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- Page navigation anchor for RE: Mandatory SARS-Cov-2 vaccination for PhysiciansRE: Mandatory SARS-Cov-2 vaccination for Physicians
Dear Sir,
I just read your editorial in the January paper CMAJ edition. I now see that it was published on-line in November last year. Do the editors of CMAJ still hold this view?
As a nearly retired neonatologist I was very grateful to finally receive my SARS-CoV-2 vaccinations. However I strongly disagree with your position that Covid vaccination should be mandatory for physicians. In our society we have taken huge steps to ensure that all healthcare interventions require informed consent. It doesn't matter whether the patient is offered treatment for hypertension, cosmetic surgery or assisted dying: there should be no coercion.
One year ago I might have agreed that the covid vaccine be an exception to the general rule. However with the current vaccine evading new variants, it has become clear that universal vaccination will not bring an end to the current pandemic. The latest data will confirm that the vast majority of Canadians contracting and transmitting the omicron variant have already been vaccinated. Transmission in health care settings is relatively unusual and patients are not contracting the virus from unvaccinated healthcare workers. The only residual benefit of the current vaccine is that a covid infection is likely to be less severe. This is a huge contrast to some other vaccines, such as measles, which actually have some public health value. That said, if I was offered measles vaccination I would refuse: I have had measles. This...
Show MoreCompeting Interests: None declared.References
- Andrew D. McRae, Andreas Laupacis. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 2021;193:E1816-E1817.
- Page navigation anchor for RE: SARS-CoV-2 vaccination should be required to practice medicine in CanadaRE: SARS-CoV-2 vaccination should be required to practice medicine in Canada
Dear Editor,
Drs. McRae and Laupacis (CMAJ Jan 2022) demand that all physicians should be vaccinated against SARS-CoV-2 before being permitted to practice medicine. The authors claim that a physician “choosing not to be vaccinated puts patients and colleagues at risk.” However, recent studies conclude that the impact on community transmission of circulating variants of SARS-CoV-2 by vaccinated people is “not significantly different from the impact among unvaccinated people.” Furthermore, breakthrough infections among fully-vaccinated health-care workers in Israel is not consistent with the idea that vaccination of physicians will protect patients from becoming infected. There is also evidence that peak viral titres in the upper airways of the lungs and culturable virus are similar in vaccinated and unvaccinated individuals. In light of the increasing number of studies demonstrating that vaccinated individuals are just as likely to spread SARS-CoV-2 virus as unvaccinated individuals, the suggestion by McRae and Laupacis that unvaccinated physicians do not provide “effective and safe care” appears unsupported by the growing evidence.
Competing Interests: None declared.References
- McRae AD, Laupacis A. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 193:E1816-E1817
- Franco-Paredes C. Transmissibility of SARS-CoV-2 among fully vaccinated individuals. The Lancet/Infection Jan 2022, Vol 22, P16
- Page navigation anchor for RE: "SARS-CoV-2 vaccination should be required to practise medicine in Canada"RE: "SARS-CoV-2 vaccination should be required to practise medicine in Canada"
McRae and Laupacis suggest that physicians should not be permitted to do in-person medical work if they aren't vaccinated against Covid-19, with the primary rationale of reducing risk of transmission to patients and colleagues - essentially a "vaccine mandate for doctors." This is a knee-jerk reaction. It reminds me of that quote, "For every complex problem there is an answer that is clear, simple - and wrong".
As others have mentioned, Covid vaccines aren't great at reducing infection/transmission, although highly effective at reducing hospitalization/ICU admission (social benefit) and other severe outcomes (personal benefit). There are many other factors that influence our risk of transmitting Covid. I've been fully vaccinated, yet nevertheless caught Covid, and with 3 kids in school I think my risk is substantially higher of contracting/transmitting Covid than an unvaccinated colleague who is rigorously limiting their potential exposure and probably using PPE more carefully than I do!
More importantly, this knee-jerk reaction feeds into the narrative that dealing with Covid-19 is black and white, vax vs anti-vax. Not only is it "clear, simple - and wrong", but it's dangerous - because how we approach these problems as a profession, and as a society, is setting the stage for the future. No matter how appealing as a gut-reaction, the side-effect of mandating physician vaccination will be to further prom...
Show MoreCompeting Interests: None declared.References
- Andrew D. McRae, Andreas Laupacis. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 2021;193:E1816-E1817.
- Page navigation anchor for RE: Evidence based infection mitigation strategies including vaccine mandateRE: Evidence based infection mitigation strategies including vaccine mandate
We read recent CMAJ editorial with interest (1). As COVID-19 continues to mutate rapidly; societies have a moral obligation to deliberate evidence based infection mitigation strategies including vaccine mandate. However, we do not know how to say this more softly, and no matter it is mandatory or otherwise, we need to protect most precarious and invaluable assert in this pandemic “Doctors”. Moreover, clinicians and their supportive staffs including the vulnerable nurses and hospital cleaning staff are at great risk when vaccination rates are low. There is also huge social and moral obligation to protect our health care workers. Therefore, principle of mandating vaccination as a barrier to transmission can be a useful strategy. Vaccines, social distancing, frequent hand washing, respiratory hygiene etiquette, and masks are effective tools for protecting the public against the SARS-CoV-2 virus. Recent emerging Canadian and global data clearly show that nearly all COVID-19 deaths and hospitalizations are being attributed to unvaccinated individuals. The rapid transmission of the Delta, and more recently, omicron variant is placing households, long term care facilities, communities, workplaces, day cares, schools, and hospitals at risk. Even those who are fully vaccinated can contract and spread the disease.
