Bradfield Owen M, Giubilini Alberto
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
Oxford Uehiro Centre for Practical Ethics & Wellcome Centre for Ethics and the Humanities, University of Oxford, Oxford, UK.
J Med Ethics. 2021 May 11;47(7):467-72. doi: 10.1136/medethics-2020-107175.
Seven COVID-19 vaccines are now being distributed and administered around the world (figure correct at the time of submission), with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity if properly implemented. Using the principle of least restrictive alternative, we have developed an intervention ladder for COVID-19 vaccination policies among healthcare workers. We argue that healthcare workers refusing vaccination without a medical reason should be temporarily redeployed and, if their refusal persists after the redeployment period, eventually suspended, in order to reduce the risk to their colleagues and patients. This 'conditional' policy is a compromise between entirely voluntary or entirely mandatory policies for healthcare workers, and is consistent with healthcare workers' established professional, legal and ethical obligations to their patients and to society at large.
目前，全球正在分发和接种七种新冠疫苗（提交时数据准确），还有更多疫苗即将问世。医护人员应享有高度优先权，这一点已得到广泛认可。然而，如果优先群体的成员拒绝接种疫苗，我们该怎么做，这一问题引发了人们的思考。以流感疫苗接种为例，我们知道，如果实施得当，强制接种疫苗的方法能有效提高医护人员的接种率，并降低患者的发病率。基于最小限制替代原则，我们为医护人员制定了新冠疫苗接种政策干预阶梯。我们认为，无医学原因拒绝接种疫苗的医护人员应被临时重新调配工作岗位，如果在重新调配期后仍拒绝接种，最终应予以停职，以降低对同事和患者的风险。这种“有条件”政策是医护人员完全自愿或完全强制接种政策之间的一种折衷，并且符合医护人员对患者和整个社会既定的专业、法律和道德义务。
