Ethical Vaccine Mandates

In the 2003 Code of Medical Ethics written by the American Medical Association (AMA), the preamble begins with a statement addressing the importance of physicians in our world, especially with increased globalization. Nearly 2 decades before the COVID-19 pandemic, they reference the “plagues and pandemics which respect no national borders in a world of global commerce and travel” (AMA Ethics Code), and how therefore physicians will be of the utmost importance to return our world back to normalcy. The entire code of medical ethics is based upon the ancient Hippocrates Oath (Encylopedia Brittanica, Hippocrates Oath) and for centuries, the main philosophy has remained the same - for physicians to continue to use their knowledge to heal.

But in the midst of the COVID-19 pandemic, another glaring question has been asked. What if it is the physicians who must use medicine on themselves in order to protect others? The most obvious example can be seen with the COVID vaccine as hospitals, schools, and employers across the nation put “vaccine mandates” into place. The instructions - get vaccinated or leave.

In July, Saint Jude, one of the most prominent research hospitals across the country, declared that all employees had to be vaccinated before September or their employment would be terminated. It was one of the largest mandates made by an employer at the time. Whilst many argued that it was not the position of the hospital to create and enforce this mandate, the next few months have proved how this decisive action was ethical and may have saved thousands of lives.

Saint Jude is a unique hospital in the sense that works in specialized cases with some of the most immunocompromised patients in the country. Even outside of cases such as SCID (Severe Combined ImmunoDeficiency) and Lupus, which both directly involve a compromised immune system, many of the treatments used at Saint Jude such as chemotherapy also reduce immunity (The Breast Cancer Organization, 2015). Therefore, while disease prevention is crucial in any hospital, it is even more important here. Normally, those with compromised immune systems only make up a small portion of the hospital, but at Saint Jude, nearly all of the 8,600 patients have a weakened immune system. Interestingly, for most hospitals (including Saint Jude), vaccines have been mandated for decades in order to “protect the interests of both the patient and the professionals” (Jecker, et al, 2021).

A 2009 paper written by the National Center for Biotechnology Information (NCBI, 2009) states that “No one is at greater risk of contracting contagious diseases or of spreading them than health care workers. Disease-causing organisms can easily spread from patients to health care workers and then back to other patients on a hospital floor” (Riddick, 2003). This paper was written at the height of the H1N1 flu virus, a time when vaccination policies were once again coming under high scrutiny. This epidemic was able to be relatively controlled due to the high vaccination rates that occurred throughout the entire country. In order to make the vaccination method ethical and efficient, they also utilized a “vaccination order” where certain groups were prioritized. During the COVID pandemic, we also followed many of these procedures, such as having healthcare workers be one of the first to be able to be vaccinated - something that the Biomedical Engineering Journal states within its list for vaccine ethics (Jecker, et al, 2021). The H1N1 vaccine was required for many employers and schools in 2009 and many continue to require such vaccination proof. All 50 states (alongside the District of Columbia) require diphtheria, polio, rubella, measles, pertussis, tetanus, and chickenpox vaccinations for students to attend school (State-by-State: Vaccinations, 2022). Every state besides Iowa requires the mumps vaccine and many others mandate other vaccinations like the HPV or Meningococcal.

It has also been proven that the COVID vaccines are safe and effective. While side-effects for the vaccine do appear to be common with 77.4% of vaccine recipients reporting an effect (CDC, Vaccine Reactions and Adverse Events), more than 91% of the events are not serious (Bean and Mackenzie). When compared to the 242 million COVID cases globally, this number seems meager in comparison. In addition, with most FDA-approved COVID vaccines having efficacies of greater than 80% (Institute for Health Metrics and Evaluation), and other vaccines like the common flu shot having efficacies of ~40% (GoodRX) - it seems clear that the COVID vaccine is one of the best methods to prevent the disease and its spread.

These statistics originate from multiple independent studies as required by the National Institute of Health (NIH), particularly in the aspect of social and clinical value (NIH Clinical Center). The trials went through multiple rounds of review and testing before even being performed, thus demonstrating how careful and rigorous the entire process was. The development of the vaccine also closely followed the Biomedical Engineering Code of Ethics to make sure that it was safe for human usage. One of the first ethical obligations of a biomedical engineer is that they must “use their knowledge, skills, and abilities to enhance the safety, health, and welfare of the public” (BMES). While this obviously correlates to the development of a COVID vaccine to mitigate the effects of the pandemic, it also means that a safe vaccine must be produced, not just the first available vaccine.

