Mandatory COVID-19 vaccination for oral health professionals (OHPs) - Ethical appraisal

Keywords: COVID-19 vaccination, oral health professionals

Abstract

The recently detected South African variant, Covid-19, 501Y.V2 is more transmissible, though not virulent as the initial strain.1 The morbidity and mortality rates due to this variant have risen exponentially, putting huge pressure on the healthcare system, locally and globally. As a consequence the South African government imposed hard lockdown measures (level 3) as a means to curb the pandemic. Governments around the world are scrambling to obtain and roll-out Covid-19 vaccination programs to save lives and livelihoods. Most developed countries have initiated inoculations, amid widespread misinformation and hesitancy. Literature indicate that healthcare professionals (HCPs) are generally complacent and hesitant about vaccination. The COVID-19 uptake is likely to be suboptimal among HCPs and the general populations. The voluntary immunization program will commence in February 2021, and the Healthcare professionals will be among the first to be vaccinated. It remains to be seen if this cohort will achieve the desired vaccinations rates. Failure for this influential group to vaccinate could derail the program and lead to failure to achieve herd immunity. In the face of emerging vaccine hesitancy among HCPs, should oral health professionals be compelled to vaccinate? Will any refusal by OHPs to be immunized be morally justified? Oral health professionals in this context of this paper, represent all oral health professionals involved in the management dental patients. No singular ethical framework is held as sufficient to resolve these questions. This paper interrogates aspect of clinical ethics, including the Hippocratic Oath, principilism, public health ethics (Utilitarianism) and Kantian deontology, 
to tackle the questions raised. We conclude that OHPs have a moral duty to be vaccinated against Covid-19.

References

1. Erol A. Are the emerging SARS-COV-2 mutations friend or foe? Immunology Letters. 2020; 230: 63-4.

2. Randolph HE, Barreiro LB. Herd Immunity: Understanding COVID-19. Immunity. 2020; 52(5): 737-41.

3. Paterson P, Meurice F, Stanberry LR, et al. Vaccine hesitancy and healthcare providers. Vaccine. 2016; 34(52): 6700-6.

4. Asma S, Akan H, Uysal Y, et al. Factors effecting influenza vaccination uptake among health care workers: a multi-center cross-sectional study. BMC infectious diseases. 2016; 16(1): 1-9.

5. Kabamba Nzaji M, Kabamba Ngombe L, Ngoie Mwamba G, et al. Acceptability of Vaccination Against COVID-19 Among Healthcare Workers in the Democratic Republic of the Congo. Pragmat Obs Res. 2020; 11: 103-9.

6. Le TT, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. 2020; 19(5): 305-6.

7. Corum J, Grady D, Wee S-L, et al. Coronavirus vaccine tracker. The New York Times 2020. Accessed at www.ny-times.com/interactive/2020/science/coronavirus-vaccine-tracker.html on 8 January2021.

8. Lipsitch M, Dean NE. Understanding COVID-19 vaccine efficacy. Science. 2020; 370(6518): 763-5.

9. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. New England Journal of Medicine. 2020; 383(27): 2603-15.

10. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. New England Journal of Medicine. 2020. https://doi.org/10.1056/NEJMoa 2035-389.

11. Callaway E. Russia announces positive COVID-vaccine results from controversial trial. Nature. 2020. https://doi.org/10.1038/d41586-020-03209-0.

12. De Soto JA. Evaluation of the Moderna, Pfizer/BioNtech, AstraZeneca/Oxford and Sputnik V Vaccines for COVID-19. 2020. https://doi.org/10.31219/osf.io/e4rqu.

13. Zhu F-C, Li Y-H, Guan X-H, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. The Lancet. 2020. https://doi.org/10.1016/S0140-6736(20)31208-3.

14. Palacios R, Patiño EG, de Oliveira Piorelli R, et al. Double-Blind, Randomized, Placebo-Controlled Phase III Clinical Trial to Evaluate the Efficacy and Safety of treating Healthcare Professionals with the Adsorbed COVID-19 (Inactivated) Vaccine Manufactured by Sinovac–PROFISCOV: A structured summary of a study protocol for a randomised controlled trial. Trials. 2020; 21(1): 1-3.

15. Keech C, Albert G, Cho I, et al. Phase 1-2 trial of a SARS-CoV-2 recombinant spike protein nanoparticle vaccine. New England Journal of Medicine. 2020; 383(24):2320-32.

16. Sadoff J, Le Gars M, Shukarev G, et al. Interim Results of a Phase 1-2a Trial of Ad26.COV2.S Covid-19 Vaccine. New England Journal of Medicine. 2021. https://doi.org/.

17. Knoll MD, Wonodi C. Oxford-AstraZeneca COVID-19 vaccine efficacy. The Lancet. https://doi.org/.

18. Tuite AR, Zhu L, Fisman DN, et al. Alternative dose allocation strategies to increase benefits from constrained COVID-19 vaccine supply. Annals of internal medicine. 2021. https://doi.org/.

19. Tegally H, Wilkinson E, Giovanetti M, et al. Emergence and rapid spread of a new severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) lineage with multiple spike mutations in South Africa. medRxiv. 2020. https://doi.org/10.1056/NEJMoa2034201.

20. Kostoff RN, Briggs MB, Porter AL, et al. [Comment] COVID‑19 vaccine safety. International journal of molecular medicine. 2020; 46(5):1599-1602.

21. Ledford H. Oxford Covid-vaccine paper highlights lingering unknowns. Nature. 2020; 588: 378-9.

22. Ather A, Patel B, Ruparel NB, et al. Coronavirus disease 19 (COVID-19): implications for clinical dental care. Journal of endodontics. 2020; 46(5): 584-95.

23. Passarelli PC, Rella E, Manicone PF, et al. The impact of the COVID-19 infection in dentistry. Experimental Biology and Medicine. 2020; 245(11): 940-4.

24. Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. Journal of dental research. 2020; 99(5): 481-7.

25. Passarelli PC, Rella E, Manicone PF, Garcia-Godoy F, D’Addona A. The impact of the COVID-19 infection in dentistry. Experimental Biology and Medicine. 2020; 245(11): 940-4.

26. Jiménez ÁV, Mesoudi A, Tehrani JJ. No evidence that omission and confirmation biases affect the perception and recall of vaccine-related information. PloS one. 2020; 15(3):e022 8898. https://doi.org/10.1371/journal.pone.0228898.

27. Parfit D. Reasons and persons: Oxford University Publishers 1984.

28. Otsuka M. The paradox of group beneficence. Philosophy & Public Affairs. 1991: 132-49.

29. Betsch C, Böhm R. Detrimental effects of introducing partial compulsory vaccination: experimental evidence. The European Journal of Public Health. 2016; 26(3): 378-81.

30. Dubov A, Phung C. Nudges or mandates? The ethics of mandatory flu vaccination. Vaccine. 2015; 33(22): 2530-5.

31. Wood AW. Kant, Immanuel. International Encyclopedia of Ethics. 2013.

32. Giubilini A, Douglas T, Savulescu J. The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Med Health Care Philos. 2018; 21(4): 547-60.

33. Wood A. Humanity as end in itself. Proceedings of the Eighth International Kant Congress 1995: 301-19.

34. Flanigan J. Mark Navin, Values and Vaccine Refusal: Hard Questions in Ethics, Epistemology, and Health Care. The Journal of Value Inquiry. 2017; 51(1):199-202.
Views
  • Abstract 0
  • PDF 0
Views and downloads are with effect from 11 January 2018
Published
2021-02-01