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

vaccination between surveys attributed the change of stress, anxiety, depression, burnout, moral distress, and
primarily to mandatory vaccination and the possibility of trauma experienced by HCWs and exacerbated by the
work restrictions (Costantino et al., 2022). These findings COVID-19 policy response, as documented in and beyond
suggest that even vaccinated HCWs may have experienced Canada (Bardosh et al., 2022; Benfante et al., 2020; Burrowes
some degree of hesitancy and may have felt pressured or et al., 2023; Prasad et al., 2021; Sinsky et al., 2023; Søvold et
coerced to comply. al., 2021). For example, in a survey conducted with BCNU
Concerning the scientific and moral rationales presented members, 76% of the respondents reported that their
by the authorities in support of the vaccination mandates workload has increased, 82% reported deteriorating mental
policy, these have been challenged by early evidence of health, 52% reported deteriorating physical health, and
the failure of COVID-19 vaccines to prevent infection or over half of the emergency room nurses reported an intent
transmission. For example, in October 2020, the editor to leave the profession (BC Nurses Union, 2021a). Similarly,
of the British Medical Journal, Dr. Peter Doshi, noted that a study in the United States (US) reported that nurses
major vaccine trials did not include transmission or even were four times more likely than other HCWs to consider
severe COVID-19 as endpoints – only prevention of mild leaving their profession due to COVID-19 (Chu et al.,
symptoms and/or negative polymerase chain reaction test 2021). An analysis of US data from 2021 to 2022 suggested
was considered sufficient to indicate “efficacy” (Doshi, that the adoption of a state-level COVID-19 mandate may
2020). This information was publicly available to anyone have worsened healthcare labor force shortages, noting
willing to examine the trial registration itself (Pfizer- that HCWs who quit their jobs in response to mandates
BioNTech SE, 2020). The failure to prevent transmission or “are slower to be replaced than workers in non-healthcare
infection was further supported by a study of 68 countries occupations” (Abouk et al., 2024, p. 2). As a result of the
and 2,947 US counties, published in the European Journal joint effect of these multilevel stressors, HCWs, especially
of Epidemiology in the summer of 2021, which found no nurses in Canada and elsewhere, have been leaving their
correlation between COVID-19 vaccination and cases jobs in large numbers – what has been labeled “The Great
(Subramanian & Kumar, 2021). Further evidence of Resignation” (Linzer et al., 2022). In this context, any policy
vaccine failures – “breakthrough” infections among fully that results in further healthcare workforce reductions will
vaccinated people – in healthcare settings and beyond has intensify these challenges and negatively impact healthcare
since been reported in the literature. Examples include a system sustainability (Bardosh et al., 2022).
“super-spreader event” among fully vaccinated patients Our findings also contribute to growing evidence that
and staff in an acute care hospital (Park et al., 2022); an vaccination mandates in the workplace have negatively
outbreak in a nursing home with fully vaccinated staff impacted not only the healthcare labor force but also the
and residents (Mateos-Nozal et al., 2021); an outbreak quality of patient care. For example, a nationwide study
among residents in a long-term care home in which nearly conducted on the staff of the UK National Health Service’s
everyone (97.3%) was vaccinated (Burugorri-Pierre et al., elderly care home found that, while mandates reduced the
2021); and an outbreak in a medical center that started rates of unvaccinated HCWs, they also led to the reduction
with a vaccinated patient and spread among a highly of HCWs, between 14,000 and 19,000. The authors
vaccinated (96.2%) patient population and staff (Shitrit concluded that this reduction had negatively impacted
et al., 2021a). In addition, a prospective, longitudinal the health and well-being of nursing home residents, thus
cohort study conducted in the United Kingdom (UK) undermining the ostensible goal of the policy – protecting
involving 602 community contacts of 471 UK COVID- patients (Girma & Paton, 2023). Other studies have
19 index cases found that a secondary attack rate among reported similar negative impacts of mandates on patient
household contacts exposed to fully vaccinated index care, including a reduction in the amount of patient care
cases was similar to household contacts exposed to provided per day (Gandhi et al., 2024), greater loss of
unvaccinated index cases (25% for vaccinated versus 23% healthcare staff in rural compared to urban settings (Hatch
for unvaccinated) (Singanayagam et al., 2021). et al., 2023; Yassi et al., 2023), and a decline in the quality
Notably, many Canadian authorities have dismissed of patient care (Hatch et al., 2023).
the impact of vaccination mandates on the staffing crisis in Pro-vaccination mandates research has claimed
BC, with the Minister of Health, as noted earlier, proffering otherwise, declaring mandates to be effective. However,
at the time that mandates would only affect “a very small this research often defines “effectiveness” as increased
percentage of the workforce” (Burns, 2023). However, if vaccination rates, rather than beneficial patient outcomes.
our findings indicate a trend, the impact of vaccination For example, one systematic review of COVID-19
mandates is significant and can only worsen the high levels vaccination mandates for HCWs concluded that they

Volume 3 Issue 3 (2025) 223 https://doi.org/10.36922/GHES025080014