The availability of COVID-19 vaccines under an Emergency Use Authorization from the FDA brings into sharp relief the question whether physicians have an ethical responsibility to accept vaccination. Guidance in the AMA Code of Medical Ethics indicates that they do.
Opinion 8.7, “Routine Universal Immunization of Physicians,” provides that in general when a safe, effective vaccine is available physicians have a responsibility to accept immunization in the interest of protecting their patients, their colleagues, and the community. It is part of their overall responsibility in responding to public health crises as well (Opinion 8.4, Ethical Use of Quarantine and Isolation). Further, accepting vaccination themselves is also important to physicians’ role as educators and role models for responsible public health practices.
The responsibility to be vaccinated is not absolute. However, as the recently adopted report by AMA’s Council on Ethical and Judicial Affairs notes, the more readily transmissible the disease and the greater the risk to patients and others with whom the physician comes into contact relative to risks of immunization to the physician, the stronger the duty to accept immunization. Physicians should not be required to accept immunization with a novel agent until and unless there is a body of scientifically well-regarded evidence of safety and efficacy.
Physicians who decline to be vaccinated, for whatever reason, must still fulfill their fundamental public health responsibility, however, by voluntarily taking other measures to protect themselves and those to whom they may transmit a vaccine-preventable disease. This includes adhering rigorously to appropriate infection control procedures, the policies of their institutions, and prevailing public health policy—up to and including refraining from patient contact when appropriate.
Opinion 8.7 also addresses the responsibility of health care institutions to protect patients and personnel—for example, by having well-considered policies for responding to public health emergencies, instituting robust infection control practices, and providing and requiring use of appropriate personal protective equipment. During outbreaks of infectious disease, this responsibility may extend to requiring immunization of staff and limiting patient and staff exposure to individuals who are not immunized and could include prohibiting nonimmunized individuals from having direct contact with patients.
Additional ethics guidance in a pandemic
The AMA offers an overview of foundational guidance regarding medical ethics for health care professionals and institutions responding to the COVID-19 pandemic.