The National Consultative Ethics Committee (CCNE) considers that in the event of a proven health crisis, the obligation to vaccinate health professionals “may be legitimate”, in an opinion published Tuesday following a vote in the plenary committee. The institution was seized in 2021 by the Minister of Health François Braun, at the end of the Covid-19 pandemic.
This pandemic has been a “conducive breeding ground for the amplification of behaviors and feelings of mistrust” and “vaccine hesitation”, declares the CCNE. This was particularly the case “with professionals working in healthcare settings who were in high demand during the management of the health crisis”. However, the institution affirms that their vaccination “is a responsibility consubstantial with the professions of the health and medico-social sectors”.
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In fact, for CCNE, one of the primary objectives of healthcare professionals remains the protection of patients. It is with this in mind that their vaccination is already compulsory for hepatitis B, diphtheria, tetanus, poliomyelitis and Covid-19. By refusing to immunize themselves against such pathologies, healthcare professionals are hindering the minimization of the risk of infection for patients, but also for themselves.
They thus risk a breach of contract, because it is about the “fundamental rights of patients”. Other vaccines, such as those against whooping cough, influenza, hepatitis A, measles, mumps, rubella and chickenpox, are strongly recommended. Despite everything, it remains true that “vaccination should not be considered as the only prevention tool, especially in healthcare settings”, reminds the CCNE: hygiene or screenings are also important.
Vaccination obligations are generally effective and respected: “in 2009 they reached 91.7% for hepatitis B” or “95.5% for the reminder of the vaccine against diphtheria”. For the Covid vaccine, the rates are slightly lower: “88.9% among liberal healthcare professionals and 88.4% among healthcare professionals in healthcare establishments”. The CCNE specifies that this share of unvaccinated caregivers includes certain professionals who are not vaccinated for medical reasons, or who are inactive.
This is why the institution considers that in the context of a health crisis “which represents a major and brutal threat for the population and which can call into question the functioning of the healthcare system”, the use of compulsory vaccination on certain pathologies “may be legitimate”. Indeed, “when recourse to vaccination is scientifically justified for individual but also collective protection, hesitation to vaccinate can harm public health”, estimates the CCNE. However, “qualifying the notion of crisis remains a complex exercise as the field covered by this term is vast”. The institution therefore undertakes “to continue the reflection in order to distinguish between the period of crisis, which may in certain cases justify the obligation to vaccinate, which is a political decision, and vaccination during the current period, so that the tools available can be adapted to both situations.
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However, some health professionals will still refuse to be vaccinated, either out of mistrust of vaccines developed more and more quickly, or to express certain “social or structural tensions within the health system”. Hence the importance for the CCNE to favor the exercise of “health democracy, encouraging the expression of all stakeholders, professionals, health system experts and users”. The CCNE considers that it is important that “vaccination recommendations and/or obligations” “follow joint construction processes”. The fight against misinformation is also an important underlying issue to prevent the spread of behavior hostile to vaccination.
To better understand the problem of compulsory vaccination for health professionals, CCNE claims to be working on the “development and validation of statistical tools” measuring vaccination coverage and the rate of vaccination hesitation, which have so far been underdeveloped. All of these projects should, according to CCNE, make it possible to offer more appropriate responses in the years to come, whether in a current context or in the event of a health crisis. With this in mind, the High Authority for Health (HAS) was seized by the Director General of Health “to assess all the obligations and vaccination recommendations of professionals in the health and medico-social sectors”.
