Meet Ailisa Theis: Daughter, Wife, Mom, and Respiratory Therapist

Against Vaccine Mandates

Ailisa Theis and Nicole Shook

Against Vaccine Mandates 

LDR614-OA: Contemporary Issues in Health Care Administration 

October 6th, 2025 

How many vaccines exist in the world today?  As of 2023, there are over 25 licensed vaccines available globally to prevent various diseases. These vaccines target a wide range of infections, including: Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis (whooping cough), Chickenpox, Influenza, Hepatitis B, Human papillomavirus (HPV), and COVID-19 (Fast facts on global immunization). There may be slight variations in the number of vaccines, depending on the country and the specific vaccines that have been approved. Also, new vaccines are constantly being developed and approved.  

With as many different vaccines that are available, there are many that are recommended to be taken. But there are some that can be mandated. States require vaccines for kids in childcare and schools, with specific rules and types of vaccines varying by state. These include DTaP, Hepatitis B, and flu shots. Vaccines are also required for U.S. immigration and not getting them can block your application for legal status, according to the USCIS.  

While getting certain vaccines is crucial, some people feel overwhelmed and oppose mandated vaccines. People who oppose vaccine mandates argue that they infringe on personal freedom, clash with religious and philosophical beliefs, could erode public trust, and lead to unfair treatment or coercion. They also doubt the need for mandates when other options exist, and question whether they're really effective.  

Today, vaccine effectiveness and fatigue are major concerns, particularly in the wake of COVID-19. Many healthcare organizations require employees to get the COVID-19 vaccine to keep their jobs. There's been a lot of debate about the impact of vaccine mandates on the workforce and the ethics of requiring them.  

Workforce effects on Mandating Vaccines: 

Mandatory COVID-19 vaccination for healthcare workers started in 2021.  The mandate came only a few months after the COVID-19 vaccine first became available in the United Sates (Hergott et al., 2025).  After Italy's implementation in April 2021, various regional and national health authorities globally introduced different vaccine mandates for healthcare workers. In Italy, unvaccinated healthcare workers were either placed on unpaid leave or reassigned to lower-risk roles to prevent viral spread. In Canada, starting December 2021, Alberta allowed unvaccinated healthcare workers to choose between rapid antigen testing or unpaid leave. Meanwhile, in British Columbia, unvaccinated healthcare workers faced termination at the end of the mandate deadline. Some regions adopted mixed approaches or implemented these measures gradually over time (Okpani et al., 2024). 

Limited information exists on how mandated vaccination policies affect the primary care clinic workforce in the United States, particularly regarding differences between rural and urban areas, especially for COVID-19. As the pandemic persists and new disease outbreaks and vaccines are expected, healthcare systems require more data on how vaccine mandates influence their workforce to inform future decisions. Qualitative analysis revealed a decrease in clinic morale, minor yet significant impacts on patient care, and varied opinions regarding the vaccination mandate (Hatch et al., 2023).  

How does the workforce vaccine mandate have an effect on workplace morale? The increase in stress and burnout following the mandates was notably substantial. This caused exacerbated staffing pressure, mixed opinions on vaccine mandates would cause friction among healthcare workers, and some believe there was an ethical conflict with the COVID-19 mandates. Some reported that it compounded existing high stress levels related to the overall challenges of COVID-19 care. Staffing issues caused by the mandate were most frequently identified as the primary source of stress or decreased morale (Hatch et al., 2023). 

Staffing was also an issue due to the vaccine mandate. Many healthcare employees did not want to take the mandatory COVID-19 vaccine. However, by not doing so, those would lose their jobs, causing more strain on those who welcomed the vaccine. Employers nationwide are dismissing workers who refuse vaccine mandates, while some individuals prefer to quit rather than receive the shot (Hsu, 2021).  

