After the collective release on travelers who left for the South during the holidays, will health workers who refuse vaccines be the new scapegoats?
It would be a cruel mistake.
Sonia Bélanger, CEO of the CIUSSS du Center-Sud-de-l’Île-de-Montréal, said recently that during the first days of vaccination in the 17 CHSLDs attached to this CIUSSS, the acceptance rate of the vaccine against COVID-19 varied between 40% and 70% among the staff. Other managers have reported similar numbers, and rumors are rife.
But it should not be deduced from this that many health workers are sulking this vaccine. “This information should be taken with a lot of caution,” nuance Ève Dubé, health anthropologist and vaccine reluctance specialist at the National Institute of Public Health of Quebec.
It seems clear, on the other hand, that the health system is struggling to advertise the vaccine to this group of the population, which is considered a high priority.
As of Jan. 19, 119,236 healthcare workers had received their first dose, according to data provided by the government, just over a third of the workforce. But for now and as M finally agreedme Bélanger, no one really knows what percentage of these workers get vaccinated when their turn comes, or whether the few probes given in the first few weeks are representative of anything. The CIUSSS du Center-Sud-de-l’Île-de-Montréal is struggling to explain how these figures were estimated.
In recent years, many studies have been done around the world on the attitude of health care workers towards vaccines. Even if they do not predict how many will refuse the one against COVID, they are still enlightening.
In Quebec, the last survey on this subject was conducted in 2018 by Ève Dubé and her colleagues from the INSPQ. It focused on the flu shot, which is offered free of charge each year to health care workers, the chronically ill and the elderly, and the general views on vaccination in each of these groups of people.
Among healthcare workers aged 18 to 65 who responded to the survey, 38% had received the flu shot that year. However, this percentage varied greatly according to the profession exercised: thus, 74% of doctors had been vaccinated, but only 46% of nurses, 27.5% of patient attendants and 42% of other health professionals.
In the general population of the same age, only people with chronic illnesses pay nothing to be immunized against the flu, which skews comparisons. During this survey, the flu vaccination rate among adults who have to pay for the injection was estimated at 14%, and 48% among chronically ill patients under 65 years of age. 65% of people over 75 have taken this vaccine.
“Despite all the incentives they receive, healthcare workers are hardly more inclined than the rest of the population to protect themselves against the flu,” says Ève Dubé.
It would be wrong, however, to think that the COVID vaccine will be so unpopular. The fact that the influenza vaccine is of limited effectiveness and that influenza is still perceived as a mild illness prompts many workers to do without it – as do the rest of the population. Many also have already had the flu after being vaccinated against the wrong strain – it remains difficult to predict which ones will circulate each winter – which does not help the popularity of this vaccine.
In clinical trials, COVID vaccines have been shown to be very effective. The disease is wreaking havoc in hospitals and CHSLDs, and its consequences directly affect health workers, many of whom work with patients, have seen patients die and have themselves contracted COVID, in addition to have to live daily with the upheaval in their working methods. We don’t really know what their perception of the severity of COVID is, compared to that of the flu, but chances are they find it much more serious and that it prompts them to be massively vaccinated.
During the survey conducted by the INSPQ, only 3.7% of unvaccinated health workers said they were opposed to vaccines in general… against 12% among chronically ill people. Other studies also show that a very small minority of healthcare workers do not wantDon’t hear about vaccines.
Many of the reasons that can decrease the vaccination rate have nothing to do with ideology. The organization of vaccination campaigns matters a lot: if a health worker has to take time out of his rare moments of rest to travel to the other side of town to be immunized, he is more likely to spend his time. only if the vaccine is offered to him at his workplace while he is there.
The complex logistics of COVID vaccines, with their stringent cold chains and changing supplies, are a pitfall in themselves, but the way appointments are made, for example, can also influence the response rate of caregivers. . Only a few weeks from the start of vaccination, the whole system is still in the process of breaking in. And Quebec does not seem to be any worse off than the other authorities who, according to Ève Dubé, are all roughly at the same point.
Surveys in other countries have already shown that being among the first to receive these new vaccines worries many healthcare workers, an understandable reaction. But among those who are still hesitant, a certain number will probably take the vaccine a little later, once they have seen the reaction of their colleagues who are already immune, believes Ève Dubé.
Although very few strictly oppose vaccines, healthcare workers are far less knowledgeable about them than one might expect.
In the survey carried out in 2018, they were just as numerous as the general population, nearly 4 in 10 people, to estimate that vaccines can weaken the immune system – which is false -, and nearly 1 in 4 said he thought that alternative medicine could replace a vaccine – which is also wrong.
“Healthcare workers have roughly the same reservations as the general population with regard to vaccines,” explains Ève Dubé.
However, for the moment, the information provided to health personnel on this subject remains very imperfect. Before these vaccines were approved, in mid-December, governments did not work on the communication tools to deploy to fully explain the benefits and risks. “For the flu shot that comes back every year, we usually start thinking about communication strategies in the spring for the following fall. It is clear that COVID does not give us this latitude! »Recalls Ève Dubé. Many of the doctors working on the front lines have yet to receive little information about vaccines and have to scramble with whatever means to try to learn more.
Exhausted and overwhelmed, workers are also plagued by directives of all kinds, a far from ideal situation to ensure that they have time to assimilate the information they need to make a decision.
Under these conditions, should vaccines be made compulsory for health workers? The answer given by the Quebec Public Health Ethics Committee joins that of many other bodies abroad: it is no.
The scientific literature on this subject is also illuminating. It is known that this measure can work when vaccination rates are very low – some states in the United States have seen a marked increase in the number of healthcare workers who have received the flu vaccine when it was imposed on them. But the exemptions for medical reasons, or in some religious cases, and the difficulty to apply the sanctions to the letter mean that where the vaccination rates are already high enough, the obligation does not change much. nothing.
There is also the very real risk of staunch opponents of vaccines quitting if forced to go against their beliefs, with the risk of losing arms in a system in dire need of it. Better an unvaccinated worker – but well equipped and conscientious to limit the risk of disease transmission – than no worker at all.
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