Compulsory vaccinations for health care workers: the honor of a profession
Press release from the French National Academy of Medicine[1]
March 31, 2023
A public consultation on the vaccination requirements imposed on health professionals was launched on November 14, 2022 by the French “Haute Autorité de Santé (HAS)” (High Health Authority) [1]. The aim was to maintain or modify the current vaccination requirements for diphtheria, tetanus, poliomyelitis, hepatitis B and Covid-19. This consultation revives a necessary debate on the choice between recommendation and obligation, needing to take into account the epidemiological situation of the target diseases, the health risks involved and the benefit/risk balance specific to each vaccination.
The polemical positions sometimes expressed in favor or against compulsory vaccination should not make us forget that the profession of healthcare provider is not a profession like any other and that it imposes a moral commitment respecting the “Primum non nocere” principle. Thus, the caregiver vaccination against some infectious diseases reduces two risks associated with their care activity: that of being infected by patients and, conversely not to infect them. While these risks have become minimal for diphtheria and poliomyelitis, they remain major for hepatitis B and must be considered for two nosocomial respiratory infections, influenza and Covid-19.
In France, 129 episodes of nosocomial influenza were reported between 2001 and 2010, with a total of 1,623 cases and 48 deaths among hospitalized patients [2]. Although influenza vaccination of healthcare professionals has been strongly recommended for several decades, vaccination coverage rates remain very low, estimated between 22% and 26% in March 2022 [3]. This failure justifies the reinstatement of compulsory vaccination, which was adopted in 2006 before being unfortunately suspended the same year by the “Conseil supérieur d’hygiène public de France” (Super Council of public Hygiene of France) [4].
Mandatory vaccination against Covid-19 was introduced on September 15, 2021 for all professionals working in the health and medico-social sectors in order to fight against nosocomial transmission of SARS-CoV-2, which is particularly deadly in the elderly or immunocompromised people. Because of the limited duration of current vaccine effectiveness against infection, shorter than the protection against severe forms, HAS recommends that people most at risk of severe forms of Covid-19 be vaccinated next fall as well as against influenza [5]. This coupling should inspire the implementation of a mandatory annual vaccination program for healthcare personnel in order to ensure effective vaccination coverage during the winter season in all healthcare and medico-social establishments housing at-risk patients. This vaccination obligation should also concern nursing staff and care assistants working with people at risk kept at home.
Far from being an attack to individual freedom, the vaccination requirements that apply to health professionals are essential preventive measures to avoid the nosocomial transmission of infections; accepted by health care workers as one of the practices aimed at protecting increasingly elderly and frail hospitalized patients, they honor their profession.
The French National Academy of Medicine recommends that annual vaccinations, each fall, against influenza and Covid-19 be included in the vaccination obligations for professionals working in the health and medico-social sectors.
References
- Haute Autorité de Santé (French High Health Authority). Vaccination obligations and recommendations for professionals. Framework, January 18, 2023wo
- Bonmarin I et al. Nosocomial influenza infections and caregivers, France, 2001-2010. Bull Épidémiol Hebd. 2011; 35-36: 379-81
- Santé Publique France. Vaccination coverage survey, June 1, 2022. file:///C:/Users/yvesb/Downloads/2022_LePointSur_ES_grippe_010622.pdf
- Press release of the French National Academy of Medicine “Vaccinating all caregivers against the flu: an obvious obligation”, September 19, 2020
- Haute Autorité de Sante (French High Heath Authority). Strategy for vaccination against Covid-19. Anticipation of vaccination campaigns in 2023; Recommendation of 23 February 2023.
[1] Communiqué from the Academy’s Rapid Communication Platform.
