PoPulationand Public HealtH etHics

policy
for exemptions and declinations helps preserve these rights. To create a true
choice, however, the consequences of exemptions and declinations should be
reasonable in terms of protecting employee health without being punitive.
Re-assignment of work during a potential exposure is likely acceptable, but
some staff may view being on leave without pay as punitive.
Based on this analysis, the need for and benefits of employee immunization
are re-affirmed. The major argument of infringement of autonomy is mitigated
by allowing for exemptions and declinations.
Scenario shift
In the event of an influenza pandemic, if a vaccine is not yet available, a large
number of employees would be required to take daily antivirals for weeks to
prevent illness. Experience is minimal for using antivirals in this way and,
therefore, there is no evidence of their safety and efficacy as prophylaxis
for a large, healthy working population. The risk assessment would have to
consider the risk of exposure to influenza, severity of the influenza, other
preventive measures, time until a vaccine is available, known risks of the
antivirals and the unknown risks of using them in a large population for an
extended period of time.
In this situation, the ethical consideration of employee autonomy has a stronger
bearing compared to mandatory immunization with routine vaccines.
Mandatory antiviral prophylaxis may not be justified given its unknown benefit
and potential side effects. Voluntary prophylaxis may be preferred, but
accommodating all employees who refuse may not be feasible and exposing
them without prophylaxis could lead to occupationally acquired influenza.
Questions for discussion
1 A health unit employee who is susceptible to chickenpox signed the
declination statement refusing immunization. Without known exposures
to chickenpox, the employee was allowed to continue in his
or her position of health promoter. However, the employee became
infected with chickenpox and was infectious while teaching a class
of expectant mothers. Should this event change the immunization
policy?
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