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

et al., 2021). The preponderance of middle-class, white and friends for their encouragement and support and to
women among participants could also suggest that low- Dr. Chaufan for her mentorship. RM extends her thanks to
income or racialized groups, regardless of gender, may her friends, family, and Dr. Chaufan for their support and
have been unable to afford to resist the policy given the guidance. All authors are grateful to the participants for
significant costs of non-compliance. In fact, the National sharing their life experiences, making this study possible.
Health Service study mentioned earlier suggests that this
may be the case: they found that vaccination mandates led Funding
to lower rates of unvaccinated HCWs, especially among This work was funded by the New Frontiers in Research
lower-income HCWs (Girma & Paton, 2023). This was Fund (NFRF) 2022 Special Call, NFRFR-2022-00305.
likely because refusal was punished with termination, The funders played no role in the conception, conduct, or
the punishment which these HCWS could afford the publication of this study.
least. Finally, we were unable to identify differences in the
impact of mandates across provincial regions, although, Conflict of interest
as mentioned earlier, the media attention to emergency
room closures in Interior and Northern Health suggests a The authors declare no conflicts of interest.
differential and negative impact in rural areas. Author contributions
5. Conclusion Conceptualization: Claudia Chaufan

Our data indicate that a discriminatory system has been Formal analysis: Claudia Chaufan, Rachael Moncrieffe
imposed on HCWs who have not complied, in whole or Investigation: Claudia Chaufan, Natalie Hemsing
in part, with workplace COVID-19 vaccination policies, Methodology: Claudia Chaufan
a system that suppresses the voices and perspectives of Writing – original draft: Claudia Chaufan
these HCWs and violates their rights to “pursue both their Writing – review & editing: All authors
material well-being and their spiritual development in Ethics approval and consent to participate
conditions of freedom and dignity, economic security, and
equal opportunity” (International Labour Organization, The study was conducted in accordance with the Declaration
1958). While critics may argue that differential treatment of Helsinki and approved by the York University Office of
of these HCWs is justified because they threaten health Research Ethics (No. 2023-389). Informed consent was
systems and patients, we have argued that a preponderance obtained from all participants involved in the study.
of evidence challenges this assertion. We further argue that,
even if unaddressed by the literature - as we have noted, it Consent for publication
appears to be more interested in overcoming “hesitancy” Permission was obtained from the study’s respondents to
that in engaging the empirical evidence that justifies it – publish their deidentified responses to survey questions.
the multiple negative impacts of vaccination mandates that
have been identified in our study on HCWs’ well-being, Data availability statement
patient care, and ethical healthcare practices are extremely The original forms are protected by a confidentiality
worthy of consideration. They indicate the importance agreement with the survey respondents.
of prioritizing informed consent, engaging competing
scientific evidence, and ensuring healthcare sustainability, Further disclosure
particularly during emergencies. They also underscore the
need to examine why the BC policy continued well beyond The paper has been deposited in MedRxiv (https://doi.org/
the end of the declared public health emergency and to 10.1101/2024.12.09.24318733).
assess the threat posed by policies that involve coercion References
to long-standing bioethical principles, such as informed
consent and bodily autonomy. Abouk, R., Earle, J., Maclean, J.C., & Park, S. (2024). Promoting
Public Health with Blunt Instruments: Evidence from Vaccine
Acknowledgments Mandates. United States: National Bureau of Economic
Research, p.w32286.
CC would like to thank the many professional and lay
organizations, students, trainees, and friends who have https://doi.org/10.3386/w32286
provided spaces for reflection and debate over the years, Achat, H.M., Stubbs, J.M., & Mittal, R. (2022). Australian
and especially her husband, Julian Field, for his editorial healthcare workers and COVID‐19 vaccination: Is
feedback and support. NH extends her thanks to her family mandating now or for future variants necessary? Australian

Volume 3 Issue 3 (2025) 225 https://doi.org/10.36922/GHES025080014