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

choose to decline vaccination, most (73% in BC and 66.5% Concerns about the potential harms of the
in Ontario) agreed that their income was lower due to COVID-19 vaccine have been admitted even by researchers
vaccination mandates, and a large minority (44.6% in BC who support the COVID-19 vaccine, acknowledging
and 42.5% in Ontario) indicated their intention to leave adverse events as a risk of mandates (Bradfield & Giubilini,
the healthcare industry due to their negatives experiences 2021; Law et al., 2022). Since no vaccine is 100% safe
with workplace COVID-19 policies. (Bradfield & Giubilini, 2021), these authors have also stated
that by mandating vaccines on such a large population,
Our findings are consistent with other studies that have
also reported greater non-compliance with vaccination some people will experience these adverse events without
mandates among women compared to men, and among the freedom of choice (Law et al., 2022). Other supporters
include the authors of a recent study by the National
nurses compared to other healthcare professionals (Casey Academies of Sciences, Engineering, and Medicine
et al., 2022; Gogoi et al., 2022; Politis et al., 2023). Other (NASEM). Despite the authors prefacing that the benefits
researchers have also reported that among HCWs, women of all of the vaccines are “well-established,” they reported,
have been more negatively impacted by COVID-19 “convincing evidence of a causal relationship between
policies throughout the pandemic (Morgan et al., 2022). mRNA COVID-19 vaccines and myocarditis;” “inadequate
Women comprise most of the global healthcare workforce evidence to accept or reject a causal relationship between
– a phenomenon referred to as the “feminization” of the mRNA-1273 (Moderna) and ischemic stroke;” “evidence
healthcare workforce (World Health Organization, 2019) – for accepting a causal relationship between Astra Zeneca
so it is expected that women are more likely to experience COVID-19 vaccines and two specific adverse effects such
the effects of the policies enacted in healthcare settings. as thrombosis with thrombocytopenia syndrome and
Women also tend to occupy lower-status and lower-paying Guillain-Barré syndrome;” and “evidence for multiple
healthcare positions (World Health Organization, 2019), vaccines and various shoulder injuries” (NASEM, 2012,
and therefore, they may have less capacity to negotiate p. 5). Most recently, one study of over 99 million participants
workplace policies such as vaccination mandates. indicated an observed versus expected ratio of 3.78 for acute
Our findings on the safety concerns among all HCWs, as disseminated encephalomyelitis, 3.23 for cerebral venous
well as high rates of adverse events post-vaccination among sinus thrombosis, and 2.49 for Guillain-Barré syndrome,
the small number of vaccinated HCWs, are also supported and an excess risk between 10.1 and 15.1 of serious adverse
by the literature. A survey on 5,372 HCWs conducted events of special interest, including death (Faksova et al.,
by Ipsos – upon request from the Public Health Agency 2024).
of Canada – indicated that 49 – 59% of the respondents, Our findings on the negative economic, emotional, and
regardless of vaccination status, had reported some degree social impacts of vaccination mandates on at least some
of hesitancy in their decision to get vaccinated. In addition, HCWs are supported by observers who have argued that
concerns about the safety and effectiveness of COVID-19 “vaccinate or terminate” policies could lead to negative
vaccines were among the largest factors contributing sequelae on the affected persons and their dependents,
to vaccine hesitancy, with 87% of the 8% of HCWs who including increased parental stress, social isolation, and
declined vaccination stating long-term safety concerns as economic deprivation in the family unit (Bardosh et al.,
their main reason (PHAC, 2023a). Unsurprisingly, HCWs 2022). Interestingly, in a study conducted with unions
who were more accepting of vaccination had fewer safety in Canada regarding the issue of workplace vaccination
concerns, because they were more willing to trust expert mandates, interviewees of all vaccination statuses described
sources of federal government recommendations (PHAC, these policies as “internally divisive,” and stated that “no
2023a). However, safety concerns have solid empirical one thought termination was an appropriate penalty for
grounds, even though, as noted earlier, they are often a worker who refused to be vaccinated” (Braley-Rattai
dismissed as unjustified by those same trusted sources. & Savage, 2024, p. 162). Further, there is evidence that
Published research discussing vaccine harms can be traced aligns with our findings, indicating that a key reason for
back to 2021. Specific concerns and adverse events post- vaccination was to prevent them from losing their jobs.
vaccination – especially relevant to a young labor force For example, in the survey conducted on Canadian HCWs,
– include the lack of reproductive toxicity data (UK.Gov, vaccination mandates were a major reason for vaccination,
2022) and myopericarditis upon receiving mRNA vaccines with 53% of healthcare professionals, 46% of allied health
(Buchan et al., 2022; Faksova et al., 2024; Fraiman et al., workers, and 47% of auxiliary health workers citing job
2022; Karlstad et al., 2022; Li et al., 2021; Mansanguan retention as a key factor (PHAC, 2023b). Similarly, in
et al., 2022; Public Health Agency of Canada, 2021; Yonker a study conducted on Italian HCWs, most participants
et al., 2023; Yun et al., 2024). who shifted their stance from rejecting to accepting

Volume 3 Issue 3 (2025) 222 https://doi.org/10.36922/GHES025080014