Vaccination mandates have been linked to increased distrust in officials, strained healthcare resources, political division, and reduced willingness to receive both COVID-19 and unrelated vaccines like chickenpox. These mandates are seen as a contentious public health measure, debated publicly and among healthcare workers. Healthcare workers are often targeted for vaccine mandates due to their moral duty to prevent harm to patients and their crucial societal role, especially during a pandemic. Even before COVID-19, vaccine hesitancy among healthcare workers was a public health issue (Politis et al., 2023). 

Healthcare workers' reasons for vaccination hesitancy, both prior to and during the COVID-19 pandemic, include mistrust of authorities, waiting for more reliable data, and doubts about vaccine safety and effectiveness. Some healthcare workers believed vaccination was unnecessary, favoring natural immunity or thinking that those previously infected shouldn't be vaccinated. Opposition to COVID-19 vaccine mandates was also driven by safety concerns, which are often heightened considering that even for the well-established flu vaccine, concerns about short-term side effects, as well as potential long-term risks like Guillain–Barré syndrome and thimerosal exposure, influenced healthcare workers opinions (Politis et al., 2023). 

 Vaccine Fatigue 

Vaccine fatigue refers to people’s inertia or inaction towards vaccine information or instructions, often caused by perceived burden and burnout. This fatigue can harm both individual and public health and may reduce people’s willingness to get vaccinated. The range of issues, from vaccine efficacy and equity to the need for booster shots, contributes to the accumulated burden and burnout, which can deepen people’s “vaccine fatigue." Additionally, confusing and conflicting media reports about vaccination may worsen the situation (Su et al., 2022). 

Extended exposure to pandemic stressors like mask mandates, lockdowns, and vaccination policies might have led to a passive or resistant attitude toward vaccines, vaccine information, or public safety. Furthermore, the relaxation of health mandates, decreased urgency for influenza vaccination post-pandemic, and continued politicization of vaccines probably increased vaccine fatigue among the public (Nofzinger et al., 2025).  

Vaccine fatigue has several negative consequences. Reduced involvement of healthcare workers may lower vaccination rates, raising the risk of outbreaks of preventable diseases. When healthcare professionals show signs of vaccine fatigue, it can diminish public confidence in these health measures. This cycle of fatigue and low vaccination uptake further stresses already overwhelmed public health resources (CNBC, 2025). Sameera et al. (2025), highlight the need for continuing professional education and support for vaccine education. 

Vaccine Effectiveness 

Vaccines are generally considered safe and effective, and COVID-19 is a newer vaccine that was introduced and is still being evaluated. Healthcare workers were at increased risk for contracting COVID-19 during the pandemic, and within months of a vaccine becoming available, it quickly became mandated throughout organizations. Healthcare workers were more than 10 times more likely to contract this virus than the general community, due to lack of personal protective equipment and exposure, demonstrating the need for a mandate (Marra, 2021). Vaccination of healthcare workers is associated with fewer patient transmission, less nosocomial infections, and reduced mortality (Sameera et al., 2025). With vaccines, infections disease rates decrease while health outcomes and enhanced public safety improve (Hodge, 2025). 

The COVID-19 vaccine first became available in December 2020 in the United Sates as an option to minimize the effect of COVID-19 (Hergott et al., 2025).  Within 4 months it started to become mandated across healthcare organizations.  By September 2021 it was estimated 70% of healthcare workers were fully vaccinated against COVID-19, however this was lower than what was needed to keep healthcare workers and patients safe (Hergott et al., 2025).  A higher percentage was needed to reduce the spread.  Herd immunity refers to enough people in a population being vaccinated to where the spread of an infectious disease is less likely to spread (Cleveland Clinic, 2022). According to Liu, et al. (2022), herd immunity would require a coverage of 93% or higher.  However, the study found that immunity varied on variant, and a result of the lack of prior natural immunity.  Although a higher percentage of vaccination would be required for herd immunity, it was determined that even when herd immunity was not reached, vaccines could reduce infections of COVID-19 by 50-62%. 

