Covid-19 vaccination decisions and impacts of vaccine mandates: A cross sectional survey of healthcare workers in British Columbia, Canada

Abstract Background Since vaccination mandates in the healthcare sector were introduced across Canada, public health authorities in the province of British Columbia implemented among the strongest ones in the country. While some workers unions opposed these mandates, they were supported by most health establishments, policymakers, and academics. Ensuing labour shortages compounded the ongoing health crisis in the province, leading to mounting calls to lift mandates and allow non-compliant, terminated or suspended, workers to return and ease pressures on the system. Nevertheless, mandates remained effective until July 2024, over one year after the World Health Organization had ended its declared Covid-19 global health emergency. Most research has focused on the perceived problem of vaccine hesitancy among healthcare workers, yet not on their lived experience of the policy or their views on its impact on access to, and quality of, patient care. Goal To document the experience and views on mandated vaccination of healthcare workers in British Columbia. Methods Between May and July of 2024, we conducted a cross-sectional survey of healthcare workers in British Columbia. We recruited participants through a snowball sampling approach, including professional contacts, social media, and word-of-mouth. Results Close to half of respondents, with 16 or more years of professional experience, were unvaccinated, and most had been terminated due to non-compliance with mandates. As well, and regardless of vaccination status, most respondents reported safety concerns with vaccination and felt unfree to make their own vaccination choices, yet did not request exemptions due to high rejection rates by employers. Most of them also reported experiencing anxiety or depression, with about one fourth considering suicide, as a result of mandates. Nevertheless, most unvaccinated workers reported satisfaction with their choices, although they also reported significant, negative impacts of the policy on their finances, their mental health, their social and personal relationships, and to a lesser degree, their physical health. In contrast, within the minority of vaccinated respondents, most reported being dissatisfied with their vaccination decisions, as well as having experienced mild to serious post vaccine adverse events, with over half within this group reporting having been coerced into taking further doses, under threat of termination, despite these events. Further, a large minority of all respondents reported having witnessed underreporting or dismissal by hospital management of adverse events post vaccination among patients, worse treatment of unvaccinated patients, and concerning changes in practice protocols. Nearly half also reported their intention to leave the healthcare industry. Discussion Our findings indicate that in British Columbia, mandated vaccination in the healthcare sector had an overall negative impact on the well-being of the labour force, on the sustainability of the health system, on patient care, and on ethical healthcare practice. Findings resemble those of a similar study in the province of Ontario, with perhaps the most salient difference being that in British Columbia the policy was implemented at the provincial, rather than the healthcare establishment, level, leaving no room for individual establishments to opt out. Conclusions Measured against the 2021 criteria proposed by the Organization for Economic Cooperation and Development to evaluate the merits or lack thereof of public policy, the policy of mandated vaccination in British Columbia failed on several fronts - scientific, pragmatic, and ethical. Future research should examine why this and similar policies persist despite the evidence against them. Findings from this and similar studies should be considered, especially during emergencies, to guarantee the quality of the evidence informing policy, health systems sustainability, and the human rights to bodily autonomy and informed consent of both healthcare workers and members of the public.

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