Cornerstone of protection

Mandatory COVID-19 vaccination for staff is one way to ensure patient and workplace safety. But why is there a reluctance in making the vaccine obligatory? How should hospitals respond?

Safety does not just cover patients. Nurses, doctors, and everyone who comes into contact with patients require protection, which is why we have infection control processes in place. This involves providing them with proper protective equipment and even immunisation.

As of writing, there are almost 200 potential vaccines currently being developed in different laboratories across the world, and a number of them have already started clinical trials on humans. Experts say we’re looking at a COVID-19 vaccine by the end of this year or early next year.

Welcome news for many, the vaccine also opens a necessary conversation on whether employees, in particular healthcare workers, should be required to get vaccinated as a prerequisite for work. While the issue looks simple on the outside, the conversations around it are nevertheless complicated.

Dr Hau-Tek Koh, Deputy Chief Medical Officer, Jiahui Health

Hospital Insights Asia talks to Dr Hau-Tek Koh, Deputy Chief Medical Officer at Jiahui Health in China, to give clarity on the reasons why employees might refuse immunisation and how hospital management can best uphold workplace safety while at the same time respecting employees’ preferences.

A safe workplace

To maintain workplace safety means to minimise the chances of infection between staff members and visitors to the workplace, says Dr Koh. While other countries have existing regulations on vaccination requirement for employees, similar state regulations in China do vary. Other than some mandatory vaccinations, employers can define their own guidelines on immunisation conditions for their staff.

At Jiahui Health, there is a vaccination requirement in place for influenza, and this is subject to the availability of the vaccine based on what’s provided by the Chinese Centre for Disease Control and Prevention (CDC). Priority is given to staff considered as “High Risk.” Additionally, the hospital provides mandatory Hepatitis A, Hepatitis B, Measles/Mumps/Rubella, and Varicella vaccines to selected staff based on job scope and exposure risk levels.

As they say, the availability of a COVID-19 vaccine is just a matter of when rather than if. Understandably, the hospital management will be keen to consider making the vaccination for their staff a requirement, as the healthcare industry is the primary sector that deals with the infection. After all, protecting the staff is essentially protecting the patients, too.

Vaccine hesitancy

Yet, others remain unconvinced; although rather than just dismissing the reluctance, we also have to understand what the reasons are. A recent international survey finds that at least three in 10 people do not want to get vaccinated if a vaccine becomes available. High acceptance rates for the vaccine are mostly seen in Asian countries. In China, especially, nine out of 10 respondents say they will get vaccinated provided the vaccine is “proven, safe, and effective.”

Dr Koh understands this conditional clause, saying that refusal to take the vaccine can be due to “the many unknowns on the efficacy and safety profile of this new vaccine.” Hence, the decision to make vaccination compulsory for Jiahui Health’s staff will depend on multiple factors, primarily the vaccine’s efficacy, safety, as well as cost.

If the vaccine provides a high degree of protection and an affordable cost, Dr Koh believes it can be a “worthwhile vaccine” to make mandatory for staff. But if the level of protection is not that high, then only the “high risk” staff will be required to take the vaccine so they get some level of protection.

Hospital management might also encounter staff hesitation to get vaccinated because of other reasons including medical, particularly allergies, philosophical or personal beliefs, religious reasons, and inadequate or sometimes incorrect information. While the first three reasons may be settled with exemptions or special arrangements, misinformation and mistrust can be resolved through vaccine literacy.

Lack of data about the vaccine would naturally make people scared, knowing that it is new and it might not work for some circumstances. Hospitals, then, need to be transparent in managing this concern. Dr Koh believes that “providing full and accurate data on vaccine protection will generate higher acceptance.”

Nevertheless, a COVID-19 vaccine should be welcome news for the healthcare sector, not only to protect patients but also the front-liners who work to keep patients safe. “If indeed the vaccine proves to be useful, such a vaccine could well be the cornerstone of protection for healthcare staff and will be a critical component of hospitals’ workplace safety,” Dr Koh believes.

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