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Posted on December 21, 2020 at 2:48 PM

by David Oxman, MD, HEC-C

 Vaccines for COVID-19 are becoming available, with the first batches of a highly effective vaccine adminstered this past week. Given limited initial supplies, doses are prioritized to high-risk groups, including health care workers. The virus has ravaged US health care workers — killing as many as 1700 and causing serious illness to tens of thousands more. Yet despite these numbers, a significant number of health care workers say they are not sure if they will take a COVID-19 vaccine. Recent survey of health care workers find a significant proportion who were uncertain about whether they would take a COIVD-19 vaccine if offered. 

     Of course, whether a health care worker takes a COVID-19 vaccine is not just a matter of their own personal health, but the health of their patients.  Asymptomatic nurses and doctors infected with COVID-19 can unwittingly transmit the virus to people they are taking of. And as the rate of COVID-19 cases in the community explodes, the chance that a health care worker brings the virus to the hospital and infects co-workers or patients increases. Moreover, if a COVID-19 vaccine is effective, it can help keeps health care workers out of quarantine and at the jobs that so critically need them.

      Seasonal flu vaccination for clinical staff has been required by many hospitals for years, with refusal grounds for termination. The justification for mandatory health care worker vaccination against influenza is strong. Healthcare workers have an obligation to protect patients from harm. And since they took their job voluntarily, if they really don’t want to get vaccinated they could quit. So why are some of the same hospitals who make employee influenza vaccination mandatory making vaccination for COVID-19 – a disease more contagious and far more deadly than the flu – voluntary? 

     Probably because hospitals are aware of the cultural environment these vaccines are entering. COVID-19 vaccines land in an increasingly vaccine-skeptical world heightened by concerns about the speed at which they were developed and produced. Vaccine development that normally takes years was accomplished in months. Unfortunately, many don’t appreciate that despite this lightning pace, no shortcuts on safety were taken. Rather the speed came from the sheer number of people working on the same problem at once, and efficiencies like combining Phase 1 and Phase 2 trials.

     While some health care workers may say that they would like to wait longer to assess the safety of the vaccine  — the question is how much longer and to what end? Almost all adverse events to vaccination occur early – within a month – so there has been more than enough time to monitor for them. Additionally, expanded post-licensing safety reporting systems adds another layer of protection. It is true a mass vaccination project on this scale has never been attempted before and there may be some unknown risks. But considering what we know about the safety and effectiveness of the vaccines, and what we know about the dangers of COVID-19 and the ongoing risks to patients from unvaccinated health care workers, the risks are vastly outweighed by the personal benefits and their duty to serve the public. 

   Whether hospitals decide to make COVID-19 vaccination mandatory or not, health care workers must step up and take the lead. Hospitals, and the people that work in them, enjoy tremendous respect from the public. And the way health care professionals behave affects public perception. Long lines of health care workers lining up to take a COVID-19 will set a powerful example to the country. COVID-19 has forced health care workers to make many sacrifices the last few months, setting an example to the country on a vaccine is a small one.

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