Vaccination Mandates for Healthcare Professionals - An Evaluation of How Ethical Concerns Impact Implementation

Influenza immunization rates for healthcare personnel (HCP) remain far below the Healthy People 2020 goal of 90%. Vaccination of HCP contributes to patient safety, protects against occupational hazards, and ensures healthcare facilities maintain a critical workforce. Our research examines precedents from historical and existing vaccine mandates to highlight ethical challenges. Our analysis shows mandating vaccination among HCP is consistent with professional ethics based on the following principles: 1) professional duty to prioritize patients’ interests above all else; 2) obligation to ‘do no harm’; 3) requirement to protect those who cannot protect themselves; and, 4) obligation to set a good example for the public. We also make the following recommendations/observations based on these principles: 1) that occupational health programs provide educational programs for HCP that address vaccination as a condition of employment; 2) that because of the burden placed on HCP autonomy, influenza vaccination should be provided free of charge; 3) there is no evidence that mandating flu vaccine diverts attention and resources away from other hospital based flu control measures, all of which are critical for preventing transmission of other respiratory viruses for which there are no vaccines; 4) that penalties for vaccine refusal are ethically justifiable in the context of public health ethics, which seeks to ensure the health and safety of populations; and 5) health care facilities have an ethical duty to provide data assessing effectiveness of vaccine mandates. Discussing and analyzing these ethical issues is important for health administrators and policy makers when mandates may be considered.