A nurse receives a COVID-19 vaccine at Providence St. Mary Medical Center in Apple Valley, Calif., on Dec. 17, 2020.
Ariana Drehsler/The New York Times News Service
As the first COVID-19 vaccine slowly makes its way into arms across Canada, debate has begun over the thorny question of mandatory immunization for employees in certain fields.
Provincial governments are encouraging Canadians to roll up their sleeves when vaccine doses become more widely available but have said they do not intend to make immunization compulsory.
However, given devastating COVID-19 workplace outbreaks, some employers have begun considering whether to eventually require vaccination and how to handle employees who decide not to get their shots.
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The issue of mandatory immunization cuts through myriad sensitive areas, including workers’ personal privacy, human rights and religious beliefs. On the other side, employers could argue vaccination is a job requirement so workers don’t transmit the disease to their colleagues and, in the case of staff in hospitals and nursing homes, vulnerable patients.
The law on the issue is not clear-cut, and because the situation is still fluid, there is uncertainty around how the courts would treat vaccine requirements. Canada approved Pfizer-BioNTech’s COVID-19 vaccine last week.
“Generally employers cannot require anyone to be vaccinated,” said Tamara Ramusovic, an employment lawyer in Vancouver. The law recognizes the need to balance the competing interests of public safety and personal privacy, she said.
How employers should strike that balance, under the law, will depend on the facts and evidence, she said. What are the risks of transmission in a particular workplace? What is the evidence of the safety and efficacy of a vaccine?
Requiring COVID-19 immunization as a condition of employment is a long way off, not least because scientists still do not know the vaccine’s effectiveness at stopping asymptomatic spread of the virus, said Allison McGeer, director of the infectious-diseases epidemiology research unit at Toronto’s Mount Sinai Hospital.
“We’ll just have to wait and see how the evidence evolves about how important vaccination is at protecting the people around you,” she said.
If it turns out that the vaccine does prevent COVID-19 transmission, Toronto’s University Health Network would weigh requiring inoculations for staff, likely through negotiations with its unions, spokeswoman Gillian Howard said.
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“This is a contagious disease and if the vaccines prove out to have the efficacy that has been seen in the trials, it would be considered,” she said in an e-mail.
Provincial rules require Ontario hospital workers to prove they are immune to several infectious diseases, including measles, mumps, rubella and chickenpox. In Alberta, front-line health care workers must be immunized against rubella.
Some Ontario long-term care operators worry uptake of the COVID-19 vaccine will be low among staff, especially in areas that have not had large outbreaks, and are hoping the provincial government will eventually make immunization mandatory in the sector, said Lisa Levin, chief executive officer of AdvantAge Ontario, which represents municipal and not-for-profit nursing homes.
“I have seen the devastation that can happen in a home when people get COVID-19, so it would seem to me that it should be considered,” she said.
Experience with the flu shot suggests that many health care workers will not get immunized for COVID-19. Flu vaccine uptake among health care workers lags the national goal of 80 per cent, although it is higher than coverage among the general public.
While many health care workers’ unions are encouraging their members to get COVID-19 shots, they strongly oppose mandatory vaccination policies.
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“We’ll wade into those waters if we need to,” said Vicki McKenna, president of the Ontario Nurses’ Association. “It’s a basic right, that people have the right to refuse.”
The only case law in the area thus far in Canada involves limited examples of flu vaccine requirements for health care workers.
Nurses’ unions have pushed back against vaccinate-or-mask rules for the flu shot. In 2018, an Ontario arbitrator ruled against such a policy, finding there was not enough evidence supporting either the use of masks or the flu vaccine.
In 2013, a British Columbia arbitrator upheld a vaccinate-or-mask policy as a reasonable limit on nurses’ privacy rights. But one year ago, the B.C. Nurses’ Union struck a deal with health employers to allow nurses to use their professional judgment, except in cases of flu outbreaks.
Among lawyers, there is wide agreement that those who refuse to be vaccinated against COVID-19 could face consequences.
Vicki Giles, an employment lawyer in Edmonton, said mandatory immunization policies will be possible – but such policies do not mean employers who refuse will be fired.
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“What is ‘mandatory’ is the requirement to have the vaccination in order to work with the vulnerable population,” she said in an e-mail.
And a similar “mandatory” policy may be put in place in workplaces such as meat-packing plants because the employer would have an obligation under health and safety law to keep other workers safe, she said.
Those who refuse to be vaccinated could face consequences such as being put on a leave of absence without pay, or being moved to other work, she said.
During flu outbreaks, some long-term care homes move unvaccinated staff to different floors or place them on unpaid leave.
Courts are unlikely to accept employers’ demands that their workers be immunized because it is a “extreme intrusion” on their bodily integrity, said Richard Press, a Vancouver employment lawyer. But the time is coming when “most employers are going to have to consider at least asking employees if they have been vaccinated.”
As with the immunizations themselves, employees probably could not be required to disclose, Mr. Press said. But employers could impose consequences on those who do not. The employees would almost certainly be treated as if they had not been vaccinated. They might then be subject to being placed on leave or, if possible, moved to another location, required to wear extra personal protective equipment, or to work remotely.
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The initial COVID-19 vaccinations in Canada and around the world raise questions about how people react to the shot, how pregnant women should approach it and how far away herd immunity may be. Globe health reporter Kelly Grant and science reporter Ivan Semeniuk discuss the answers.The Globe and Mail
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
