ROCHESTER, Minn. — As the Jan. 4 deadline approaches for large employers to certify COVID-19 vaccination for all employees, researchers have begun to make a case for the narrower question of mandatory vaccination in health care settings.

The legal foundation for requiring vaccination is not considered controversial.

"Given existing information about COVID-19 vaccines and current EEOC/CDC guidelines, the question faced by healthcare organizations ... is not so much whether vaccination can be mandated legally, rather whether it is ethically justifiable to do so," wrote a coalition of physician-authors in a Society of Critical Medicine blog post last summer.

For a team of medical ethicists writing in the latest issue of the journal Mayo Clinic Proceedings, the duty of health care workers to get vaccinated is an easy call as well.

"You don't want to expose patients ... who are by definition vulnerable especially if they are in the ICU, to the risk of getting COVID," says Robert S. Olick, Associate Professor Emeritus, the Center for Bioethics and Humanities SUNY Upstate Medical University.

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As co-author of "Ethical Issues in Mandating COVID-19 Vaccination for Health Care Personnel," Olick says the basis for requiring vaccination comes down to greater good.

"There's clear evidence supporting the idea that vaccination is important and works to protect the health care institution, the community and surrounding community against infection with a highly contagious and potentially life-threatening virus and disease. So the rationale of protecting the greater good for the greater number outweighs respect for individual choice to say no, I don't want to be vaccinated."

Olick says a common counter-argument that the vaccinated need not worry about the unvaccinated is weakened by the fact of breakthrough infections and high percentages of immunocompromised patients not fully protected by vaccination.

He saves a sharp critique for those who would depict the refusal to take a vaccine as an expression of individual choice.

"While I would strongly support the right of everybody to make their own health care decisions," he says, "freedom to choose and to choose not be vaccinated ends when risk of harm to others begins. In other words, you can make that choice, but there are potential consequences for refusing vaccination."

Of those who face getting fired, he says this:

"I would characterize that sort of situation as unfortunate but not unfair."

"What sometimes is missing is the idea that while you may have a right to say no to vaccination, you don't have a right to put others in harm's way."

ICU beds at capacity

Ethcists say the refusal by health care workers to get vaccinated creates an undue burden on those who must work overrun, understaffed hospitals and ICU's, a phenomenon now affecting over one half of the state. (Graphic: Minnesota Department of Health)
Ethcists say the refusal by health care workers to get vaccinated creates an undue burden on those who must work overrun, understaffed hospitals and ICU's, a phenomenon now affecting over one half of the state. (Graphic: Minnesota Department of Health)

Statewide, 55 of 91 staffed ICUs are effectively maxed out In Minnesota, with less than 5% of beds available. As for non-urgent beds, 65 of 130 of all non-ICU beds are at capacity as well.

At 1,159 persons hospitalized with COVID-19 in the state, the ongoing crunch is believed to be causing ripple effects throughout the system.

"There are additional burdens placed on the health care staff who are vaccinated and who are working when the unvaccinated are not able to do the jobs they were doing," Olick says.

"Other people have to pick up the slack to care for patients. That's an unwelcome burden and it also poses potential risks to patients."

Asked what those who see the issue only in terms of individual rights are missing, Olick says it comes down to a missing sense of obligation to others. And he breaks those who are "stubbornly opposed" into two types.

"In my view, you could sort most of those people into two categories, those who are have opposition to other vaccines and not just this one, and those who, for whatever reason, have singled out the COVID vaccine as something that they object to even though all health care personnel have for many years complied with vaccination requirements."

"My best guess is some of these folks have embraced the idea that this a political and cultural statement."