We will fire good people, exacerbating inequities:
- A colleague of mine once said: “Yes, I’m in favour of mandatory vaccines. But no one should lose their job because of it.” Mandates mean firing good people. For example, Benjamin Franklin, who we would all define as a good person, would not get his kids vaccinated against smallpox despite a mandate. Additionally, there are clearly systemic issues and systemic inequality with letting people go as a result of vaccine mandates, because the people who are most hesitant about vaccines are culturally the people who don’t trust public health, who are new immigrants, racialized, and poor.
- Mandates mean that a small but non-trivial percentage of staff feel coerced, and that their relationship with the institution is damaged, and, possibly, their relationship with public health and vaccines.
Do we have a sufficiently clear rationale for vaccine mandates?
- My second concern about vaccine mandates is how clearly we’re thinking about what our goal is. There are generally three criteria for enacting a vaccine mandate:
- Direct benefit to individuals;
- Direct public health benefit to others;
- No other options.
- We’ve often talked about vaccine mandates as creating safe places for patients. But in fact, we have to ask what the risk to patients is. In general, hospitals in Toronto have done a really good job of protecting patients throughout the pandemic; long-term care: different issue, much more difficult. So if the stated purpose is to keep patients in hospitals safe, these criteria are met for some health-care workers, like those who work in transplant units or where there are frail elderly people, but it’s a little harder to argue that in dental clinics and sports-medicine clinics and some elective surgical areas, that there is a direct benefit. And it’s even harder to argue in laboratories or finance departments, where people don’t have any exposure to patients, particularly when we’re layering vaccines on top of the other things we’ve been using to protect patients.
- So there has to be some other benefit beyond just protecting patients that goes with this, and we have to think clearly about what that is and why we need it.
Vaccine mandates can’t be allowed to interfere with other public health measures:
- Mandates also carry the risk of believing the vaccines are all that you need. It’s really important that we don’t allow this mandate to interfere with the great job that our infection-control departments and all of our workers in health care have been doing.
- As efficacy against asymptomatic and mild disease wanes (never mind Omicron), these IPAC measures will remain vitally important.