A widely debated topic in health care is the implementation of mandatory vaccination programs.

Historically, the focus has been on vaccination for influenza, but the coronavirus disease 2019 (COVID-19) pandemic has again brought the topic to the fore.

A vaccination is a minor medical procedure that involves “introducing a vaccine into the body to produce immunity to a specific disease,” according to the CDC.1

What makes vaccines so powerful and unique is that they can prevent diseases rather than treat them.2 Although receiving a vaccination does not guarantee an individual complete immunity against a disease, that individual is at significantly less risk of contracting a disease that is easily spread. Vaccination is especially important for health professionals as they have more opportunity to be exposed to a disease and spread it.3

In 1905, the US Supreme Court decided Jacobson v Commonwealth of Massachusetts, a case involving smallpox vaccination.4

In this case, the Supreme Court recognized the “police powers” that states are granted under the Tenth Amendment, authorizing them to require immunization.5

Police powers are the authority of state governments to regulate public health, safety, and welfare. They allow the government to impose restrictions on an individual’s rights for the sake of public well-being.5 Arguments against this requirement claim it is a violation of constitutional rights. Others argue that the Jacobson case is not relevant to influenza, because the disease does not pose the same level of present danger as smallpox did.

However, “the Supreme Court did not limit its holding in Jacobson to diseases presenting a clear and present danger.”5

Despite these arguments, “the judiciary has consistently affirmed that an individual’s right to refuse immunization is outweighed by the community-wide protection conferred by immunization.”5

States may require the immunization of health care workers and of patients or residents of health care facilities, according to the CDC.6 The CDC’s Public Health Law Program has compiled a state-by-state list of such legislation.7

So, why is this such a hot topic? Hospitals have attempted many different techniques to increase immunization via their staff members, specifically those with direct patient care.

Despite numerous approaches to make vaccination as convenient as it could be, the only approach with successful near-total adherence is mandatory vaccination, often with the ultimatum that employees will be fired if they do not comply.3

Mandate supporters see vaccination as a great way to decrease the burden of influenza and increase patient safety. Requiring vaccination promotes public health, especially because the risk associated with receiving a vaccine is minimal. Studies show that the smaller the percentage of vaccinated employees in a hospital, the higher the patient death rate, illustrating how much a vaccine can increase safety for patients.3

Although mandatory vaccination pro - grams have many supporters, there are also a number of individuals who oppose them. One of the primary reasons for the opposition is that they are seen as a violation of the Health Insurance Portability and Accountability Act of 1996. Because many employers require a tag on employees’ name badges showing that they received the vaccine that season, a part of those employees’ health records is revealed to others. Another common concern that prevents many health professionals from receiving the influenza vaccine is a lack of trust in the vaccine itself. Many do not believe in the effectiveness and safety of the vaccine, whereas others lack trust in the health authorities and individuals promoting the vaccine.8 Finally, some unions representing nurses openly oppose vaccine mandates.

Although the unions support voluntary vaccination and strongly encourage mem - bers to receive vaccinations, they “believe that each health care worker should be entitled to make his or her own decision,” pointing out that all vaccines can pose risks.3

It is imperative to think about mandatory vaccines from the patient’s perspective. Who would want to be hospitalized during the height of influenza season only to find out that many of the staff members providing care decided not to receive the influenza vaccine that year? For some patients, this might not matter, and others may simply not be aware of the potential consequences. However, for patients who are immunosuppressed or otherwise vulnerable, this could be dangerous. When employers make decisions, it is important they keep in mind not only their employees but the patients those employees care for.

Finally, another issue is the COVID-19 pandemic. Because COVID-19 has many of the same symptoms as influenza, including body aches or muscle pain, cough, fever, difficulty breathing or shortness of breath, fatigue, fever, headache, runny or stuffy nose, and sore throat, it can be difficult to distinguish between the 2 diseases.9 Regardless of whether it is required by an employer, individuals should examine their situations and understand the importance of receiving the influenza vaccine, this year more than ever. Increasing vaccination numbers this influenza season will decrease the number of cases. This could prevent unnecessary COVID-19 screenings and testing due to the overlap of many symptoms.

Health professionals have a responsibility to care for patients. Although receiving a vaccine protects the health professional, it also protects patients. Does that make receiving the vaccine part of this responsi - bility? Or is mandating vaccination a violation of health care worker rights? These are questions to consider when discussing the implementation of mandatory vaccination.
KRISTIN A. MEYER is a PharmD-MBA candidate at the University of Kentucky College of Pharmacy in Lexington.

JOSEPH L. FINK III, JD, DSC (HON), BSPHARM, FAPHA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

  1. Immunization: the basics. Centers for Disease Control and Prevention. Updated May 16, 2018. Accessed January 22, 2021. https://www.cdc.gov/vaccines/vacgen/imz-basics.htm
  2. Vaccines: the basics. Centers for Disease Control and Prevention. Updated March 14, 2012. Accessed January 22, 2021. https://www.cdc.gov/vaccines/vpd/vpd-vacbasics.html
  3. Field RI. Mandatory vaccination of health care workers: whose rights should come first? P T. 2009;34(11):615-618.
  4. Jacobson v. Massachusetts . 197 U.S. 11 (1905). Justia. Accessed January 22, 2021. https://supreme.justia. com/cases/federal/us/197/11/
  5. Stewart, AM. Mandatory vaccination of health care workers. N Engl J Med. 2009;361(21):2015-2017. doi:10.1056/NEJMp0910151
  6. Requirements & laws: state vaccination requirements. Centers for Disease Control and Prevention. Updated November 15, 2016. Accessed January 22, 2021. https:// www.cdc.gov /vaccines/imz-managers/laws
  7. State vaccination requirements. Centers for Disease Control and Prevention. Updated February 28, 2018. Accessed January 22, 2021. https://www.cdc.gov/ vaccines/imz-managers/laws/state-reqs.html
  8. Pless A, McLennan SR, Nicca D, Shaw DM, Elger BS. Reasons why nurses decline influenza vaccination: a qualitative study. BMC Nurs. 2017;16:20. doi:10.1186/ s12912-017-0215-5
  9. Similarities and differences between flu and COVID-19. Centers for Disease Control and Prevention. Updated December 29, 2020. Accessed January 22, 2021. https://www.cdc.gov/flu/symptoms/flu-vscovid19.htm