Mandatory Covid Vaccination

Mandatory vaccination for a small portion of the population (regardless of which portion) will not achieve herd immunity and thus will not achieve the effect of protecting the public while it is infringing in medical autonomy; something that healthcare professionals do not acquiesce as part of our profession. If mandatory vaccination is required for public safety then why is it not being mandated for all people? A grocery clerk is a higher vector (an organism that transmits a disease or parasite from one animal to another) risk then myself given the number of customers they serve in a day compared to the 5 patients I have in a shift. Yet, the clerk is not mandated. Why is that? Either mandate the vaccine for everyone because it’s that important or don’t mandate it at all because this selection of a small group achieves little.

Additionally, there is no science that proves this vaccine prevents me from spreading the virus to others (outside herd immunity). So, how can it be argued that mandating the vaccine is protecting patients when it does not achieve herd immunity? The CDC is recommending that even vaccinated people continue to wear masks because the research suggests that vaccinated individuals are completely capable of carrying and transmitting the virus. Being vaccinated will not keep health care staff from giving the virus to their patients. What would be more helpful is making sure that there was enough PPE that the health care workers can use them as intended: single use. Even after almost two years of pandemic, I am still being asked to reuse PPE. That means that I am wearing CONTAMINATED stuff into a patient’s room. Makes perfect sense, right?

There are those that say to me that the covid vaccine being mandatory is just like all the other vaccines that are mandatory for me to be a nurse. No, it is currently not the same. The difference is that the other mandatory vaccinations are those that are mandatory for public schools and colleges. This means that a large portion of the population is being vaccinated and herd immunity can be achieved. Because herd immunity can be achieved, there is a benefit to getting these vaccines. The problem with the current mandate for the covid vaccine is that it is mandatory for such a small group of people that it will not achieve herd immunity and thus will have no benefit for the community. When you are considering if it is ethical to revoke a person’s medical autonomy, the first thing that must be answered is if there is a benefit in doing so. This mandate does not offer benefit to the community, thus it does not make sense to revoke individual rights.

Why is it not an option to demonstrate immunity with a positive titer? The research is demonstrating that immunity garnered from having had a covid infection is more robust than immunity gained from the vaccination. There is not much additional benefit to getting the vaccination once you already have a positive titer. There are other vaccines that we already have this as a standard for, such as varicella. If you have a positive titer, you are not required to get the varicella vaccine. There is no scientific reason not to make this the standard with the covid vaccine as well. Why are we not following the science? Best medical practice should always follow the scientific evidence. But in this case, with the mandate, the policy is choosing to ignore the science and it simply makes no sense.

The last point is that the mandate is suppose to protect the working population by maintaining the work force. On the surface, this makes sense. However, we are loosing nurses because of this mandate. This is not maintaining the work force. It makes the shortage of nurses worse. While covid illness will require nurses to be out, the majority will return after recovering. There is no returning to work for those not vaccinated as long as the mandate is in place. This makes an already difficult job that much harder. Not to mention that hospitals are seriously evaluating which areas of the hospital can be closed to maintain core functions. That means there will be a reduction in needed services because of the reduced staff because of the mandate. That’s not helping our patients.

Many people are attacking health care workers for advocating for their medical autonomy in context of this vaccine mandate. Let us not forget that as health care professionals, it has always been and always will be our duty to protect medical autonomy. Would you want a health care system without it? Imagine not being able to choose if you had surgery or not. Imagine if doctors could force you to take any medication they felt you should. It is medical autonomy that protects us from this. And to be clear, medical autonomy is a right that is legally protected, hence why we have to sign consents for care. We health care professionals share in these rights and hold them sacred as they are central to providing excellent care. So, do not challenge our sense of duty towards our patients because we fight for medical autonomy. Let us not forget how important that right is.

Vaccines have value in protecting others ONLY when herd immunity is achieved. That’s what the science tells us. Mandatory vaccination for a small portion of the population will not achieve herd immunity and thus will not offer protection to anyone beyond the person receiving the vaccine. So, no benefit to my patients. The risks for vaccination are low, but they exist. I should not be mandated to take any amount of risk without benefits. That is unethical. Mandate the vaccine for EVERYONE or NO ONE. That’s what’s ethical.

And for the sake of clarity, I’m talking about medical autonomy which is the right of competent adults to make informed decisions about their own medical care. This is a core ethical principle in medicine. And it is a very different concept then simple autonomy which is the state of being self governing. Medical autonomy applies when a person is presented with a medical situation that they then have the right to make choices about without outside pressure to make a specific decision. In order for medical autonomy to apply there first needs to been a medical situation that presents the individual with a choice. This is why this ethical principle doesn’t apply for the majority of the things we as health professionals are required to do for our patients. However, there are times that it does come up. This is when medical autonomy has to be weighed against the social contract (community). Ethical dilemmas of the individual vs the community are common in medicine especially in the area of infection control. With Typhoid Mary being the classic example case for ethical consideration. But medical ethics has a long history with many cases that can be reviewed. These are never black and white issues; they are always messy and grey. Of all the ethical debates within the medical field those involving the individual vs the community are most complex to resolve. At the core of these issues is that in order for there to be a dilemma they must be mutually exclusive choices.

There are some things to keep in mind when debating these issues. Some people value individual rights over community needs while others will value the community needs higher. Neither person is wrong or bad for their choice in ethical priorities. But understanding that perspective can help in understanding the stance they are choosing to take in an ethical debate. Just because someone doesn’t completely agree with your opinion doesn’t mean that: 1. They are demons, 2. Don’t have an intelligent foundation for their arguments, 3. Shouldn’t be heard. Having ethical debates in health care is essential for making sure that we are appropriately balancing the rights of individuals versus the social contract (needs of the group).

My last point on this topic is that many people are telling me that I am wrong because I am disagreeing with medical experts. Medical ethics has never been and never will be relegated to “experts”. Medical ethics is something that everyone working in the field is expected to engage in because we are expected to behave in an ethical way. And let’s be clear that it was not immunologists or virologists who recommended or decided upon the policy of mandating the vaccine for a small portion of the population. That was decided by politicians who are decidedly not experts in this arena. So, in the end, I’m not disagreeing with the medical experts, but with politicians.

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