Many studies were performed that show the effectiveness of COVID-19 vaccines.  Studies were done after one and two doses. Thirteen studies evaluated over 173,000 healthcare workers for vaccine effectiveness (Marra, 2021). What they found was those with at least one dose had an estimated vaccine effectiveness of 92.8%. Seven of the thirteen studies evaluated the effectiveness of two doses and estimated the effectiveness to be 93.5%. Between December 2021 and April 2021 these thirteen short-term vaccine effectiveness studies, demonstrated the vaccines decreased COVID-19 symptoms (Marra, 2021). When the COVID-19 vaccine was first released, uptake was high due to mandating and perception of risk (Sameera, et al., 2025).  However, vaccine fatigue and perceptions of disease severity have caused booster coverage to be less as time went on. 

Long-term effectiveness of COVID-19 can be defined as a time of greater than 5 months after the second dose of the vaccine (Marra, 2021).  Sixteen studies were performed on nearly 18 million individuals, with 10 of them showing long-term vaccine effectiveness of COVID-19 being 84.2% effective at reducing symptoms (Marra, 2021).  However, these results varied based on which variant was present at the time of the study.  Ssentongo et al. (2022) found that vaccine effectiveness with all COVID-19 infections declined from 83% in the first month of vaccination series to 22% at 5 months or longer.  Furthermore, Petráš et al. (2022), demonstrate that two doses demonstrated early on protection against COVD-19, yet the risk of new antigenically distinct variants could influence effectiveness.  Long-term effectiveness showed the vaccine reduced symptoms, but did not necessarily reduce chances of contracting COVID-19. 

Vaccine effectiveness is evaluated over time, with short term being one month and long term being roughly six months and longer.  Feikin et. al., found that protection against severe cases remains high in long and short term, however protection against infection and symptoms starts to diminish by six months (2022). Vaccines in general are considered safe and effective, however COVID-19 is newer and long-term effectiveness and risks are still being evaluated. 

Ethics on Mandating Vaccines 

Ethics in regards to mandating vaccines involve moral principles around individual autonomy with public health needs, as well as responsible research and specific beliefs. Hergott et al. (2025) recognize that vaccine mandates are usually not supported by most courts or governments.  However, private employers and the government are allowed to require their employees to be vaccinated as a condition of employment.  According to Hodge (2025), the long history of vaccination is tied to the use of mandates. Mandating removes the choice, or gives an ultimatum to risk losing a job or opportunity if one chooses not to get a vaccine. Although it is argued that vaccine mandate infringes on personal freedom, local public health officials, federal, state and legislators have all leaned on vaccine mandates to promote the publics health and safety. Mandating vaccines can also clash with religious and philosophical beliefs as some religions believe their body is a temple of God, and getting the vaccine would go against this. 

At a time when healthcare was critically staffed, and several employees were out sick, the question arises if it was ethically right to mandate vaccines. Mandating vaccines further reduced the workforce when staff tried to get an exemption and were denied.  Hergott, et al. (2025) expand upon how mandating the COVID-19 vaccine caused a loss of critical employees when healthcare system was near the breaking point due to the large influx of critically ill patients and many employees needing sick leave themselves. 

Vaccine mandates are driven by the need to quickly achieve public health goals of herd immunity.  However, the mandates must be assessed for their safety and effectiveness.  Transparency around evidence, safety and efficacy help people make informed choices with known risks disclosed (Akumiah, & Yaria, 2023).  COVID-19 vaccination mandates had a short follow-up time post-vaccination, not allowing for thorough review (Wu, et al., 2021).  When there are limited sample sizes and shorter time frames, testing and trials may not detect side effects. Unknown risks can be a concern with newer vaccines, when evidence and testing is still evolving (Akumiah, & Yaria, 2023).  New technologies were used with COVD-19 vaccine development (Wibawa, 2020).  mRNA vaccine safety was identified, where it could lead to inflammation and autoimmune conditions.  DNA-based vaccines involve the chance of triggering mutagenic effects.  When the COVID-19 vaccine came out these approaches were not used with any authorized vaccines prior, raising concerns on if they were truly safe. 

