When there’s a safe, effective vaccine to help prevent spread of a pandemic disease, physicians without a medical contraindication have an ethical duty to become immunized.

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That is among the recommendations contained in an AMA Council on Ethical and Judicial Affairs report adopted at the November 2020 AMA Special Meeting. The council’s report, especially timely in light of encouraging news from SARS-CoV-2 vaccine trials during the COVID-19 pandemic, updates advice previously published in the AMA Code of Medical Ethics as opinion 8.7, “Routine Universal Immunization of Physicians.”

“Physicians and other health care workers who decline to be immunized with a safe and effective vaccine, without a compelling medical reason, can pose an unnecessary medical risk to vulnerable patients or colleagues, said AMA Board Member Michael Suk, MD, JD, MPH, MBA. “Physicians must strike an ethical balance between their personal commitments as moral individuals and their obligations as medical professionals.”

The ethical opinion adopted by the AMA House of Delegates says that doctors “have an ethical responsibility to encourage patients to accept immunization when the patient can do so safely, and to take appropriate measures in their own practice to prevent the spread of infectious disease in health care settings.

“In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues, or threatens the availability of the health care workforce, particularly a disease that has potential to become epidemic or pandemic, and for which there is an available, safe and effective vaccine, physicians have a responsibility to accept immunization absent a recognized medical contraindication or when a specific vaccine would pose a significant risk to the physician’s patients,” the new policy says.

“Physicians who are not, or cannot be, immunized have a responsibility to voluntarily take appropriate action to protect patients, fellow health care workers and others,” says the ethical opinion. “They must adjust their practice activities in keeping with decisions of the medical staff, institutional policy, or public health policy, including refraining from direct patient contact when appropriate.

“Physician practices and health care institutions have a responsibility to proactively develop policies and procedures for responding to epidemic or pandemic disease with input from practicing physicians, institutional leadership, and appropriate specialists,” says the updated opinion. “Such policies and procedures should include robust infection-control practices, provision and required use of appropriate protective equipment, and a process for making appropriate immunization readily available to staff. During outbreaks of vaccine-preventable disease for which there is a safe, effective vaccine, institutions’ responsibility may extend to requiring immunization of staff.

“Physician practices and health care institutions have a further responsibility to limit patient and staff exposure to individuals who are not immunized, which may include requiring unimmunized individuals to refrain from direct patient contact,” the ethical opinion concludes.

The COVID-19 pandemic is bringing new medical ethical questions to the forefront. The AMA is your source for guidance on ethical issues such as triage and resource allocation during COVID-19.

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