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By Maxwell J. Smith.
Consider: Kelly is a nurse who has been employed by her city’s general hospital for nearly thirty years. She is single, has two kids preparing to go to university, and a mortgage to pay. Her job is threatened when she is told that, as a condition of continuing her employment, she must be vaccinated against a novel pandemic virus. Kelly is unwilling to get the vaccine and is fired as a consequence.
Recognizing there are many considerations that should inform the ethical assessment of vaccine mandates, is it sufficient to simply point to the harms associated with Kelly losing her job to show that the vaccine mandate is unethical?
No, it’s not, because terminating someone’s employment can be justified irrespective of the harms that may be associated with their termination. In other words, failing to meet certain employment conditions, including health and safety conditions, can be considered disqualifying irrespective of the harms visited upon those unwilling to meet them. This is important to emphasize because objections to vaccine mandates grounded in the harms resulting from people being fired do not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of their jobs. If this were the case, the objection should centre on the baseless nature of the requirement, not (only) the harms that may be experienced by existing employees who are unwilling to be vaccinated. Yet, commentators frequently point to such harms as sufficient reason to object to vaccine mandates: “It’s not right that Kelly lost her job because of the vaccine mandate. She has two kids to feed and a mortgage to pay.” Alternatively, some argue the harms outweigh the benefits: “The harms to these people losing their jobs outweigh the harms they are apparently trying to prevent with the vaccine mandate.”
Instead, the pertinent question (which may in fact tacitly underlie objections to vaccine mandates grounded in the harms experienced by those fired as a result of them) is whether the mandate is justified in the first place. If a mandate is not justified (e.g., if it is useless, arbitrary, etc.), then firing people for failing to comply with it is clearly wrong. While this may seem rather obvious, what it reveals is that the locus of scrutiny shouldn’t be on the magnitude of harms associated with people losing their jobs as a result of mandates, but rather on whether such mandates are necessary and justified in the first place. If they are, then the harms employees may experience as a result of being unwilling to get vaccinated should not on their own be dispositive of whether or not such mandates are ethical. We should therefore be sceptical of arguments that simply count the harms experienced by those who are unwilling to be vaccinated as a sufficient reason to think vaccine mandates are unethical.
Now, this argument says nothing about the overall justification of vaccine mandates. And nothing I’ve said here should be taken to suggest we shouldn’t attempt to limit the negative consequences experienced by employees affected by vaccine mandates, for example, by offering reasonable and available alternatives, like remote work, or by providing reasonable accommodations to those for whom vaccination is medically contraindicated or in accordance with human rights obligations, or that we should be indifferent to the consequences of vaccine mandates for existing employees. What I have argued is more narrow, i.e., that the fact that people can lose their jobs as a result of vaccine mandates, and that these harms may be rather severe, is not on its own sufficient to tell us that vaccine mandates are unethical.
Paper title: The ethics of firing unvaccinated employees
Author: Maxwell J. Smith
Affiliations: Faculty of Health Sciences and Rotman Institute of Philosophy, Western University
Competing interests: None declared
Social media accounts of post author: @maxwellsmith
The post Vaccine mandates can result in people losing their jobs. Does that make them unethical? appeared first on Journal of Medical Ethics blog.
Enlarge / Florida surgeon general Joseph Ladapo speaks at a press conference. (credit: Getty | Paul Hennessy)
Florida health officials deleted key data and statistics from a state analysis on the safety of mRNA COVID-19 vaccines, falsely making them appear unsafe for young men, according to draft versions of the analysis obtained by the Tampa Bay Times through public records requests.
The final analysis, which was widely criticized for its poor quality and dubious conclusions, was the basis for a statewide recommendation by Surgeon General Joseph Ladapo last October that young men, ages 18 to 39, should not receive an mRNA COVID-19 vaccine. The analysis—posted on the Florida Department of Health's website with no authors listed—claimed to find "an 84% increase in the relative incidence of cardiac-related death among males 18-39 years old within 28 days following mRNA vaccination."
Ladapo, who has a history of fearmongering about COVID-19 vaccines, touted the analysis, saying in a press release at the time that "these are important findings that should be communicated to Floridians.”
About a year ago, Dicky Barrett — then lead singer of the legendary ska band, the mighty mighty Bosstones — coproduced an anti-vax musical anthem with professional anti-vaxxer Robert Kennedy, Jr. Several days later, the Bosstones abruptly announced that the band was finally, officially done for. — Read the rest
Enlarge / A medical director in Germany sits in front of a monitor showing the real-time data of a patient with a heart attack. (credit: Getty | Arne Dedert)
A bout of COVID-19 is known to increase a person's long-term risks of having a major cardiovascular event, such as a heart attack or stroke. But being fully vaccinated or even partially vaccinated appears to bring that risk down, according to a study published this week in the Journal of the American College of Cardiology.
The study, led by researchers at Icahn School of Medicine at Mount Sinai in New York, drew on medical records from over 1.9 million patients who were infected with COVID-19 between March 2020 and February 2022. Of those 1.9 million patients, a "major adverse cardiac event," namely a heart attack, stroke, or another cardiac event, was identified in 13,948 patients, and 3,175 died following the event.
