Should the doctor caring for you or a sick loved one be expected to have the COVID-19 vaccine?
What about the nurse changing your IV, the midwife delivering your baby, or the personal care worker looking after your immune-compromised parent or child who can’t get the shot for themselves?
The question is a growing one for Canadians right across the country as the COVID-19 pandemic increasingly becomes a pandemic of the unvaccinated, and as vaccine holdouts appear poised to become the primary drivers of new infections amid a surge in the highly contagious Delta variant.
“There actually is quite a bit of legal basis to say that employers, if need be, can require vaccinations,” said Malini Vijaykumar, a labour and employment lawyer with Nelligan Law in Ottawa.
“Let’s say they have a nursing home, and there’s a lot of vulnerable people in the nursing home who would be at high risk of severe illness if they were to contract COVID-19,” she explained.
“An employer may very well be justified, legally justified in saying, ‘If you’re going to come into this workplace, you have to have proof of your COVID vaccinations.”
She noted there are some caveats on that: an employer can’t just spring a new requirement on their employee and would need to give appropriate notice of the change, and would also have to make it clear that they are aware of their duty to accommodate if required.
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In Canada, vaccination rates are high and breakthrough infections are rare — but not impossible.
According to the most recent federal data, 80 per cent of Canadians aged 12 and over have received at least a first dose of a COVID-19 vaccine, or 70 per cent of the total population. Sixty-three per cent of those aged 12 and over are fully vaccinated, which is roughly 56 per cent of all Canadians.
Only 0.5 per cent of COVID-19 cases in Canada are in fully vaccinated people.
The surging Delta variant, however, has put the spotlight on the fact it spreads significantly more easily than the original strain of the virus. There’s also concerns that it may be “likely more severe” than earlier strains, though researchers have cautioned there isn’t enough data to say for sure right now.
All of that has raised questions about how — or if — Canadians should be expected to accommodate those who make the choice to put themselves at risk: especially when that decision endangers others.
The latest to join the call for mandatory vaccination for healthcare professionals are two of the largest groups representing health care workers in the country: the Canadian Medical Association and the Canadian Nurses Association. Both said the urging is part of a “fundamental duty of care” to patients.
Dr. Katharine Smart, incoming president of the CMA, spoke with Global News Morning B.C. on Wednesday about the decision and said the focus is making sure places where health care is provided are as safe as possible for all patients.
“I think our job as leaders in healthcare is to sometimes make difficult decisions,” she said. “I think as healthcare professionals we have an accountability to the public, and I think there’s no question that this is the right move.”
Smart said data on healthcare worker vaccination is still being collected but that there do appear to be “pockets” of low vaccination levels that could create risk.
So far, there’s been little consistency from provinces or employers in Canada towards the issue of mandating vaccination for healthcare workers.
Ontario, New Brunswick, Nova Scotia and others have ruled it out, though Ontario has said workers in long-term care homes will be required to disclose their vaccination status.
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Without any requirements from the province or guidance from the federal government — akin to the mandate announced by the U.S. administration last month — the decision is falling largely up to individual employers to gauge whether and how to oversee vaccination.
Global News reached out to several care providers on Wednesday asking whether they are planning to require proof of vaccination for their employees.
Amica, a retirement home provider with residences in Ontario, Alberta and BC., declined to comment on whether they will require vaccinations or prioritize new hires with both doses.
The Canadian Association for Long Term Care said it is “currently developing its position on this matter and is not prepared to comment at this time,” while a spokesperson for The Ottawa Hospital said vaccination status does not play a role in decisions about new hires.
Michaela Schreiter, spokesperson for the hospital, said more than 90 per cent of doctors and more than 85 per cent of staff are fully vaccinated so far, and vaccination status of staff is documented.
“Staff who are unimmunized are given an opportunity to receive their COVID-19 vaccine through the Occupational Health vaccine clinic,” she said. “We will continue to follow provincial guidelines on this, and explore all options to ensure the safety of everyone in the hospital.”
Hannah Ward, spokesperson for the Ontario Hospital Association, pointed to the lack of guidance from the province for health care staff despite strong support from members of the group.
“Until formal direction and or requirements are issued by the Ontario government regarding COVID-19 vaccinations for healthcare workers, the application of hospital-based policies will vary across hospitals,” she said, adding hospitals are relying right now on employees to self-report their status.
Millions of U.S. federal workers are now required to show proof of vaccination or else face tough new rules in place after President Joe Biden cracked down last week in an attempt to set an example for private sector employers.
Biden has encouraged the U.S. military to require shots for soldiers and federal contractors in the latest effort by American employers to put clear incentives on vaccination. Multiple others including hospitals and assisted living facilities south of the border have also implemented vaccine requirements.
So when could or should Canadians start seeing moves to implement vaccine requirements?
Sabina Vohra-Miller, co-founder of the South Asian Health Network, said mandates should happen only after efforts to increase vaccine uptake are exhausted.
“I think that making vaccines mandatory should be done at a point where we’ve exhausted every other avenue,” she said, noting that health care workers should “absolutely” be vaccinated not only to protect those they care for, but also themselves.
But she said there can be many issues that are keeping some from getting the vaccine, pointing to factors like working 100-hour weeks and not having time to be laid out with side effects, or underlying concerns in some communities where medical racism remains a barrier to getting good information.
Others might be caught up in disinformation, she added.
“A lot of health care workers are marginalized women, so a lot of them have questions on pregnancy, fertility,” she said, noting the fear that disinformation campaigns stir can be “pervasive.”
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She said one-on-one conversations are vital to helping people who are vaccine-hesitant, and can take up to 45 minutes to walk people with concerns through the actual facts.
“They’re definitely very resource heavy,” Vohra-Miller said of the discussions.
“But every single person I’ve spoken to has, in fact, gone and gotten the vaccine themselves.”
Vijaykumar said applying requirements for vaccination to new hires will likely prove less complicated for employers than making it mandatory for existing employees.
But as concerns grow about the potential for a fourth wave of the virus, she said employers appear primarily focused on adapting and preparing for the uncertainties facing them right now.
“There’s been so much uncertainty over the last year and a half,” she said, adding many employers are focused on immediate questions like: “‘Should I still be treading water, keeping cash reserves, not rocking the boat?'”
“I think a lot of companies are just hoping and praying that we can actually plan for a full return to the office. And then I think they’re going to start turning their minds to sort of requirements,” she continued.
“I think the health care sector might be turning their minds to it sooner, but for the rest of the employers, the office workers, I think really, they’re just looking to see which way it’s going to go first.”
With files from Global’s Abigail Bimman.