Conclusion 

Vaccines have long played a role in public health, and as of 2023 more than 25 licensed vaccines are in use worldwide. The COVID-19 pandemic challenged the limits, safety and ethics of vaccination. While vaccines have proven effective in reducing transmission and severity of symptoms, the implementation of mandates remains a concern for many. 

The COVID-19 vaccines were mandated within months of becoming available. Multiple of these vaccinations involved newer vaccine technology, and due to how rapidly the vaccines were developed they were not as thoroughly tested as other vaccines are.  The mandates were implemented with a goal of herd immunity and protecting those who were at high risk. Short- and long-term effectiveness of the vaccines demonstrated efficacy in reducing symptoms. However, long-term effectiveness declined over time with newer variants and vaccine fatigue. 

Vaccine mandates require transparency, and informed consent. Mandates need to be backed with clear evidence and continually reassessed as new data emerges. Vaccines are a key part of public health, however effectiveness, mandates and fatigue remain major concerns.  Balancing public health with personal rights is complex, and the ongoing need for data, studies and education can help reduce concerns around vaccine safety and effectiveness. 

References 

Akumiah, F., & Yaria, J. (2023, September 8). The equitability of universal vaccine mandates – A bioethical analysis of COVID19 vaccine. African Journal of Bioethics. https://doi.org/10.58177/ajb230004 

Centers for Disease Control and Prevention. (n.d.). Fast facts on global immunization. Centers for Disease Control and Prevention. https://www.cdc.gov/global-immunization/fast-facts/index.html  

Cleveland Clinic. (2022, March 16). Herd immunity: History, vaccines, threshold & what it means. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22599-herd-immunity 

CNBC. (2025, June 10). Field: Vaccine fatigue has caused flu vaccination rates to fall slightly. CNBC. https://www.cnbc.com/video/2025/06/10/field-vaccine-fatigue-has-caused-flu-vaccination-rates-to-fall-slightly.html?&qsearchterm=vaccine+fatigue  

Ethical considerations for a COVID-19 vaccine mandate. Society of Critical Care Medicine (SCCM). (n.d.). https://www.sccm.org/blog/ethical-considerations-for-a-covid-19-vaccine-mandate#:~:text=If%20basic%20requirements%20for%20HCW,Issues%20to%20Consider  

Feikin, D. R., Higdon, M. M., AbuRaddad, L. J., Andrews, N., Araos, R., Goldberg, Y., Groome, M. J., Huppert, A., O’Brien, K. L., Smith, P. G., WilderSmith, A., Zeger, S., Deloria Knoll, M., & Patel, M. K. (2022, March 5). Duration of effectiveness of vaccines against SARSCoV2 infection and COVID19 disease: Results of a systematic review and metaregression. The Lancet, 399(10328), 924–944. https://doi.org/10.1016/S0140-6736(22)001520 

Hatch, B. A., Kenzie, E., Ramalingam, N., Sullivan, E., Barnes, C., Elder, N., & Davis, M. M. (2023, June 27). Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making. PLOS ONE, 18(6). https://doi.org/10.1371/journal.pone.0287553  

Hergott, M., Andreski, M., & Rovers, J. (2025, January 7). Vaccine hesitancy among health paraprofessionals: A mixed methods study.PLoS One, 20 (1) https://doi.org/10.1371/journal.pone.0312708 

Hodge, James G, Jr,J.D., L.L.M. (2025, July). On The Efficacy and Legality of Vaccine Mandates.American Journal of Public Health, 115(7), 985-987. https://sienaheights.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/on-efficacy-legality-vaccine-mandates/docview/3232513605/se-2 

Hsu, A. (2021, October 24). Thousands of workers are opting to get fired, rather than take the vaccine. NPR. https://www.npr.org/2021/10/24/1047947268/covid-vaccine-workers-quitting-getting-fired-mandates  

