The COVID-19 pandemic has had a huge impact on the economy and society in general. After the first vaccines were developed at the end of 2020, the issue of vaccination became one of the main concerns of the government, healthcare organizations, businesses, and the general public. As some employers were mandated to vaccinate their employees, others were not. The Occupational Safety and Health Administration (OSHA) is going to address the private sector with a standard that requires businesses with 100+ employees to mandate vaccination as well. Moreover, the COVID-19 vaccination is obligatory for all nurses after the new COVID-19 policy, which requires all healthcare workers to receive both shots of the vaccine by January 4, 2022 (Khunti et al. 2021). As the rule is still discussed and developed, the benefits of compulsory COVID-19 vaccination for nurses include patient and public safety. On the contrary, mandate immunization is a violation of personal freedoms and body autonomy of the healthcare workers.
While Joe Biden’s administration requires all healthcare providers to get fully immunized, some nurses remain hesitant to this idea. The discussion on whether or not the COVID-19 vaccination should be mandatory for employees has been going on since the vaccine’s creation. While policies are developed, there is no international agreement that would approve compulsory vaccination at the workplace and especially the vaccination of healthcare workers. While the experience of Greece and France developed compulsory immunization policies, German chancellor Angela Merkel spoke against it (Khunti et al. 2021). Hence, the issue is associated with an ongoing debate, which remains to be unresolved. This is one of the reasons why making a final decision on the mandatory vaccination of nurses could be considered hasty.
There are several ethical issues in the discussion of mandatory vaccination. The first one is the ethical principle of non-maleficence, which is mentioned in most professional codes of ethics. It states that one’s actions should never be aimed at causing intentional or unintentional harm towards another person. Hence, it can be argued whether this principle is followed in the case of obligatory vaccination. First, the long-term effects of the vaccine are not studied yet; moreover, 50% of people who were vaccinated reported weakness, pain, and even fewer in a few days after vaccination (Khunti et al. 2021). Hence, the dates when healthcare workers want to get vaccinated as well as the decision itself should be up to their choice and made without pressure from the facility or the government.
However, the debate on whether vaccination for nurses should be mandatory is complex due to the nature of the healthcare provision. The discussion is mainly centered around the argument of public safety versus personal freedom. Pro-vaccination policies are based on the premise that fully immunized healthcare workers are less likely to transmit the COVID-19 disease to patients (Khunti et al. 2021). This way, healthcare facilities are acting according to their duty of care. However, this argument can be countered by the fact that there are other ways of preventing the transmission of COVID-19, which does not require injections. This may include protection suits and respiratory masks, which are used in COVID departments in hospitals.
On the contrary, the argument that mandatory vaccination violated personal freedom and body autonomy cannot be countered. A healthcare practitioner who refuses to get immunized will be fired from the current workplace and will not be able to receive any work, which would correspond to his or her knowledge and skillset. In such circumstances, education, prior experience, and sacrifice made by a worker are put on the line. Therefore, nurses are neglected and forced into positions where they have no freedom of choice.
In addition, mandating employees to inject a substance, which is not fully researched, makes them financially and socially vulnerable because if they refuse, they risk losing their income. Such a case does not represent a situation where freedom of will and choice is respected. The government and healthcare facilities violate the duty of care rule regarding highly valued healthcare workers. This is because the long-term effects of the vaccine are not studied, and mandating vaccination violates a non-maleficence ethical principle.
Furthermore, there is number of negative effects that are associated with injecting a vaccine. Possible side-effects of COVID-19 vaccination that have already been reported include pericarditis/myocarditis, flickering scotoma, secondary immune thrombocytopenia (ITP), and even ischemic stroke (Gabka et al. 2021; (Hudson et al., n.d.; Koch et al. 2021; Rattanawong et al. 2021). Moreover, the short term severe illness, which is occurs in 50% of Pfizer vaccinated people, creates additional schedule disruptions (Visagie, 2021). The government or the healthcare facility that required nurses to get vaccinated will not be held accountable for the adverse effects that the vaccine had on healthcare workers. Hence, the decision on whether to get immunized, should be made by people who will be accountable for those decisions.
The reasoning behind enforcing the rule of mandatory vaccination for healthcare workers is based on the premise that compulsory immunization would bring more people and nurses back to work and would decrease workforce disruptions because of the decreased risk of getting COVID-19. However, in states that have already enacted the policy, such as California and New York, workers who have refused to get vaccinated were dismissed or suspended (Khunti et al. 2021). This poses a question – does the mandatory vaccination policy benefit the healthcare system?
There is no simple answer to this question as there are some facts should be taken into consideration. Healthcare providers are essential workers in the job market because of the constantly growing demand for healthcare practitioners, and nurses in particular. The shortage of nurses has been an issue in the United States and in the world, especially amidst the global COVID-19 pandemic. According to Haryanto (2019), 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage. There is a variety of complex causes, which led to this situation. In particular, the stress of the job itself causes nurses to work long hours, make life-altering decisions, which consequently leads to burnout, decreases the retention of experienced workers and makes it less attractive to the future generation of nurses. Therefore, suspending nurses amidst the increased demand for healthcare workers can be problematic and lead to more issues in the healthcare system.
In conclusion, the rule of mandatory COVID-19 vaccination violates the personal freedom of nurses; hence, they should be left with a choice of not getting immunized while keeping their jobs. In cases where the absence of vaccination does not affect the work process and does not pose any risk to clients or co-workers, vaccination does not have to be mandated as it violates the non-maleficence ethical principle. Healthcare workers should evaluate all risk factors associated with the vaccination and make their own informed decisions, which is optimal and at the same time ethical.
References
Gabka, K., Groselli, S., & Ulbig, M. (2021). Flickering scotoma after COVID vaccination: A further possible side effect of vaccination? Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 118(7), 735-740.
Haryanto, M. (2019). Nursing shortage: Myth or fact? Orthopaedic Nursing, 38(1), 1-2.
Hudson, B., Mantooth, R., & DeLaney, M. (2021). Myocarditis and pericarditis after vaccination for COVID‐19. Journal of the American College of Emergency Physicians Open, 2(4), 12498.
Khunti, K., Kamal, A., Pareek, M., & Griffiths, A. (2021). Should vaccination for healthcare workers be mandatory? Journal of the Royal Society of Medicine, 114(5), 235-236.
Koch, M., Fuld, S., Middeke, J. M., Fantana, J., von Bonin, S., & Beyer-Westendorf, J. (2021). Secondary immune thrombocytopenia (ITP) associated with ChAdOx1 Covid-19 vaccination–A case report. TH Open, 5(3), 315-318.
Rattanawong, W., Akaratanawat, W., Tepmongkol, S., Chutinet, A., Tantivatana, J., & Suwanwela, N. C. (2021). Acute prolonged motor aura resembling ischemic stroke after COVID− 19 vaccination (CoronaVac): The first case report. The Journal of Headache and Pain, 22(1), 1-4.
Visagie, N. (2021). The war on COVID-19 and vaccination mandates: Ethical code of conduct. Belitung Nursing Journal, 7(5), 443-444. Web.