The ethical argument for compulsory vaccination against Covid-19 for health workers
By Dr Tharani Loganathan
Recently, an unvaccinated employee sparked an outbreak of Covid-19 at a nursing home in the state of Kentucky, United States, with dozens of residents infected and several deaths.
Likewise, the Covid-19 outbreaks in hospitals in Malaysia have highlighted the importance of vaccinating our healthcare workers to protect themselves, their colleagues and their patients.
This has led to a debate over whether hospitals should make vaccination mandatory for all healthcare workers. The answer is apparently simple: vaccination is a necessary prerequisite for all healthcare workers working in clinical settings with patients. Yet, some fear that compulsory vaccination limits an individual’s freedom and right of choice.
Most countries, including Malaysia, have prioritized healthcare workers among the first groups to be vaccinated. This is in line with the ethical principle of reciprocity, in which healthcare workers, police officers, teachers and other essential workers facing exceptional risks of Covid-19 infection are given priority in national immunization programs.
By the very nature of their work, healthcare workers are at risk of contracting Covid-19, yet their jobs are essential to the functioning of the healthcare system. Healthcare workers in Malaysia were vaccinated during the first phase of the National Covid-19 Vaccination Program (PICK) from February to April 2021.
However, some healthcare workers may have chosen not to be vaccinated for a variety of reasons, including reluctance to vaccinate. Vaccination against Covid-19 has not yet been made compulsory in Malaysia.
In public health, the ethical principles of non-maleficence (doing no harm) and beneficence (doing good to others) take precedence over autonomy (individual choice). Public health interventions, such as vaccinations, are delivered at the population level and utilitarian principles come into play – “doing the most good for the most people”.
In the case of Covid-19, the pandemic has been devastating for society, wreaking havoc on lives and livelihoods. Several vaccines are available and have been proven by real evidence to be safe and effective. Vaccination remains the only real hope for a return to normal.
However, compulsory vaccination as a public policy is unpleasant and should be used as a last resort.
In Malaysia, citizens are encouraged to register for vaccination voluntarily through the MySejahtera app and receive the information needed to make an informed choice.
But we have to look at it in a different light when it comes to clinical health workers. The priority here is patient safety, and the guiding principle is always non-maleficence or “do no harm”. Healthcare workers in clinical settings should be vaccinated now that vaccines are available or play a non-clinical role without contact with the patient.
It is our obligation as healthcare providers to protect patients, and it would be unreasonable for hospitals to endanger patients by allowing unvaccinated healthcare workers to come into contact with patients.
Dr Tharani Loganathan is a public health physician in the Department of Social and Preventive Medicine at Universiti Malaya.
The opinions expressed are those of the author and do not necessarily reflect those of FMT.
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