Liu, H., Zhang, J., Cai, J., Deng, X., Peng, C., Chen, X, Yang, J., Wu, Q., Chen X., Chen, Z. Zheng, W., Viboud, C., Zhang, W., Ajelli, M. & Yu, H. (2022, January 31). Investigating vaccine-induced immunity and its effect in mitigating SARS-CoV-2 epidemics in China. BMC Med 20, 37 https://doi.org/10.1186/s12916-022-02243-1 

Marra, A. R., Kobayashi, T., Suzuki, H., Alsuhaibani, M., Bruna, M. T., Luigi, M. B., Mariana de, A. A., Salinas, J. L., Edmond, M. B., João Renato, R. P., Luiz, V. R., & Schweizer, M. L. (2021, October 21). The short-term effectiveness of coronavirus disease 2019 (COVID-19) vaccines among healthcare workers: a systematic literature review and meta-analysis. Antimicrobial Stewardship and Healthcare Epidemiology, 1(1)https://doi.org/10.1017/ash.2021.195 

Nofzinger, T. B., Huang, T. T., Lingat, C. E., Amonkar, G. M., Edwards, E. E., Yu, A., Smith, A. D., Gayed, N., & Gaddey, H. L. (2025, June 17). Vaccine fatigue and influenza vaccination trends across pre-, peri-, and post-covid-19 periods in the United States using epic’s cosmos database. PLOS One, 20(6). https://doi.org/10.1371/journal.pone.0326098  

Okpani, A. I., Adu, P., Paetkau, T., Lockhart, K., & Yassi, A. (2024, Feburary 15). Are covid-19 vaccination mandates for healthcare workers effective? A systematic review of the impact of mandates on increasing vaccination, alleviating staff shortages and decreasing staff illness. Vaccine, 42(5), 1022–1033. https://doi.org/10.1016/j.vaccine.2024.01.041  

Petráš, M., Máčalík, R., Janovská, D. et al. Risk factors affecting COVID-19 vaccine effectiveness identified from 290 cross-country observational studies until February 2022: a meta-analysis and meta-regression. BMC Med20, 461 (2022, November 25). https://doi.org/10.1186/s12916-022-02663-z 

Politis, M., Sotiriou, S., Doxani, C., Stefanidis, I., Zintzaras, E., & Rachiotis, G. (2023, April 21). Healthcare Workers’ attitudes towards mandatory COVID-19 vaccination: A systematic review and meta-analysis. Vaccines, 11(4), 880. https://doi.org/10.3390/vaccines11040880  

Sameera, A., Alyafei, A. A., Semaan, S., AlNuaimi, A. A., & Al Muslemani Maryam, A. (2025, June 11). Coronavirus Disease 2019 and Influenza Vaccination Compliance Among Healthcare Workers at the Primary Health Care Corporation, Qatar, 2020–2024: A Retrospective Study.Cureus, 17(6), 9. https://doi.org/10.7759/cureus.85761 

Ssentongo, P., Ssentongo, A.E., Voleti, N. et al. SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis. BMC Infect Dis22, 439 (2022, May 7). https://doi.org/10.1186/s12879-022-07418-y 

Su, Z., Cheshmehzangi, A., McDonnell, D., da Veiga, C. P., & Xiang, Y.-T. (2022, March 9). Mind the “vaccine fatigue.” Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.839433  

Wibawa, T. (2020, October 19). COVID-19 vaccine research and development: Ethical issues. Tropical Medicine & International Health, 26(1), 14–19. https://doi.org/10.1111/tmi.13503 

Wu, Q., Dudley, M. Z., Chen, X., Bai, X., Dong, K., Zhuang, T., Salmon, D., Yu, H., & for the others [if more authors] (2021, July 28). Evaluation of the safety profile of COVID19 vaccines: A rapid review. BMC Medicine, 19(1), 173. https://doi.org/10.1186/s12916021020595 

Vaccination requirements | USCIS. (n.d.-b). https://www.uscis.gov/tools/designated-civil-surgeons/vaccination-requirements