Regulation against influenza, but not on COVID-19, ethically justified for medical staff

Influenza regulation for medical staff is ethically justified, but the same cannot be said for vaccination against COVID-19, say leading ethics in an extended essay published online at Journal of Medical Ethics.

Unlike COVID-19 vaccination, the advantages outweigh the disadvantages for all age groups: influenza vaccination is safe and has few side effects; reduces the risk of infection; and it minimizes staff shortages and “presentation”, they suggest.

And healthcare professionals have a professional duty to protect patients from the virus, which is particularly deadly for older people who are over-represented among hospital patients. The authors argue that such obligations trump restrictions on personal liberty.

In light of the problems of pandemic infections and the steps taken by different countries to overcome vaccination hesitations, the authors compare the ethical criteria for mandatory vaccination of health professionals against COVID-19 and seasonal flu.

The mandate of the vaccine for healthcare professionals would be in line with existing professional requirements based on the prevention of harm to patients. However, not every professional duty is also a legal requirement.

Therefore, additional ethical criteria are needed to justify such a policy, the authors explain. These include the advantages and disadvantages of vaccines and the availability of less restrictive alternatives to achieve comparable health benefits.

During the pandemic, several countries ordered vaccinations against health professionals against COVID-19: France; Italy; many US states; several Canadian provinces; and Australia.

The British government also planned to do the same, but stopped due to fears of staff losses and perceived the cumbersomeness in light of the emergence of the milder Omicron variant.

However, it consulted regulations on seasonal influenza vaccination for health professionals, of which approximately 1 in 4 will not be vaccinated against the virus.

The flu kills more than 11,000 people each year in England alone, with the number rising to more than 22,000 in 2017-18.

Data from London University College hospitals during the 2018-2019 flu season suggest that 15% of hospitalized flu patients became infected during a hospital stay (nosocomial infections).

In some flu seasons, large numbers of unvaccinated staff become ill, leading to scarcity or “presentation” – where staff with the infection continue to work – increasing the risk of it spreading to patients and colleagues.

“Vaccination orders are typically controversial because they involve restrictions on individual freedoms in the common good,” the authors acknowledge.

“It simply came to our notice then [healthcare workers]it is more difficult to apply counter-arguments based on freedom. Quite simple, [healthcare workers] they have an ethical and professional obligation not to harm patients, or to minimize the risk of harm to patients, which other people do not have, “they warn.

“It simply came to our notice then [healthcare workers] they should accept at least some additional health risk in the interests of their patients… It is not at stake whether this is justified, but how much additional risk is justified by contractual and professional obligations, ”they add.

COVID-19 vaccines are associated with a low risk of blood clots and myocarditis (inflammation of the heart muscle) and due to the relatively low risk of serious COVID-19 disease in younger staff, the disadvantages may very well outweigh the benefits. propose.

Even the current crop of COVID-19 vaccines does not appear to be very effective in preventing the spread, while the protection they provide against symptoms is declining over the months.

What’s more, the severity of COVID-19 has decreased due to changes in the circulating form of the virus, high absorption of vaccines in the highest risk, high levels of innate immunity and increasingly available treatments, the authors warn.

These problems do not concern the seasonal influenza vaccine, which has been used for decades, has a well-established safety profile and highlights few and mostly less serious side effects.

Higher absorption of influenza vaccination minimizes the risk of harm to patients, not only by reducing the risk of infection, but also by reducing the risk of staff shortages due to illness. And evidence suggests that mandatory flu vaccinations increase intake by more than less stringent measures, the authors say.

But the question remains as to what level of coercion is ethically acceptable. “One way to strike a balance between the freedom of the individual and the interests of patients is to make vaccination a condition of entry into the profession rather than prescribing those who are already employed and to accept a conditional mandate, if possible, for those already in the profession. are, “they said. write.

“Ultimately, there is an ethical balance between protecting patients (including their own right not to acquire serious but preventable nosocomial infections) and forcing some healthcare professionals to have a vaccine that they would rather not receive.”

They conclude: “For the reasons given above, the risk-benefit balance suggests that at present the mandate of the influenza vaccine would be ethically appropriate, but not the mandate of COVID-19.”

However, they warn: “Credentials should be introduced on the basis of a specific disease and a specific vaccine. The problem must be serious; vaccines must be safe and effective in preventing disease and / or transmission; mandatory measures must be better than less coercive alternatives and loss costs. freedoms and risks for healthcare professionals must be professionally proportionate to the benefits for patients. ”