Abstract
Healthcare workers (HCWs) are at increased risk of contracting infections at work and further transmitting them to colleagues and patients. Immune HCWs would be protected themselves and act as a barrier against the spread of infections and maintain healthcare delivery during outbreaks, but vaccine uptake rates in HCWs have often been low. In order to achieve adequate immunisation rates in HCWs, mandatory vaccination policies are occasionally implemented by healthcare authorities, but such policies have raised considerable controversy. Here we review the background of this debate, analyse arguments for and against mandatory vaccination policies, and consider the principles and virtues of clinical, professional, institutional and public health ethics. We conclude that there is a moral imperative for HCWs to be immune and for healthcare institutions to ensure HCW vaccination, in particular for those working in settings with high-risk groups of patients. If voluntary uptake of vaccination by HCWs is not optimal, patients’ welfare, public health and also the HCW’s own health interests should outweigh concerns about individual autonomy: fair mandatory vaccination policies for HCWs might be acceptable. Differences in diseases, patient and HCW groups at risk and available vaccines should be taken into consideration when adopting the optimal policy.
Highlights
Healthcare workers (HCWs) – all persons employed in acute or long-term healthcare facilities having direct contact with patients or patient’s’ specimens, regardless of their employment status – are at increased risk of contracting infections and further transmitting them to colleagues and patients
Transmission involving HCWs has been reported for a variety of healthcare facilities and diseases, including seasonal and pandemic influenza, measles, mumps, rubella, varicella, pertussis, hepatitis A, hepatitis B and meningococcal invasive disease: this nosocomial transmission has led to outbreaks and deaths, and the burden for HCWs themselves has been considerable in terms of morbidity and mortality [2,3,11,12,13]
Despite recommendations by the United States Centers for Disease Control and Prevention (CDC) on influenza vaccination for all HCWs since the early 1980s, uptake rates in the United States have stagnated around 40–50% [4,7], only reaching up to 60–70% after intense promotion and sustained campaigns [4,6,11]
Summary
Citation style for this article: Galanakis E, Jansen A, Lopalco PL, Giesecke J. Healthcare workers (HCWs) are at increased risk of contracting infections at work and further transmitting them to colleagues and patients. Immune HCWs would be protected themselves and act as a barrier against the spread of infections and maintain healthcare delivery during outbreaks, but vaccine uptake rates in HCWs have often been low. We conclude that there is a moral imperative for HCWs to be immune and for healthcare institutions to ensure HCW vaccination, in particular for those working in settings with high-risk groups of patients. If voluntary uptake of vaccination by HCWs is not optimal, patients’ welfare, public health and the HCW’s own health interests should outweigh concerns about individual autonomy: fair mandatory vaccination policies for HCWs might be acceptable. Differences in diseases, patient and HCW groups at risk and available vaccines should be taken into consideration when adopting the optimal policy
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