Thank you for the invitation to speak to you today.
I would like to address the issue of health care worker COVID vaccination.
Vaccination of health care workers has been an incredibly effective intervention in the control of COVID-19. A study by the Cleveland veterans affairs department found that health care workers who had been vaccinated had a 19-fold lower risk of acquiring COVID than those who were unvaccinated. Furthermore, the institution suffered from four COVID outbreaks, all of which were associated with transmission from unvaccinated health care workers. There were no outbreaks from vaccinated workers.
A recent outbreak involved a single unvaccinated health care worker who transmitted COVID to 20 other health care workers and 26 residents, and led to three patient deaths. This occurred despite the facility having extensive patient vaccination.
In Canada, there is a wide variation in health care worker vaccination rates between institutions, with many having staff vaccination rates well below the general population. As having your personal health care worker vaccinated can help protect you from exposure, these variable rates in vaccination raise an important issue of equity in health care delivery and patient safety.
Many patients do not respond to the vaccine because of serious underlying conditions, such as cancer, dialysis, organ transplantation or other immunocompromising conditions. They are vulnerable, and thus dependent on the health care workers and those around them to shield them from exposure to COVID.
Unlike going into a private business, patients who need to go to hospital cannot simply choose to stay home. Therefore, we have a moral obligation to assure these people that we will do everything we can to prevent them from becoming catastrophically ill and dying while in our care.
This then raises the issue of whether vaccination should be mandatory for health care workers who provide direct patient care.
Several concerns about a mandatory vaccination policy have been raised. Firstly, due to personal privacy concerns, health care workers do not have to even report their health care information to their institution.
Although it is true that the principle of privacy of health care information needs to be maintained, there are well-established exceptions where the public has a right to know in order to be protected. An individual’s struggles with alcoholism should remain a private matter. However, if that individual is a commercial pilot, the airline safety regulator has a well-established right to demand this information.
In our own experience, many of us would not be comfortable having someone who was unvaccinated come into our home. However, when a patient is ill in hospital, they at present have no right to even ask whether the health care worker entering their room is vaccinated.
The vast majority of patients would not consent to being directly cared for by a non-vaccinated person. However, this practice is still commonplace and is only maintained because of a lack of transparency, which enables the system to deny this information to the patient.
Patients have a right to expect that when they are being cared for in a medical facility, scientific principles will be used to determine the approach to care. We would not accept a health care worker making a unilateral decision, based on the belief that hand washing is not necessary, to continue to provide care between patients without washing their hands. Certain scientific principles that have overwhelming consensus and important patient safety issues must be maintained in order to provide a science-informed basis in care.
I am not recommending that any individuals who feel strongly opposed to vaccination must undergo it against their will. However, I do say that providing frontline health care services is a privilege and not a right.
If health care workers choose not to be vaccinated, despite the well-documented risks to both themselves and their patients, then hospitals should be able to decide not to allow their patients to be put at risk. These workers may be redeployed to non-frontline activities, if possible, or if not, then terminated. Special arrangements for health care workers with a vaccine allergy will have to be made, but a true vaccine allergy is an extremely rare phenomenon.
Our hospitals already mandate that health care workers provide proof of vaccination against other common transmissible agents, including measles and hepatitis B. Several countries have instituted mandatory health worker COVID vaccination policies.
The United States Equal Employment Opportunity Commission has ruled that all companies can mandate employees to be vaccinated in order to protect their customers. Many large U.S. hospitals have, therefore, undertaken a mandatory staff vaccination policy.
In Canada, however, despite the fact that most health care leaders would like to institute such a policy, they have been hamstrung by concerns regarding the legal framework, including the Charter of Rights and Freedoms, and a lack of federal or provincial direction.
Federal guidance and a national strategy on this issue are urgently needed. I therefore request that a committee be set up that would include representatives of health care institutions, health care providers, ethicists, patient advocacy groups and legal experts. This would enable rapid development of guidelines regarding implementing mandatory COVID vaccination policies for frontline health care workers.