitalizations requiring extended stays in large common areas such as ICUs and recovery rooms exacerbate these risks if patients are exposed to large numbers of unvaccinated healthcare workers.
To date, healthcare systems have implemented many policies and practices to curb hospital-acquired transmissions. Restricting visitation, screening of new admissions, cohorting, isolation, improved ventilation systems, surveillance testing and a host of infection control policies have helped, but they are not enough. Mask mandates—for both staff and patient populations—have also proved beneficial, but many patients are too sick to be masked thereby compromising these efforts.
Notwithstanding their training, knowledge and dedication, healthcare workers reflect attitudes similar to the population at large—most may embrace the promise of the vaccines, but large segments remain hostile to it. In the face of such resistance, vaccination mandates are both justified and essential. The times call for it. It defies logic to suggest that a COVID test and proof of vaccination is required to attend a sporting event, but we should require more from those caring for the critically ill. Patients have a right to know that their caretakers are immune and unlikely to be transmitters of the virus. Without a vaccination mandate, it will be impossible to ensure that.
We have all witnessed profound sacrifices and commitment from our healthcare heroes over the course of the epidemic. Accepting vaccination mandates, for their own protection as well as that of their patients and co-workers, is no more onerous than many of the restrictions they have so selflessly abided, or the myriad requirements to which all healthcare workers must comply throughout their credentialing and professional careers.
It will be difficult for any single healthcare institution to implement a vaccination mandate unless and until it becomes the common practice. Universal mandates, at the federal level, would certainly be helpful as would a clear directive incorporated into the CDC's COVID guidelines.
However proposed, there will surely be resistance at first. Yet, like all mandates, it will most likely become accepted as it is incorporated into routine practice. Given the costs of inaction and the benefit of its implementation, the time to mandate vaccinations among healthcare workers is now.
