Mandatory vaccination for healthcare professionals – critical discussion
By Alexios Peter Makotose
Despite many people voicing reasons for refusing to be vaccinated against Covid-19, governments across the world are considering policies to enforce mandatory vaccination. Already, there are rules and regulations regarding gatherings and sporting events in many nations.
These regulations include the requirement to provide proof of vaccination to gain access to pubs and churches and to participate in sporting events. International travellers are also required to produce this proof to avoid forced quarantine.
Recently governments have ordered mandatory vaccination for healthcare professionals. Furthermore, other governments have requested all civil servants get vaccinated or they may potentially lose their jobs. Are employers right to force the healthcare professionals to be vaccinated against their will, and are employees right to decline mandatory vaccination?
What is vaccination in general?
According to the World Health Organisation (WHO), vaccination is a way of protecting an individual against harmful diseases before one is exposed to the disease. The vaccine contains weakened bacteria or virus that is injected into the human body to build resistance to specific infections with the aid of natural bodily defences. The vaccination process works for specific diseases as the weakened virus or antibody injected into the body is meant to fight a specific disease. Common vaccinations have been around for decades for diseases such as polio, measles, hepatitis, chicken pox, flu and others.
What is the source of vaccine resistance?
The current Covid-19 vaccination is debated in various circles and numerous theories are put forward by various groups of people from different walks of life. Prominent world citizens, scientists, businesspeople and religious leaders have spoken against the Covid vaccines that are available on the market. The reasons provided have mainly centred around individual choices influenced by what the anti-vaxxers call “scientific” and “religious” ideas.
Some of the prominent arguments claim that all the people vaccinated with covid vaccines will die in two years. They also allege that the vaccines may contain chips designed to control people and invade their privacy. However, none of these theories are backed by scientific evidence. They are nonetheless believed by various groups of the population.
The “religious” resistance is based on the theory of the biblical mark of the devil “triple six,” (Revelations 13:18). This mark is believed to be forced on people by the devil as a tool to control them. The Bible states that this devils mark will be found on the right hand or on the forehead and one may not buy or sell without the mark as indicated. The mark in the Bible is referred to as a number of a man’s name which can add up to triple six. It is therefore not clear whether the injection could be a number or made up of numbers that add up to triple six.
Other arguments holding doubt and scepticism regarding the vaccines focus on the short time taken for clinical trials when compared to other diseases such as HIV and cancer. Proponents of this argument assert that the vaccines cannot be trusted as other longstanding illness such as HIV and cancer do not yet have vaccines available. Whenever a theory is put forward, it is bound to get some believers and there is no exception to the Covid-19 vaccine theories that are popular on all media platforms. Some people place trust in these theories, hence the resistance to Covid-19 vaccination.
So, what are the facts on vaccination against covid-19 and why people are encouraged to get vaccinated?
Publicised facts by The World health organisation (WHO 2021) regarding the benefits of Covid-19 vaccines indicate that the vaccine boosts one’s immune system and prevents the disease from developing into a severe form of illness. The available covid vaccines, Pfizer and Moderna are said to be 94-95% effective against Corona virus after the second dose. Sinopharm is 78% effective and AstraZeneca 67% effective. All the vaccines were however found to reduce the need for hospitalisation after contracting Covid-19.
The direct benefit for the vaccinated person is the boost to the immune system and a reduction in the likelihood of severe symptoms, which could lead to hospitalisation and death (WHO 2021). However, according to WHO information, a vaccinated person may still contract the disease and pass it on to others. As the vaccinated person can still contract and pass on the disease, the main difference between the vaccinated and unvaccinated individual is that the unvaccinated person is more likely to develop severe symptoms, be hospitalised and potentially die from the disease. The unvaccinated person does not enjoy the same reported benefits as the vaccinated person hence the encouragement for people to get vaccinated.
Governments’ promises regarding the acceptance of the vaccine at the time the first vaccine was discovered.
From the time the first vaccine was developed in December 2020, most nations, if not all, announced that none of their citizens would be forced to accept the vaccine. Individuals would be vaccinated as a matter of choice. Governments referred to human rights and recognised that individuals should have a choice as to whether they accepted vaccination. The human rights referred to include the right to privacy and integrity. This gave hope that individuals would not be forced to get treatment against their will.
What if the individual decision to decline the vaccine will result in death?
In some jurisdictions, it is an offense to medically treat someone against their will, hence the requirement for patients to sign consent forms. There have been cases wherein people have opted not to get surgical treatment after being diagnosed with cancer, tumours, or gangrene. These decisions to refuse surgical intervention were likely to lead to the persons death. In such cases, death could have been avoided had the persons consented to surgical intervention. However, it is both an ethical and legal issue to force treatment on an individual when they do not consent.
One example of this is of a London Judge that ruled in favour of a woman who had refused kidney dialysis on the grounds that she had lost her “sparkle” and wanted to die because she did not want to grow old. The Judge remarked that;
“Many people may be horrified by the woman’s thinking and her decision to refuse treatment could be characterised as unwise and even immoral. But the woman was the “sovereign” of her own body and mind and was entitled to make such a decision.” King’s College Hospital NHS Foundation Trust v C and V (2015).
The argument for sovereign over the body is also advanced in the abortion legalisation debates by pro-choice individuals. They use the phrase “my body my choice” when advocating bodily autonomy regarding reproductive choices, rights, and in some areas, this right has been granted.
The right to consent has been a big issue in the UK since the case of Montgomery v Lanarkshire Health Board (2015). In this case the ruling was made that the patient had the right to be given material information in order to make an informed decision and give consent to treatment.
