Thursday, August 20, 2009

Ethics of Mandatory H1N1 Vaccination

For weeks I have been spouting that the H1N1 vaccine would not be made mandatory. All I have read coming from CDC said so, and I believed it. My apologies. I regret to note that New York will be requiring healthcare workers to have both the seasonal vaccine and the H1N1 vaccine. .

They argue this is a patient safety issue. And I do agree with that argument. Last winter, I investigated a pediatric influenza-related death of a child who contracted influenza while hospitalized with something else. Of course I could not say whether the child caught it from a healthcare worker or visitor. Nonetheless, I am an advocate of vaccinating healthcare workers for flu. I am fully on board with the seasonal vaccine.

I am NOT an advocate of forcible vaccinations, however.

I read somewhere recently (sorry that I cannot recall the source) that the essence of bioethics is the answer to the question, does this harm anyone? On the one hand, we could argue that an unvaccinated healthcare worker has the potential to harm patients. Certainly in cases of fragile or at-risk patients this is a concern. You might recall an early post about a pulmonologist with H1N1. The flip side is that one could harm the healthcare worker with the vaccine. While the science is good, we are pushing out a new vaccine. Some healthcare workers will be clearly contraindicated, such as with an egg allergy. The news article referenced above does not talk about exemptions, but surely there are medical exemptions. Some healthcare workers will have religious objections. Some will simply be afraid to take a new, under-studied vaccine.

Massachusetts has deputized additional healthcare workers to give H1N1 vaccinations. I love that word in this context. Perhaps they will be issuing guns and badges as well? They could meander over to New York and help enforce the vaccine mandate.

A colleague today accused me of being anti-vaccine. This is not the case at all. I am a big proponent of vaccines. Vaccines have spared uncountable deaths and suffering. Rather, I am advocating for safety and science. I don't want to be sucked into the vortex of pandemic panic. I have been there, it is not a pleasant place to be.

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