ABSTRACT
BACKGROUND: The devastating effects of COVID-19 sparked debates among professionals in the fields of health, law, and bioethics regarding policies on mandatory vaccination for healthcare workers. Suboptimal vaccine uptake among healthcare workers had been implicated in the increased risk of nosocomial spread of COVID infection and absenteeism among healthcare workers, impacting the quality of patient care. However, mandatory vaccine policies were also seen to encroach on the autonomy of healthcare workers. AIMS AND OBJECTIVES: To synthesise the arguments for and against mandatory vaccination for healthcare workers (HCWs) and its long-term impact on the healthcare workforce, through an analysis of texts and opinions of professionals from different fields of study. METHODS: This is a systematic review of opinions published in peer-reviewed journals. After initial search in Cochrane and JBI systematic review databases to ensure no previous review had been done, five databases were searched (PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus). Inclusion criteria were: 1) focused on COVID-19; 2) healthcare workers specific; 3) specific to mandatory vaccination; 4) opinion piece with an identified author; and 5) in English. EXCLUSION: 1) focus on other vaccine preventable diseases, not COVID-19 and 2) discussion on mandatory vaccination not-specific to healthcare workers. The Joanna Briggs Critical Appraisal tool for Text and Opinions was used to assess quality. Data were synthesised in the summary table. RESULTS: The review included 28 opinion and viewpoint articles. Of these, 12 (43â¯%) adopted a pro-mandatory vaccination stance, 13 (46â¯%) were neutral or had presented arguments from both sides of the debate and only three (11â¯%) were against. The overall arguments among those who were pro-, neutral and anti-mandatory COVID-19 vaccination were underpinned by ethical, moral and legal principles of such a mandate on a vulnerable healthcare workforce. This review highlighted the polarised opinions concerning choices, human rights, professional responsibilities and personal risks (i.e. health risks, losing a job) with the introduction of vaccination mandate. However, the articles found in this review discussed mandatory vaccination of healthcare workers in the USA, Europe and Australia only. CONCLUSION: The review underscores the need to balance the rights of the public to safe and quality care with the rights and moral obligations of healthcare workers during a public health emergency. This can be achieved when policies and mandates are guided by reliable scientific evidence which are flexible in considering legal and ethical dilemmas. TWEETABLE ABSTRACT: To mandate or not to mandate COVID-19 vaccination for healthcare workers: A synthesis of published opinions in health, law, and bioethics.
ABSTRACT
Background The devastating effects of COVID-19 sparked debates among professionals in the fields of health, law, and bioethics regarding policies on mandatory vaccination for healthcare workers. Suboptimal vaccine uptake among healthcare workers had been implicated in the increased risk of nosocomial spread of COVID infection and absenteeism among healthcare workers, impacting the quality of patient care. However, mandatory vaccine policies were also seen to encroach on the autonomy of healthcare workers. Aims and objectives To synthesise the arguments for and against mandatory vaccination for healthcare workers (HCWs) and its long-term impact on the healthcare workforce, through an analysis of texts and opinions of professionals from different fields of study. Methods This is a systematic review of opinions published in peer-reviewed journals. After initial search in Cochrane and JBI systematic review databases to ensure no previous review had been done, five databases were searched (PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus). Inclusion criteria were: 1) focused on COVID-19;2) healthcare workers specific;3) specific to mandatory vaccination;4) opinion piece with an identified author;and 5) in English. Exclusion: 1) focus on other vaccine preventable diseases, not COVID-19 and 2) discussion on mandatory vaccination not-specific to healthcare workers. The Joanna Briggs Critical Appraisal tool for Text and Opinions was used to assess quality. Data were synthesised in the summary table. Results The review included 28 opinion and viewpoint articles. Of these, 12 (43 %) adopted a pro-mandatory vaccination stance, 13 (46 %) were neutral or had presented arguments from both sides of the debate and only three (11 %) were against. The overall arguments among those who were pro-, neutral and anti-mandatory COVID-19 vaccination were underpinned by ethical, moral and legal principles of such a mandate on a vulnerable healthcare workforce. This review highlighted the polarised opinions concerning choices, human rights, professional responsibilities and personal risks (i.e. health risks, losing a job) with the introduction of vaccination mandate. However, the articles found in this review discussed mandatory vaccination of healthcare workers in the USA, Europe and Australia only. Conclusion The review underscores the need to balance the rights of the public to safe and quality care with the rights and moral obligations of healthcare workers during a public health emergency. This can be achieved when policies and mandates are guided by reliable scientific evidence which are flexible in considering legal and ethical dilemmas. Tweetable To mandate or not to mandate COVID-19 vaccination for healthcare workers: A synthesis of published opinions in health, law, and bioethics.
