The Ethical Argument for Mandatory COVID-19 Vaccination of Health Workers

Recently, an unvaccinated employee set off a COVID-19 outbreak in a nursing home in Kentucky, USA with dozens of residents infected and several deaths. COVID-19 outbreaks in hospitals in Malaysia have brought home with urgency the importance of our healthcare workers being vaccinated to protect themselves,their colleagues, and patients.

This has led to some debate on whether hospitals should require healthcare workers to be vaccinated.The answer is seemingly straight forward: vaccination is a necessary pre-requisite for all healthcare workers working in a clinical setting with patients. Yet, some are concerned that mandatory vaccination may curb individual’s freedom and right of choice.

Most countries,including Malaysia have prioritized healthcare workers as amongst the first groups to be vaccinated. This is in accordance with the ethical principle of reciprocity, in which healthcare workers, policemen, teachers, and other essential workers who face exceptional risks of COVID-19 infection are given priority in national immunization schemes.

By the very nature of their job, healthcare workers are at risk of contracting COVID-19, and yet their jobs essential for the functioning of the healthcare system. Health care workers in Malaysia received vaccinations during the first phase of the National Covid-19 Immunization Programme (PICK) from February to April 2021. However, some healthcare workers may have opted against vaccination for various reasons including vaccine hesitancy. COVID-19 vaccination has not been made mandatory yet in Malaysia.

In public health, the ethical principles of non-maleficence (do no harm) and beneficence (doing good to others) takes a precedence to autonomy (individual choice). Public health interventions, like vaccinations, are given at population level and utilitarian principles come into play – ‘do the greatest amount of good for the greatest number of people’. In the case of COVID-19, the pandemic has been devastating to society, wreaking havoc with lives and livelihoods. Several vaccines are available that been proven by real world evidence to be safe and effective. Vaccination remains the only true hope for the return to normalcy.

Nevertheless,mandatory vaccination as a public policy is distasteful, and should be used as a last resort. In Malaysia, citizens are encouraged to voluntarily register for vaccination through the MySejahtera app and are provided with necessary information to make an informed choice.

But we must consider things in a different light in the case of healthcare workers in a clinical setting. The priority here is patient safety, and the guiding principle is always non-maleficence or ‘do no harm’. Healthcare workers in a clinical setting must be vaccinated now that vaccines are available or take a non-clinical role without patient contact. It is our obligation as healthcare providers to protect patients, and it would be unconscionable for hospitals to put patients at risk, by allowing unvaccinated healthcare workers to come in contact with patients.

About the author:

Dr Tharani Loganathan is an Atlantic Fellow for Health Equity in Southeast Asia and a Public Health Medical Physician at the Department of Social and Preventive Medicine at University Malaya. She teaches Masters in Public Health (MPH) candidates Ethics and Law in Health.

The views expressed in this article which was first published in Free Malaysia Today on June 18, 2021 are the author's own.

The Ethical Argument for Mandatory COVID-19 Vaccination of Health Workers

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