Monday, June 17, 2024

Rozeman: Why some healthcare workers say ‘no’

by BIZ Magazine

My parents taught me not to cast judgment unless I first walk in the shoes of the person I am judging. When I learned the Supreme Court upheld the Federal Government vaccine mandate, I knew there were going to be many working within my hospital who would lose their job. The issue of government ordered vaccine mandates will hit close to home.

Let me first be fully transparent. I was near the front of the line to get the mRNA vaccine and booster. I am a 65 year old physician that does a great deal of work in the ER and ICU and have consulted on many very ill COVID patients. With that said, I realize my situation is not the same as others who might decide not to undergo vaccination.

Healthcare providers—doctors, nurses, and allied health professionals—all get instruction in immunology in their education. They understand T cells, B cells, and antibodies. They understand that the body creates a tremendous antibody response to viral illness like the flu and other common viruses. To many, the idea that natural immunity doesn’t matter conflicts with what they have learned and experienced.

When they see large studies from Israel and the Cleveland Clinic specifically support the importance of natural immunity in COVID, they are highly skeptical of public health pronouncements to the contrary. Being a group with increased incidence of COVID illness over the general population, the issue of natural immunity takes on even greater importance. Many of those refusing vaccines worry vaccines may create risks for them without concomitant benefit if they already have natural immunity.

Healthcare workers know sometimes new risks are discovered after new treatments are released for general use. Many young women who make up a significant proportion of the healthcare workforce are concerned about the potential impact of the vaccine on pregnancy and infertility. Over time, evidence tipping the scale for benefits of the vaccine in pregnancy has decreased but not eliminated skepticism. The same is true in the area of infertility where the vaccine has not been used long enough to really be certain about the impact.

A significant percentage of healthcare workers—especially in the hospital—fall in the COVID lower risk category of young people in their 20’s and 30’s without significant underlying health issues. They know the impact of serious COVID illness is lower in their demographic and that is confirmed with their own experience at work. They know the overwhelming majority of people with serious COVID illness are older, overweight, and chronically ill before they get sick with COVID.

Many of my colleagues believe these vaccine mandates threaten the foundation principles of freedom, individual autonomy, and personal sovereignty regarding medical treatment. They believe the threshold to justify usurping individual patient rights to choose requires proof of exceptional benefit and zero or near zero harm. Many don’t believe the COVID vaccine even comes close to clearing this bar to justify a vaccine mandate.

They know the COVID vaccine is much less valuable in preventing the spread of COVID infection and more valuable to prevent serious illness in the person receiving it. They know the original main reason for mandates was preventing spread and this benefit of the vaccine is much less notable with the Omicron variant. The original main reason for vaccine mandate is no longer as pressing a concern. This will be especially true as new therapeutics become even more available.

At the start of the pandemic, we initiated lockdowns to reach our goal of flattening the curve to protect the healthcare system. What we have learned over the course of the pandemic is that the healthcare system is not really limited by the number of hospital beds. The limitation is sufficient healthcare workforce to take care of the people in those beds.

The healthcare workforce shortage is real. The presence of burnout, difficult working conditions, illness, and viral infections—seasonal and COVID—should cause us to pause before adding vaccine mandates as another negative impact on our worker shortage.

It is easy to criticize people who refuse vaccination but these people staffed our hospitals and faced COVID every day over the last two years. There have also been vaccine complicatons.  I can only hope this thought piece allows people to better understand and at least reduce the vitriol directed at people who have chosen not to be vaccinated.

Beyond this, I hope the plight of the people who lose their job in healthcare or another sector are re-examined when the surge of Omicron is over—and that will be soon. Easter or Memorial Day holiday make good re-evaluation points for us to consider reversing vaccine mandates at school and at work.

Justifying use of the vaccine mandates will just get harder and harder as the Omicron surge disappears and new therapeutics become available. Way too little attention has been paid to the law of unintended consequences and learning from mistakes in health policy during this pandemic. My hope is that the future brings the same diligence to removing restrictions as we have had to adding them.

Dr. Phillip Rozeman is a practicing cardiologist. He is a recent recipient of the Distinguished Service Award from the Northwest Louisiana Medical Society and Council for a Better Louisiana and is past recipient of the John Miciotto Healthcare Lifetime Achievement Award.

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