How do we treat the unvaccinated?  And how can they treat us?

By | February 24, 2021

As the challenges to get an appointment for a COVID-19 vaccine get harder and not easier, and as the pressure for schools to open their doors for in-person learning, as long as teachers will get vaccinated, rises, the question remains: What about those who choose not to?

In the midst of so many individuals clamoring to get vaccinated, there remain many who will not get vaccinated. Not this week, not next week, and very likely, not ever. Health care workers were the first to be offered vaccines in this country, yet up to 40 percent have refused to be immunized. There are some, specifically pregnant or nursing women, or women hoping or planning to become pregnant, who were given some pretty mixed messages from the WHO and the CDC regarding the safety of the vaccine either before, during or after pregnancy, that they decided to wait. Although the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), the latter focuses on higher-risk pregnancies, recommended the shot, the overall recommendations came across loud and unclear. As a result, many female health care workers between the ages of 25 and 45 will wait. Some will get vaccinated after they deliver; some will get vaccinated after the second trimester of pregnancy. Some will wait until the recommendations become crystal clear.

But others are not waiting. They will never get this vaccine. Just as many individuals outside of medicine are anti-vaccine and anti-science, many health care workers are vaccine-averse, conspiracy theorists, and COVID-19 deniers. Even after having literally seen the ravage of COVID infections before their very eyes, they do not trust the vaccines. Should you, as a patient, and should I, as a physician, allow these individuals to partake in patient care? While it remains unclear whether or not the vaccine prevents viral transmission and ability to infect others, the fact that having antibodies blocks viral replication means that even if the vaccinated person can catch and spread the virus, the viral load will be so low that it’s much less likely to infect others. By now, all hospital workers have had access to a vaccine. If a worker has refused it — not postponed it, but refused it — should you as a patient have a right to refuse being cared for by them, and should I as a physician be protecting my patients, as they are more likely to be infected by an un-vaccinated worker? The short answer is “no.” This is simply because you, as a patient, do not have a right to know a caregiver’s vaccine choice. Nor do I as a physician.

As schools begin to crack their doors open, and as teachers soon have access to the vaccine, do you as a parent have a right to know if your child’s teacher is immunized, further lowering the risk of contagion to your child? Vaccines for children will not be approved until the late summer at the earliest, and this will only be for children ages 12 years and up. It will be at least another year before vaccines are approved for younger children. If an unvaccinated teacher is teaching your 6- or 9-year-old, can you request a switch out of the class? The short answer is “no,” mainly because medical interventions are a matter of privacy, so unless your student’s teacher voices their immunization status, you do not have a right to know their choices. And while teachers’ unions throughout the country are (rightly) demanding access to COVID vaccines before they head back to the classroom, upwards of 50 percent may pass on the vaccine. At least for now. And maybe forever.

Nina Shapiro is a pediatric otolaryngologist and the author of Hype: A Doctor’s Guide to Medical Myths, Exaggerated Claims, and Bad Advice – How to Tell What’s Real and What’s Not. She can be reached on her self-titled site, Dr. Nina Shapiro, and on Twitter @drninashapiro

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