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Global Health Economics and
Sustainability
COVID-19 vaccination decisions and mandate impact

Preventive Measures order. This order required healthcare 2023). Indeed, BC was the last Canadian province to
workers (HCWs) in long-term care and assisted living maintain vaccination mandates for HCWs, albeit only to
facilities to provide proof of completing a primary series replace them with a mandate requiring HCWs to “report
of COVID-19 vaccinations by October 12, 2021, or they their immunization for COVID-19, influenza, and other
would be prohibited from working (BC Ministry of Health, critical vaccine-preventable diseases as a way to help
2021; Office of the Provincial Health Officer, 2022b). keep people safe and to assure that unvaccinated HCWs
On September 12, 2021, the Hospital and Community follow appropriate measures such as wearing face masking,
COVID-19 Vaccination Status Information and Preventive modifying duties, or being excluded from work” (BC
Measures order was introduced. This order required Ministry of Health, 2024a).
HCWs in the provincial and five regional health authorities In contrast to the strong support for vaccination
in BC, provincial mental health facilities, and hospital mandates from most healthcare organizations, some
and community care settings – including employees, unions, such as the BC Nurses Union (BCNU) and the
contractors, volunteers, students, administrative, and Hospital Employee Union (HEU), have raised concerns.
fully remote workers – to provide proof of vaccination by They have argued that the mandates pose serious risks to
October 26, 2021, to maintain their employment (Office of an already understaffed healthcare system, thus expressing
the Provincial Health Officer, 2022a). In the wake of these their preference for voluntary vaccination (BC Nurses
orders, over 2,500 HCWs in the province were terminated Union, 2021b; Hospital Employee Union, 2021; Slepian,
for non-compliance – more than half of them were from 2021). Like other Canadian provinces, BC has experienced
the Interior and Northern Health regions, where labor a critical shortage of nurses and family doctors for some
shortages have resulted in ongoing emergency room time (Ahmed & Bourgeault, 2022; BC Nurses Union,
closures (DeRosa, 2023). Other sources have reported over 2021a). This shortage has been exacerbated by population
4,000 unvaccinated HCWs were placed on unpaid leave, growth, a shrinking healthcare labor force, and an ongoing
resulting in hospitals being compelled to cut services due toxic drug crisis in the province (BC Care Providers
to staffing shortages (Government of Canada, 2025), as Association, 2018; Government of British Columbia, 2023;
well as loss of workers due to early retirements (Burns, Health Sciences Association of BC, 2021). The BCNU
2023) or resignations. president noted that nurses in BC had long cautioned about
Nevertheless, the BC’s Minister of Health stated that a staffing shortage, observing that there were over 5,300
the staffing challenges were not due to the mandate, but nurse vacancies as of 2023. Furthermore, it is expected
primarily due to “people not coming into work when that an additional 27,000 nurses will be needed to meet
they’re sick.” However, since 99% of the full-time HCWs the demands of a growing population by 2031 (BC Nurses
were vaccinated, this suggests that only “a small number Union, 2023). The government data has confirmed this
of them” were unable to work (DeRosa, 2023). In a similar scenario, indicating that out of 286,300 people employed
spirit, the BC’s PHO stated that due to the “risk inherent in BC’s healthcare sector in 2021, approximately 93,000
in accommodating persons who are not vaccinated,” were directly involved in patient care, representing 11.2%
exemptions would only be approved if “vaccination would of employment in all industries in the province. However,
so seriously jeopardize the individual’s health that the risk many of them have been leaving the sector because of
to the individual’s health posed by vaccination outweighs “reported high levels of exhaustion and stress,” attributed
the benefit” (Office of the Provincial Health Officer, 2022a, in large part, though not exclusively, to the “difficult work
p. 27). The PHO further stated that the measures would conditions during the pandemic” (Government of Canada,
balance “the interests of the people working or providing 2025). As a result, on September 16, 2021, the BCNU
services in the hospital and community care sectors against stated that it “cannot support any order which will serve to
the risk of harm posed by unvaccinated people working remove even a single nurse or [HCW] from the healthcare
or providing services in the hospital or community care system at a time of severe crisis” (BC Nurses Union, 2021b,
sectors” (Office of the Provincial Health Officer, 2022a, p. 2). The union stated that while it encouraged vaccination
p. 8). The orders remained in effect until July 26, 2024, among its members, it expected the “government and
when they were finally rescinded, and the PHO declared health employers to avoid any measures that may take
an end to the public health emergency and associated nurses away from providing patient care” (Slepian, 2021, p.
emergency powers invoked under the Public Health Act 2). The BCNU also expressed concerns about the potential
(BC Ministry of Health, 2024b). Notably, this rescission negative impact of the mandates in underserved areas,
came over 1 year after the World Health Organization warning that “in some rural communities, losing just a
declared, in May 2023, that COVID-19 was no longer a single nurse or healthcare worker from the system” can be
global health emergency (World Health Organization, “disastrous” (Shaw, 2023).

Volume 3 Issue 3 (2025) 207 https://doi.org/10.36922/GHES025080014