PoPulationand Public HealtH etHics

Case
Mandatory immunization is contentious in any setting. While most public
health practitioners support vaccination as a public good, implementing
a policy requiring immunization of employees raises issues of autonomy,
leading to resistance to such a policy. An ethical analysis can help identify
potential issues and suggest ways to mitigate them.
Ensuring that employees are immune to vaccine-preventable diseases (VPDs)
provides a wide range of benefits for the public health unit. It prevents both
illness in employees and transmission of VPDs from employees to friends,
family or clients. Employees who are health-care professionals may already
require immunizations as part of their duty to protect clients under the policies
of their college or regulatory body. With well-established safety profiles
of routinely recommended vaccines, the potential harms of vaccination are
outweighed by the benefits to the individual employee and the community.
Although the benefits are apparent, the need for a mandatory immunization
policy to protect employee health should be carefully weighed against
less-coercive measures. Occupational health and safety policies addressing
other mechanisms to reduce the risk of employee exposure to VPDs, such as
personal protective equipment, should be in place. Immunization policies
also depend on the target disease. Because some VPDs such as chickenpox,
for instance, can be contagious before the individual is ill, immunization is
the only way for employees to fully prevent acquiring or transmitting the
infection. For influenza, a single immunization appears less coercive than
requiring employees to take daily antiviral prophylaxis for extended periods.
A mandatory policy must be fairly, reasonably and consistently applied within
the unit. Only applying the mandatory policy to new employees as a precondition
of employment, for instance, when these employees are performing
the same duties as existing employees is deemed unjust. Additionally, the
justification that the policy is needed to protect employee health would be
undermined by its differential application to the same job function.
The most significant consideration to a mandatory policy is the infringement
of individual rights in imposing immunization. Employees may refuse immunization
by claiming a violation of their right to “life, liberty and security of
the person” under Section 7 of the Charter of Rights and Freedoms. 2 Allowing
Mandatory immunization of local public health employees
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