Healthcare professional and professional stakeholders’ perspectives on vaccine mandates in switzerland: a mixed-methods study

BACKGROUND: There currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates. METHODS: A national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members. RESULTS: 1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend < 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend < 0.001). Physicians (p < .001) and pharmacists (p < .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants’ perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement. CONCLUSION: In Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates

COVID-19, la grippe et les ­syndromes grippaux

L'épidémie de «grippe» de l'hiver 2020/2021 sera un défi pour les médecins généralistes et les médecins des hôpitaux. La COVID-19 ne peut pas être cliniquement distinguée de la grippe et d'autres syndromes grippaux – le diagnostic différentiel le plus important de la «grippe» étant la COVID-19. La PCR du nasopharynx reste la méthode de diagnostic la plus sensible pour la COVID-19. Les tests rapides permettent de détecter rapidement les personnes infectieuses et donc de réduire la ­durée de leur contagiosité (résultat disponible en 15–20 minutes; un test rapide négatif n'exclut pas la COVID-19

COVID-19, Influenza und grippe-ähnliche Erkrankungen

Die «Grippe»-Welle im Winter 2020/2021 wird zur Herausforderung für Haus- und Spitalärzt/-innen. COVID-19 kann klinisch nicht von einer Influenza und anderen «grippe-ähnlichen» Erkrankungen unterschieden werden – die wichtigste Differenzialdiagnose der «Grippe» ist COVID-19. Die PCR-Diagnostik aus dem Nasopharynx bleibt die sensitivste Diagnosemethode für COVID-19. Antigen-Schnelltests erlauben es, infektiöse Personen rasch zu erkennen und so die Dauer ihrer Infektiosität abzukürzen (Resultat liegt innert 15–20 Minuten vor; ein negatives Resultat schliesst COVID-19 nicht aus)

COVID-19, Influenza und grippeähnliche Erkrankungen

Distanzierung- und Hygienemassnahmen sind gegen Influenza und COVID-19 präventiv wirksam. Bei hospitalisierten COVID-19-Patient/-innen mit Pneumonie kommt zurzeit eine Therapie mit Dexamethason mit/ohne Remdesivir in Frage. Venöse thromboembolische Ereignisse sollen bei COVID-19 niederschwellig gesucht und vorgebeugt werden. Eine wirksame und sichere SARS-CoV-2-Impfung stellt eine enorme Herausforderung dar. Wahrscheinlich werden wir noch jahrelang mit SARS-CoV-2 leben müssen