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Mandatory COVID-19 vaccination for healthcare workers: Need of the hour

1 Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, India
2 Department of Microbiology, Viral Research Diagnostic Laboratories, Government Doon Medical College, Dehradun, Uttarakhand, India

Date of Submission24-Jul-2021
Date of Acceptance17-Aug-2021

Correspondence Address:
Deepak Juyal,
Department of Microbiology, Viral Research and Diagnostic Laboratory, Government Doon Medical College, Dehrakhas, Patel Nagar, Dehradun - 248 001, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wjnm.wjnm_91_21

How to cite this URL:
Juyal D, Pal S, Negi N, Thaledi S. Mandatory COVID-19 vaccination for healthcare workers: Need of the hour. World J Nucl Med [Epub ahead of print] [cited 2022 Jun 29]. Available from: http://www.wjnm.org/preprintarticle.asp?id=329785

Dear Editor,

The world is in the mid of an ongoing coronavirus disease-2019 (COVID-19) pandemic caused by the emergence of a 2019-novel coronavirus or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), as it is now known.[1] The global health crisis caused due to the COVID-19 pandemic and the damage to health, wealth, and well-being have been enormous. The consequences of the same have been far reaching, particularly among the healthcare workers (HCWs), who got infected and succumbed to COVID-19 globally. The overall global magnitude of COVID-19 among HCWs during the first wave was recently documented in a survey from 37 countries, wherein the authors have documented 2736 HCW deaths.[2] The WHO Director General, Dr. Tedros Adhanom Ghebreyesus also emphasized during the announcement of the WHO Health Worker Safety Charter September 17, 2020, that “thousands of health workers infected with COVID-19 have lost their lives worldwide.”[3] According to the WHO, 14% of the COVID-19 cases reported worldwide were among HCWs, and in some low- and middle-income countries, the number has been as high as 35%.[4]

HCWs, particularly the doctors and nursing staff, are at highest risk of acquiring COVID-19 infection or spreading it to their patients. The situation turns out to be more challenging in low- and middle-income countries, where the healthcare systems are already weak but overwhelmed and the HCWs are working under stressful conditions, sometimes even without proper personnel protective equipment (PPE). A recent review published by Mhango et al. identified lack of and/or inadequate PPE, exposure to infected patients, work overload, poor infection control practices, and preexisting medical conditions as the important risk factors for COVID-19 infection among HCWs.[5] The capability of SARS-CoV-2 to be transmitted from asymptomatic and presymptomatic individuals may also contribute to the increased risk among HCWs. Estimates based on pooled serological studies carried out in different countries suggest that 7%–8.7% of HCWs were infected by SARS-CoV-2.[6] Data available from various other studies also suggested that frontline HCWs had greater exposure to SARS-CoV-2 infection as compared to nonclinical staff.[7],[8],[9] As per the data available from the Indian Medical Association, while 748 doctors died in the first wave of COVID-19 last year, 776 doctors have succumbed to COVID-19 during the second wave across India.[10] Moreover, the shortage of HCWs in India, with only one doctor for every 1511 people and one nurse for every 670 people, which is well below the WHO's minimum norms, is another crucial challenge for the country.[11]

As the highly effective and safe COVID-19 vaccines are now available and with the ongoing worldwide vaccination drive, not only the active cases of COVID-19 have declined but also the number of patients seeking hospitalization has also decreased substantially. Mounting evidence suggests that the vaccines are associated with decreased asymptomatic infections and transmission of SARS-CoV-2.[12] Moreover, among those who have been vaccinated but still got infected, the severity of infection has been considerably low and the hope of the return of healthcare system to pre-COVID-19 era has grown stronger. As of now, the pandemic is still rapidly increasing in some parts of the world and the protection of HCWs is imperative as they are at the forefront of fighting the pandemic. The formulation of effective and efficient occupational health policies for HCWs, especially in the context of COVID-19 pandemic, is the need of the hour. Mandatory COVID-19 vaccination for all the HCWs is one such important preventive measure and if implemented will not only be helpful to mitigate HCWs exposure risk to COVID-19 infection but will also ensure the safety of their patients, family members, and fellow HCWs. A study from the United Kingdom reported a lower risk of COVID-19 infection among household contacts of vaccinated HCWs compared with household members of unvaccinated HCWs.[13] A recent report of COVID-19 outbreak in a skilled nursing facility attributed to an unvaccinated HCW underlines that the risk unvaccinated HCWs can pose to their patients and other HCWs.[14]