In addition, while no one can advocate for a human being to put their life on the line, thousands of healthcare workers have been doing so from the start of the pandemic. As the AMA Code of Ethics states in point 4 of its Declaration, “The members of the world community of physicians, solemnly commit ourselves to: apply our knowledge and skills when needed, though doing so may put us at risk.” Healthcare workers have been doing this for ages with the polio crisis, the Ebola pandemic and now with COVID. But when a solution has been created to mitigate their risk as workers and that of the patients, should it not be considered ethically right to ensure that all are protected?

Dr. Field, a professor of Law at Drexel University, began the introduction of his paper by asking, “What would you do if you knew that by undergoing a minor medical intervention, you might save the life of another person? What if you could potentially save dozens of lives? How risky would the intervention have to be before you would even hesitate?" In a world where we are able to be living transplant donors to others, why do we hesitate for something that would protect us and those around us? Particularly as healthcare professionals, they have committed to protecting humanity and human life. By not getting vaccinated, they risk breaking their most solemn oath and commitment - they risk their own lives and those of every person with whom they interact. Therefore, it is not only the right, but the duty of Saint Jude to require that all of their employees be vaccinated in order to protect everybody’s health. Vaccination isn’t simply a “check” on a long to-do list, it is a disease prevention technique that can save lives - both of others and your own.

References

[1] Bean, G. M. and M. (n.d.). Covid-19 vaccine side effects and transmission: 4 QS, answered. Becker’s Hospital Review. Retrieved February 27, 2022, from https://www.beckershospitalreview.com/public-health/do-intense-vaccine-side-effects-point-to-past-covid-19-infection-4-vaccine-claims-fact-checked.html

[2] Biomedical Engineering Society Code of ethics - BMES. BMES. (n.d.). Retrieved February 27, 2022, from https://www.bmes.org/files/CodeEthics04.pdf

[3] Centers for Disease Control and Prevention. (2021, November 5). Pfizer-biontech COVID-19 vaccine reactions & adverse events. Centers for Disease Control and Prevention. Retrieved February 27, 2022, from https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html

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[7] Encyclopædia Britannica, inc. (n.d.). Hippocratic oath. Encyclopædia Britannica. Retrieved February 27, 2022, from https://www.britannica.com/topic/Hippocratic-oath

[8] Field, R. I. (2009, November). Mandatory vaccination of health care workers: Whose rights should come first? P & T : a peer-reviewed journal for formulary management. Retrieved February 27, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810172/.

[9] GoodRx. (n.d.). Which flu shot is the most effective for the 2021-22 flu season? GoodRx. Retrieved February 27, 2022, from https://www.goodrx.com/conditions/flu-vaccination/how-effective-is-the-flu-shot-this-year

[10] How chemotherapy affects the immune system. Breastcancer.org. (2015, February 5). Retrieved February 27, 2022, from https://www.breastcancer.org/tips/immune/cancer/chemo

[10] Is the COVID-19 vaccine safe? Johns Hopkins Medicine. (n.d.). Retrieved February 27, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/is-the-covid19-vaccine-safe

[11] Jecker, N. S., Wightman, A. G., & Diekema, D. S. (2021, May 1). Vaccine ethics: An ethical framework for global distribution of COVID-19 vaccines. Journal of Medical Ethics. Retrieved February 27, 2022, from https://jme.bmj.com/content/47/5/308.

[12] Mayo Foundation for Medical Education and Research. (n.d.). Are the vaccines safe? Mayo Clinic. Retrieved February 27, 2022, from https://www.mayoclinic.org/coronavirus-covid-19/are-the-vaccines-safe.

[13] Riddick, F. A. (2003). The code of medical ethics of the American Medical Association. The Ochsner journal. Retrieved February 27, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399321/.

[14] State-by-state: Vaccinations required for public school kindergarten - procon.org. Vaccines. (2022, February 23). Retrieved February 27, 2022, from https://vaccines.procon.org/state-by-state-vaccinations-required-for-public-school-kindergarten/.

[15] U.S. Department of Health and Human Services. (n.d.). Ethics in clinical research. NIH Clinical Center. Retrieved February 27, 2022, from https://clinicalcenter.nih.gov/recruit/ethics.html