Mandatory Immunization of Health Care Workers Leads to Controversy

Pharmacy TimesMarch 2024
Volume 90
Issue 3

Legal issues surfaced once again with the COVID-19 pandemic

Although many health care facilities implemented policies to mandate vaccinations for health care workers (HCWs) during the COVID-19 pandemic, hesitancy and mistrust remained a major concern among this important target group.1 HCWs have a clear responsibility to prevent transmission of infections because vaccine-preventable diseases continue to emerge sporadically, such as the current challenges associated with respiratory syncytial virus. COVID-19 raised the question once again: Should vaccine mandates be implemented to meet the challenges of an increasingly complex health care landscape?

Doctor hands holding a vaccine bottle and syringe,beginning of worldwide mass vaccination for coronavirus COVID-19,influenza or flu,world immunization concept. Selective focus - Image credit: Aron M - Austria |

Image credit: Aron M - Austria |

A long history of controversy surrounds mandatory immunization policies. An abundance of litigation based on such mandates has arisen in a wide variety of court systems. The leading legal authority recognizing such power for governmental units in the United States was the 1905 decision of the US Supreme Court in Jacobson v Massachusetts.2 In that case, the state had adopted a statute empowering cities and towns to enforce mandatory, free immunizations for adults older than 21 years. In 1902, there had been a smallpox outbreak, and the Cambridge Board of Health in Massachusetts ordered the vaccination or revaccination of all adults. A religious leader challenged that requirement, arguing that subjecting him to fines or imprisonment for nonadherence was an invasion of his liberty. The nation’s highest court did not agree with his arguments.2

About the Authors

Ali S. Abud is a biology major at Western University in London, Ontario, Canada.

Joseph L. Fink III, JD, DSc (Hon), BSPharm, FAPhA, is emeritus professor of pharmacy law and policy as well as former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

Fast-forward more than a century to the current day, when the US Supreme Court declined to hear employees’ challenges of immunization mandates. In these cases, employees challenging the mandates ranged from nurses in New Jersey to federal employees and members of the military.3-5

Public health officials cite patient safety as a core responsibility, whereas those in opposition continue to advocate for worker autonomy. Clearly, the ethical obligations of HCWs to do no harm must be carefully balanced with workers’ rights.6

Voluntary efforts to increase vaccination rates and stop the spread of contagious diseases have traditionally had mixed results.7 Seasonal influenza, which causes more than 290,000 deaths annually,8 has a Healthy People 2030 vaccination target goal of 90% among health care personnel, a figure that greatly exceeds the 70.2% immunization rate from survey respondents in an ambulatory-based study.9 It is estimated that roughly 60% of US HCWs support mandatory influenza vaccination policies. Still, opinions vary among different continents and demographics.10

In exploring possible alternatives to mandatory vaccination, one study implemented several interventions, including emailing staff informational pieces on the benefits of vaccines, improving vaccine accessibility within the health care facility, and increasing communication by providing influenza surveillance reports to employees. Through repeated emphasis on these measures, results from postintervention surveys revealed that the 90% vaccination rate among HCWs can be achieved without a formal vaccination mandate.9

Pharmacists can serve as educators and advocates and help dismantle barriers to receiving vaccines. Aside from addressing vaccine hesitancy, pharmacists can act as immunizers, when applicable, which has been shown to have a significant impact on vaccination rates.11

As one of the most cost-effective forms of health care intervention,12 vaccines play a vital role in contributing to the health and well-being of modern society. Mandatory immunization for HCWs, however, is a complex issue that requires considering both the benefits and ethical dilemmas of such a mandate. Policy makers should work closely with frontline workers to determine the best course of action that prioritizes patient safety while respecting worker autonomy.

  1. Maltezou HC, Theodoridou K, Ledda C, Rapisarda V, Theodoridou M. Vaccination of healthcare workers: is mandatory vaccination needed? Expert Rev Vaccines. 2019;18(1):5-13. doi:10.1080/14760584.2019.1552141
  2. Jacobson v Massachusetts, 197 US 11 (1905).
  3. Woolston G. Justices pass on nurses’ challenge to NJ vaccine mandate. LAW360. November 13, 2023. Accessed February 7, 2024.
  4. Schliep T. Justices vacate vax mandate injunctions as moot. LAW360. December 11, 2023. Accessed February 7, 2024.
  5. Schonfeld Z. Supreme Court wipes rulings on federal employee, military vaccine mandates. The Hill. December 11, 2023. Accessed February 7, 2024.
  6. Field RI. Mandatory vaccination of health care workers: whose rights should come first? P T. 2009;34(11):615-618.
  7. Van Hooste WLC, Bekaert M. To be or not to be vaccinated? the ethical aspects of influenza vaccination among healthcare workers. Int J Environ Res Public Health. 2019;16(20):3981. doi:10.3390/ijerph16203981
  8. Influenza (seasonal). World Health Organization. October 3, 2023. Accessed February 7, 2024.
  9. Frisina PG, Ingraffia ST, Brown TR, Munene EN, Pletcher JR, Kolligian J. Increasing influenza immunization rates among healthcare providers in an ambulatory-based, university healthcare setting. Int J Qual in Health Care. 2019;31(9):698-703. doi:10.1093/intqhc/mzy247
  10. Gualano MR, Corradi A, Voglino G, et al. Healthcare workers’ (HCWs) attitudes towards mandatory influenza vaccination: a systematic review and meta-analysis. Vaccine. 2021;39(6):901-914. doi:10.1016/j.vaccine.2020.12.061
  11. Le LM, Veettil SK, Donaldson D, et al. The impact of pharmacist involvement on immunization uptake and other outcomes: an updated systematic review and meta-analysis. J Am Pharm Assoc (2003). 2022;62(5):1499-1513.e16. doi:10.1016/j.japh.2022.06.008
  12. Rémy V, Zöllner Y, Heckmann U. Vaccination: the cornerstone of an efficient healthcare system. J Mark Access Health Policy. 2015;3:10.3402/jmahp.v3.27041. doi:10.3402/jmahp.v3.27041 \\
Related Videos
Concept of health care, pharmaceutical business, drug prices, pharmacy, medicine and economics | Image Credit: Oleg -
Image credit: |
Medical team -- Image credit: Flamingo Images |
Semaglutide Ozempic injection control blood sugar levels | Image Credit: myskin -
© 2024 MJH Life Sciences

All rights reserved.