FAQ: Are there ethical arguments for mandatory immunization programs for HCPs?

Are there ethical arguments for mandatory immunization programs for HCPs? [FAQ Date: April 1,  2013]

Art Caplan, writing in Clinical Therapeutics [citation and excerpt below] is the most recent  peer-reviewed journal contribution on this question. See also articles by Derber et al. and Nair et al [both below)..

Morality of influenza Vaccine Mandates
Caplan, Arthur L., PhD.
Clinical Therapeutics
Volume 35, Number 2, 2013, April 1 (2013)
DOI: 10.1016/j.clinthera.2012.11.010
“ … Decades of relying on voluntary efforts to secure adherence to influenza vaccination              have not succeeded. Influenza immunization rates among healthcare workers have          averaged 50% over the past decade in the United States. Given the failure of voluntary  vaccination strategies and the concomitant dangers of low vaccination rates present to vulnerable patients, should all healthcare workers not be required to be vaccinated against influenza as a condition of employment?  The ethical case for employment mandates for those who care for patients is persuasive … “

“ … The moral case for limiting healthcare workers’ choice concerning influenza vaccination rests on 4 principles: the professional duty to put patients’ interests first, the obligation to do no harm, the requirement to protect those who cannot protect themselves, and the obligation to set a good example for the public. It is hard to see how the invocation of personal liberty claimed by some healthcare workers who oppose mandates could overcome this powerful ‘four-legged’ moral case in support of an influenza vaccination mandate … ”


Health-Care Worker Vaccination for Influenza: Strategies and Controversies
C.J. Derber, S. Shankaran
Current Infectious Disease Reports
December 2012, Volume 14, Issue 6, pp 627-632
Influenza infections cause significant morbidity and mortality throughout the world, and vaccination rates of health-care workers remain well below target goals. Strategies for increasing vaccination rates include mandatory vaccination of health-care workers, mandatory declination, employee incentives, intensive education, increased access to vaccines, and the use of social media to inform employees of the safety and efficacy of vaccination. While these strategies in combination have been shown to be effective in increasing vaccination rates, personal and religious objections, as well as the potential for infringing on individual autonomy, remain challenges in our efforts to bring health-care worker vaccination rates up to target goals.


Influenza vaccination in healthcare professionals should be mandatory — Editorial
Harish Nair, Alison Holmes,  Igor Rudan, Josip Car
British Medical Journal
May 26, 2012 (Vol 344, Issue 7858)
FAQ Editor’s Excerpt
“…Recommendations by health authorities and promotional campaigns for flu vaccination only marginally increase vaccine uptake by healthcare workers.12 In light of accumulating evidence that flu vaccination in healthcare workers is an effective and useful strategy, there is therefore a  strong case for mandating vaccination in healthcare workers who are in direct contact with patients. All healthcare workers should strive to “first do no harm.” If vaccination can prevent harm to patients there is a clear ethical and legal argument that workers should be vaccinated. Moreover, employers are ethically bound to protect their staff from hospital acquired infections. There is  also an economic case for vaccinating healthcare workers.12 It is pointless to have a policy without the will to mandate it in the interest of patients. Adverse events are always possible after flu vaccination, and resistance to a mandatory vaccination policy is probably inevitable. However, 98% coverage has been achieved in the US among healthcare workers whose employers require compulsory flu vaccination,3 and minor adverse reactions have been reported in less than 1% of vaccine recipients in the general population, similar to adverse events for other vaccines.

“Although good quality studies (such as randomised controlled trials of a vaccine with a good strain match over several years in different settings) are still needed to firmly establish that vaccinating healthcare workers prevents nosocomial flu in patients, the current policy of strongly recommending annual flu vaccination to healthcare workers cannot continue. The English Department of Health needs to make flu vaccination mandatory in all healthcare workers who have direct contact with patients. “

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