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As previous research have shown that the households will continue to be a significant venue for transmission of SARS-CoV-2, the priority of and goal of preventing ho...Competing Interests: None declared.References
- Andrew D. McRae, Andreas Laupacis. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 2021;193:E1816-E1817.
- Shah ASV, Gribben C, Bishop J, Hanlon P, Caldwell D, Wood R, Reid M, McMenamin J, Goldberg D, Stockton D, Hutchinson S, Robertson C, McKeigue PM, Colhoun HM, McAllister DA. Effect of Vaccination on Transmission of SARS-CoV-2. N Engl J Med. 2021 Oct 2
- de Gier B, Andeweg S, Backer JA; RIVM COVID-19 surveillance and epidemiology team, Hahné SJ, van den Hof S, de Melker HE, Knol MJ; RIVM COVID-19 surveillance and epidemiology team (in addition to the named authors). Vaccine effectiveness against SARS-CoV-
- Harris RJ, Hall JA, Zaidi A, Andrews NJ, Dunbar JK, Dabrera G. Effect of Vaccination on Household Transmission of SARS-CoV-2 in England. N Engl J Med. 2021 Aug 19;385(8):759-760. doi: 10.1056/NEJMc2107717.
- Liu Q, Qin C, Liu M, Liu J. Effectiveness and safety of SARS-CoV-2 vaccine in real-world studies: a systematic review and meta-analysis. Infect Dis Poverty. 2021 Nov 14;10(1):132. doi: 10.1186/s40249-021-00915-3. PMID: 34776011; PMCID: PMC8590867.
- Page navigation anchor for RE: SARS-CoV-2 vaccination should be required to practise medicine in CanadaRE: SARS-CoV-2 vaccination should be required to practise medicine in Canada
In the editorial “SARS-CoV-2 vaccination should be required to practise medicine in Canada,” McRae and Laupacis state, “The most important argument for universal vaccination of physicians is the prevention of transmission of SARS-CoV-2 to patients and colleagues by physicians who become infected.”1
While we fully support the key role of vaccination in preventing severe outcomes due to COVID-19 infection and agree that prevention of transmission in health care settings is essential, the effectiveness of SARS-CoV-2 vaccination at preventing transmission is not well established. The phase III efficacy trials for the mRNA and adenovirus vector vaccines used symptomatic COVID-19 as their primary endpoints and did not assess asymptomatic infection.2,3 Subsequent studies have shown that efficacy of vaccination against symptomatic infection wanes significantly over time,4 and that close contacts of vaccinated individuals with COVID-19 do not have a lower risk of acquiring infection compared to contacts of unvaccinated individuals.5
The goal of preventing transmission in health care settings is an important one, but many questions remain about the extent to which mandatory vaccination will contribute to achieving that goal. Do vaccines prevent SARS-CoV-2 transmission? To what extent are physicians transmitting COVID-19 to patients and others in the health care setting? What is the incremental benefit of vaccination when there is a hierarchy of infection prevention a...
Show MoreCompeting Interests: None declared.References
- Andrew D. McRae, Andreas Laupacis. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 2021;10.1503/cmaj.211839.
- Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J Med. 2020;383(27):2603.
- Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lanc
- Chemaitelly H, Tang P, Hasan MR, AlMukdad S, Yassine HM, Benslimane FM, et al. Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar. N Engl J Med 2021;NEJMoa2114114. doi: 10.1056/NEJMoa2114114.
- Ng OT, Koh V, Chiew CJ, Marimuthu K, Thevasagayam NM, Mak TM, et al. Impact of Delta variant and vaccination on SARS-CoV-2 secondary attack rate among household close contacts. Lancet Reg Health West Pac 2021;17:100299. doi: 10.1016/j.lanwpc.2021.10029
- Page navigation anchor for RE: SARS-CoV-2 vaccination should be required to practise medicine in CanadaRE: SARS-CoV-2 vaccination should be required to practise medicine in Canada
Interesting article. I am amazed and saddened that any physician would refuse Covid vaccination. I also think an argument should be made that any student unwilling to be vaccinated NOT be admitted into any of our medical schools across Canada. Support vaccinations which have help over 14 diseases successfully or do not enter the medical faculty as vaccines have saved so many lives and disability.
Competing Interests: None declared.References
- Andrew D. McRae, Andreas Laupacis. SARS-CoV-2 vaccination should be required to practise medicine in Canada. CMAJ 2021;10.1503/cmaj.211839.