The recognition of HCW vaccination is an essential component of patient and HCW safety programs emerged during the mid-2000s with a focus on influenza vaccination. Mandatory influenza vaccination programs for HCWs have been associated with high vaccination rates and a significant decrease in healthcare-associated influenza among hospitalized patients as well as among HCWs.[15] Similar policies can be adopted for formulating mandatory COVID-19 vaccination scheme for HCWs; however, there are several logistic concerns that need to be addressed. First, it is still unclear that any vaccine approved under EUA by the US-FDA can actually be mandated or not. Second, separate provisions should be made for HCWs who cannot be vaccinated due to some contraindicated medical conditions. For instance, some individuals may develop allergic reactions after first dose of an mRNA vaccine and may not be able to receive second dose to achieve full immunity. Such individuals should be able to opt for other types of COVID-19 vaccines (vector vaccines or inactivated whole-virus vaccine) so that the percentage of unvaccinated HCWs remains low. Third, alternative approaches for HCWs who refuse to get vaccinated should be included. Such HCWs should adhere to strict infection control measures such as hygiene protocols and use of masks and PPEs while working in healthcare facility and should undergo periodic testing for any asymptomatic infection while SARS-CoV-2 is still circulating. Moreover, an exemption to vaccination on religious or personal beliefs is another complicated situation, more so in Indian setting, and needs to be reviewed thoughtfully with a nonjudgmental approach.

COVID-19 infections and deaths among HCWs add on to the existential health crisis and can paralyze the already overwhelmed healthcare infrastructure. The ongoing tragedy will continue as long as most nations will lack effective occupational health policies for HCWs. Data on the effectiveness of COVID-19 vaccines against symptomatic as well as asymptomatic COVID-19 infection are promising, and considering the global impact of the COVID-19 pandemic, particularly among the HCWs, it is imperative to implement mandatory COVID-19 vaccination for them. HCWs are vital resources for the healthcare system of any nation; their health and safety are crucial and of paramount importance. Evidence shows that institutional policies and state laws if implemented effectively and efficiently can increase the vaccination rates among HCWs and decrease the rate of transmission in healthcare settings. However, addressing the legal, ethical, administrative, and attitudinal barriers is required to achieve the same.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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WHO Geneva. Keep Health Workers Safe to Keep Patients Safe. Available from: https://www.who.int/news-room/detail/17-09-2020-keep-health-workers-safe-to-keep-patients-safe-who. [Last accessed on 2021 Jun 28].  Back to cited text no. 3
Sharma NC. 14% of Global COVID-19 Cases are Among Health Workers: WHO. Available from: https://www.livemint.com/news/india/14-of-global-covid-19-cases-are-among-health-workers-who-11600406028538.html. [Last accessed on 2021 Jul 04].  Back to cited text no. 4
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Gómez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Díaz ZM, Wyssmann BM, et al. COVID-19 in health-care workers: A living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol 2021;190:161-75.  Back to cited text no. 7
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Calcagno A, Ghisetti V, Emanuele T, Trunfio M, Faraoni S, Boglione L, et al. Risk for SARS-CoV-2 infection in healthcare workers, Turin, Italy. Emerg Infect Dis 2021;27:303-5.  Back to cited text no. 9
Abraham B. 776 Doctors Have Died During Second Wave Of COVID-19 in India, More Deaths Than in First Wave. Available from: https://www.indiatimes.com/news/india/doctor-deaths-second-covid-wave-india-ima-543581.html. [Last accessed on 2021 Jul 03].  Back to cited text no. 10
Kwatra N, Imad S. COVID-19: Trauma from India's Second Wave May Have Lingering Effects on its Frontline Workers. Available from: https://scroll.in/article/998947/covid-19-trauma-from-indias-second-wave-may-have-lingering-effects-on-its-frontline-workers. [Last accessed on 2021 Jul 07].  Back to cited text no. 11
Centers for Disease Control and Prevention. Science Brief: COVID-19 Vaccines and Vaccination. Available from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html. [Last accessed on 2021 Jul 04].  Back to cited text no. 12
Shah AS, Gribben C, Bishop J, Hanlon P, Caldwell D, Rachael W, et al. Effect of vaccination on transmission of COVID-19: An observational study in healthcare workers and their households. medRxiv 2021; doi: 10.1101/2021.03.11.21253275. Available from: https://www.medrxiv.org/content/10.1101/2021.03.11.21253275v1.full.pdf [Last accessed on 2021 Jun 30].  Back to cited text no. 13
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