This judgement together with the Mental Capacity Act (2005) makes it mandatory for clinicians to give full information to the patient and only proceed with the treatment after the patient has given full and informed consent.
The Mental Capacity Act assumes that an adult has mental capacity to make a decision regarding treatment and is capable to consent to or refuse treatment even though the decision may be fatal. One may not be mistaken to believe that the same approach should be used for the treatment of corona virus from vaccination to treatment of the infected person.
The belief is based on that fact that the person still retains the right to consent to treatment either for the vaccine or the oxygen ventilator. That right cannot be taken away unless in cases of an emergency, and the person is not in a state of mind to either consent to or refuse treatment.
Under such circumstances healthcare professionals must act in the best interests of the patient, which would usually entail ensuring their survival through medical intervention. If the person lacks capacity due to mental illness, then a decision that takes the person’s lifestyle, beliefs and aspirations must be made by other people who knew the person before the illness.
What is the history of mandatory vaccination?
Mandatory vaccination has been an issue since the seventeenth century, after the outbreak of smallpox disease in the 1850s. Other disease outbreaks such as measles and influenza have carried punitive consequences for non-compliance with vaccination. Professionals throughout the world have undergone vaccination as a requirement for them to work for certain companies such as airlines.
In some cases, the nature of the job may require employees to be vaccinated against certain diseases. It is a known fact that healthcare professionals in some countries must be vaccinated or provide evidence of immunity to certain diseases which are transmittable from person to person.
Nurses for example must be vaccinated against Hepatitis B and C, tetanus, and tuberculosis. This is considered as a matter of health and safety at work and is meant to protect both the nurses and the patients. In some cases, the healthcare worker may not be able to start work until they have undergone the vaccination process.
Currently in the UK there is an annual vaccination for the Flu. The flu vaccine is not mandatory to the healthcare professionals or the public. Flu is an infectious disease which can be easily transmitted from one person to the other in a similar fashion to covid-19. NHS England recognises the dangers of infection amongst healthcare professionals and the vulnerable service users.
Healthcare professionals have not been forced to get the flu jab even though there is the possibility of spreading the disease to their colleagues and patients. The government has employed an encouraging approach to attempt to spur staff on to get vaccinated. The following statement is found on the government website;
“It is important that as many health and social care workers as possible get the vaccine- it protects you, your family, and the people you care from the flu-but if you don’t want to have the vaccine for whatever reason, you don’t have to have it.” (Public Health England: www.gov.uk).
Since the UK government has encouraged the healthcare professionals to be vaccinated against flu, the question is why not have the same approach with covid-19? It is recognised that both Flu and Covid-19 have similar effects on the body and population, however Covid-19 is currently a pandemic. Flu causes serious illness and death to vulnerable groups especially the elderly. The flu vaccine is the best protection available currently. The vaccine reduces chance of the individual contracting flu and will reduce the severity of symptoms if contracted. This is the same narration with the covid-19 vaccine.
The big question is why mandatory Covid vaccination?
Vaccination is said to provide a fifty percent chance of contracting and passing on the coronavirus, but its core benefit remains prevention against severe illness and death. Both covid-19 and flu can cause serious illness and in some cases death.
The difference between the two is that Covid is a recent outbreak and currently still a pandemic. Death figures from covid-19 are currently very high when compared to the flu virus. Flu may not be a pandemic currently. However, flu has reached this level in the last one hundred years with the 1918 H1H1 virus being the deadliest.
According to United States Centre for Diseases Control and Prevention (CDC), five hundred million people were infected, and fifty million people died worldwide. There were no pharmaceutical interventions but nonpharmaceutical interventions where akin to those implemented early on during the covid-19 pandemic.
Governments throughout the world do not appear to apply the same rules for mandatory vaccinations. For example, in the United Kingdom only healthcare professionals must be vaccinated by the first of April 2022. The Zimbabwean government gave 14th October 2021 as the deadline for all civil servants to be vaccinated and failure to comply resulted in employees being barred from entering places of work and not being paid their salaries.
The Zimbabwean directive applies to all government workers including teachers, police, soldiers, agricultural officers, metrology workers, road workers and others who may or may not be in contact with vulnerable groups of people during the course of their work. Austria has become the first European country to declare mandatory vaccinations for everybody in the country from February 2022.
The other question to ask is whether healthcare professionals should be given the option not to get the vaccination if they wish to decline? It is understandable in healthcare profession to consider mandatory vaccination as it is generally a prerequisite for this career path. Therefore, refusing the vaccine may not be a strong argument for healthcare professionals as they are aware of their profession requirements regardless of their religious, cultural, and moral beliefs.
The source of the argument for an option is understandable due to other vaccinations being optional, such as the flu vaccine. The difference appears to be in the current statistics, but this cannot be used to override human rights as people still retain their rights to consent, which cannot be suspended. A balance between employers and employees’ positions is needed.
The public may be forgiven to think that mandatory vaccination appears to be a result of political pressure rather than a scientific measure to eradicate the disease considering the above discussion. There could be no reason advanced for the mandatory vaccination of one disease which has the same devastating effects as the other disease.
Citizens have the right to consent or not consent to treatment, however, it is pertinent to observe that the government do have the power to override individual rights in favour of societal rights, thereby removing consent as an absolute right for individuals.
Employers have a duty also, to craft and implement policies in line with health and safety of their employees and clients to cover themselves from litigation hassles.
Alexios Peter Makotose, LLM Medical Law & Healthcare Ethics