ABSTRACT
During a pandemic, dentists face enormous challenges due to restrictions placed on their practice and the need to comply with biosafety measures. This study aimed to explore the impact of the COVID-19 pandemic and infection control measures on dentists and their practice in Jordan and the global implications for other primary healthcare workers. A qualitative exploratory study employing face-to-face or telephone interviews, was conducted with ten dentists from the 9th May to 20th September 2020. An inductive thematic approach to analysis was used identifying three themes, each with two accompanying subthemes: (1) Response to COVID-19 pandemic: (1a) Government response and (1b) People's response;(2) The effects of the pandemic and response measures: (2a) Impact on work and practice and (2b) Impact on personal and social life;(3) The unanticipated gains: (3a) Altruism and (3b) Leadership and change. Stringent infection control measures were implemented to slow the spread of the virus, however limited government support made implementation unsustainable and caused financial hardship. Lack of clear guidelines, changes in practice, social distancing measures, and altered social interactions, adversely impacted daily life, triggering mental distress. Misinformation influenced response to COVID safety measures. Despite the negatives, working during the pandemic reaffirmed dental professionals' roles and purpose, with strong leadership boosting morale. Education, adequate biosafety resources and clear guidelines or policies to support and sustain stringent infection control procedures are crucial in ensuring that measures are implemented to meet the safety requirements of the pandemic response. Promoting the well–being of the healthcare workforce is equally important. Finally, altruism and strong leadership among healthcare workers can contribute to a meaningful and humane pandemic response.
Subject(s)
COVID-19 , Nurses , COVID-19/epidemiology , Humans , Mental Health , Pandemics , SARS-CoV-2ABSTRACT
AIMS AND OBJECTIVES: To synthesise evidence regarding vaccination intention, identify factors contributing to vaccine hesitancy among healthcare professionals and the general populations globally. BACKGROUND: As COVID-19 vaccine becomes available worldwide, attention is being directed to community vaccine uptake, to achieve population-wide immunity. A number of factors have been reported to influence vaccine intention. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of COVID-19 vaccination intention related literature published on or before 31 December 2020 from seven databases was undertaken. RESULTS: Thirty articles were included in this systematic review. Overall COVID-19 vaccination intention during the first year of the pandemic ranged from 27.7% to 93.3%. Findings highlighted that socio-demographic differences, perceptions of risk and susceptibility to COVID-19 and vaccine attributes influenced vaccination intention. Healthcare professionals particularly, nurses have higher vaccine hesitancy reportedly due to concerns regarding vaccine safety and efficacy and mistrust of health authorities. Negative information about COVID-19 vaccines in the social media and low confidence in the health system were associated with lower acceptability among the community. Interestingly, cumulative increase in COVID-19 caseloads of countries over time was not associated with vaccination intention. CONCLUSIONS: The significant variability in vaccine intention rates worldwide would hamper efforts to achieve immunity against COVID-19. Nurses' concerns about vaccine safety and efficacy need to be addressed to increase vaccine acceptance and maximise their influence on vaccination decision in the community. As misinformation through social media negatively impacts vaccination uptake, authoritative and reliable information on vaccine attributes, disease risks and vaccination benefits are needed. RELEVANCE TO CLINICAL PRACTICE: Concerns about vaccine safety and efficacy including misinformation are important contributors to vaccine hesitancy. Addressing these factors, particularly among nurses who are considered trusted influencers of vaccination decisions in the community is an important strategy for pandemic preparedness.