Overall, the researchers found that being vaccinated—fully or partially—was linked to fewer cardiac events in the six months following a case of COVID-19. After adjusting for demographics, comorbidities, and time since the pandemic began, the researchers found that being fully vaccinated reduced the risk of having a major cardiac event by about 41 percent, while being partially vaccinated reduced the risk by about 24 percent.
Enlarge / Those lab coats aren't going to protect you from your own biases. (credit: Caiaimage/Robert Daly)
It's no secret that ideology is one of the factors that influences which evidence people will accept. But it was a bit of a surprise that ideology could dominate decision-making in the face of a pandemic that has killed over a million people in the US. Yet a large number of studies have shown that stances on COVID vaccination and death rates, among other things, show a clear partisan divide.
And it's not just the general public having issues. We'd like to think people like doctors would carefully evaluate evidence before making treatment decisions, yet a correlation between voting patterns and ivermectin prescriptions suggests that they don't.
Of course, a correlation at that sort of population level leaves a lot of unanswered questions about what's going on. A study this week tries to fill in some of those blanks by performing controlled experiments with a set of MDs. The work clearly shows how ideology clouds professional judgments even when it comes to reading the results of a scientific study.
Enlarge / Transmission electron micrograph of poliovirus type 1. (credit: Getty | BSIP)
An eradicated form of wild polio surfaced in routine wastewater monitoring in the Netherlands last year, offering a cautionary tale on the importance of monitoring for the tenacious virus, researchers report this week in the journal Eurosurveilance.
The sewage sample came up positive for infectious poliovirus in mid-November and genome sequencing revealed a strain of wild poliovirus type 3, which was declared globally eradicated in 2019. Its potential revival would be a devastating setback in the decades-long effort to stamp out highly infectious and potentially paralytic germ for good.
For brief background, there are three types of wild polioviruses: type 2 and type 3 have been eradicated, with the former being knocked out in 2015. Wild poliovirus type 1 continues to circulate in Afghanistan and Pakistan. There are also occasional vaccine-derived polioviruses that circulate in communities with low vaccination rates, which recently occurred in New York.
Enlarge / US President Joe Biden speaks to members of the media on the South Lawn of the White House in Washington, DC, US, on Monday, Jan. 30, 2023. (credit: Getty | Chris Kleponis/Bloomberg)
President Joe Biden plans to end two national emergency declarations over the COVID-19 pandemic on May 11, which will trigger a restructuring of the federal response to the deadly coronavirus and will end most federal support for COVID-19 vaccinations, testing, and hospital care.
The plan was revealed in a statement to Congress opposing House Republicans' efforts to end the emergency declarations immediately.
“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system—for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” the Office of Management and Budget wrote in a Statement of Administration Policy.
Enlarge / Dr. Peter Marks, director of the Center for Biologics Evaluation and Research within the Food and Drug Administration, testifies during a Senate Health, Education, Labor, and Pensions Committee hearing on the federal coronavirus response on Capitol Hill in March 2021, in Washington, DC. (credit: Getty | Pool)
The US Food and Drug Administration's committee of independent vaccine experts gathered Thursday to discuss the future of COVID-19 shots. The meeting seemed primed for explosive debate. Earlier in the week, the FDA released documents that made clear the agency is holding steadfast to its idea that COVID vaccines will fit the mold of annual flu shots—with reformulations decided in the first half of each year, followed by fall rollouts in anticipation of winter waves.
But outside experts, including some on the FDA's advisory committee, have questioned almost every aspect of that plan—from the uncertain seasonality of COVID-19 so far, to the futility of chasing fast-moving variants (or subvariants, as the case may be). Some have even questioned whether there's a need to boost the young and healthy so frequently when current vaccines offer protection against severe disease, but only short-lived protection against infection.
One particularly outspoken member of FDA's committee, Paul Offit, a pediatrician and infectious disease expert at Children’s Hospital of Philadelphia, has publicly assailed the bivalent booster, writing a commentary piece in the New England Journal of Medicine earlier this month titled: Bivalent Covid-19 Vaccines — A Cautionary Tale. (The FDA's advisory committee voted 19-2 in support of the bivalent boosters last year, with Offit being one of the two votes against.)
Enlarge / A container of syringes used to administer COVID-19 vaccine. (credit: Getty | Hannah Beier/Bloomberg )
A Utah plastic surgeon and three of his associates are facing federal charges for a year-long scheme in which they allegedly squirted around 2,000 vaccine doses down the drain, sold falsified vaccination cards for $50 each, and tricked kids into thinking they were vaccinated against COVID-19 by injecting them with saline, collectively, 391 times.
Federal prosecutors last week indicted Dr. Michael Kirk Moore Jr., who owns and operates Plastic Surgery Institute of Utah in Midvale, south of Salt Lake City, as well as the business' office manager, Kari Dee Burgoyne, its receptionist, Sandra Flores, and a neighbor of Moore's, Kristin Jackson Andersen. All four are charged with conspiracy to defraud the federal government, along with two counts related to improper disposal of government property.
According to the indictment, which was unsealed on January 17, Moore, Burgoyne, Flores, and Andersen set up a scheme in which the plastic surgery practice became a legitimate COVID-19 vaccine provider. Moore signed the government's COVID-19 Vaccination Program Provider Agreement in May 2021, allowing the site to receive bona fide, government-purchased COVID-19 doses. Between October 15, 2021, and September 6, 2022, the group ordered around 2,200 vaccine doses from the federal government.
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