Edmonton·In Depth

Vaccinated or not? Health-care system in Alberta dealing with how to deploy workers

Though Alberta's supply of COVID-19 vaccine has dwindled in recent weeks, health agencies and other employers are grappling with thorny questions about how to staff facilities when some workers are vaccinated against COVID-19 and others are not.

Questions about COVID-19 vaccinations pose challenges for employers

A nurse gives Sahra Kaahiye the first COVID-19 vaccine in Edmonton on Dec. 15, 2020. (Jason Franson/The Canadian Press)

Though Alberta's supply of COVID-19 vaccine has dwindled in recent weeks, health agencies and other employers are grappling with thorny questions about how to staff facilities when some workers are vaccinated against COVID-19 and others are not.

Many Alberta health-care workers want the vaccine but haven't been able to get it to this point. Some others may say they don't want it even it's offered to them.

Alberta Health Services could mandate that its workers get shots, but has decided against it.

"As an employer, AHS would have the ability to implement mandatory vaccines for its workforce if it chose to do so," Alberta Health spokesperson Tom McMillan said in a statement to CBC News.

And, so far, an "overwhelming majority" of staff who have been offered doses have taken them, said AHS spokesperson Kerry Williamson.

No health authority in Canada has a mandatory vaccine policy, Williamson said.

Certain health-care workers are among the first groups included in the initial phase of Alberta's vaccine roll-out.

As of Jan. 26, almost 50,000 doses have been administered to eligible health-care workers.

More than 38,700 Alberta health-care workers have received at least one dose of the vaccine, Williamson said.

Second doses for many have been pushed back in the wake of manufacturer delays that have seen Alberta run through its supply. 

At present, a worker's COVID-19 immunization status will not affect any workplace considerations, Williamson said.

"Vaccinated workers will still have the same PPE requirements, exposure criteria, isolation and quarantine requirements, and testing requirements as an unvaccinated worker," he said.

"Unlike with other communicable disease outbreaks, declining the COVID-19 vaccination will neither change their ability to work in outbreak settings nor have any other negative employment repercussions."

Policy to be revisited

But as supply of the COVID-19 vaccine increases, the policy will be reassessed. 

An online resource for AHS staff explains that, eventually, the same policy that exists for workers who decline the influenza vaccine will be enforced.

Williamson said in those cases, a worker's influenza immunization status may mean that if an outbreak occurs in the unit where they work, they may be reassigned elsewhere until it's over.

In 2019-20, 67 per cent of AHS staff got the influenza vaccine. That was down slightly from 68 per cent the previous year but up from 63 per cent the year before that.

Still, that's more than double the rate of flu immunization for the general population in Alberta.

In January, an Angus Reid poll found that Albertans are more likely than people in any other province to say they won't ever get the COVID-19 vaccine.

That hesitancy in the general population may be part of the calculation when it comes to determining whether or not to make immunization mandatory for AHS staff, said Lorian Hardcastle, a law professor who works with the University of Calgary's Cumming School of Medicine.

"Alberta has a relatively high population of people who have said that they are not going to get the COVID vaccine, and I think the government is perhaps concerned that if they mandate it for health-care workers, it could perhaps be seen as less safe," Hardcastle said. 

U of C health law associate professor Lorian Hardcastle said arguments for and against compelling health-care workers to get the COVID-19 vaccine are complex. (Submitted by Lorian Hardcastle)

As well, Hardcastle said, Canadian governments are generally reluctant to mandate vaccines: few provinces require children to be vaccinated to attend schools, and the Alberta government has said it will not use the Public Health Act to compel vaccines for the general public.

In December, Premier Jason Kenney said the government will soon amend that legislation to remove the power of mandatory inoculation that has been on the books since 1910.

"But we need as many Albertans as possible to get vaccinated," Kenney said at a news conference on COVID-19. "And let me be clear about that — I will certainly choose to receive this vaccine when it's my turn, and I strongly urge others to do so."

She added that up to this point, legal challenges and discussions about mandatory immunization for health-care workers in Canada have largely centred on labour law and the annual influenza vaccine.

Some Canadian academics argue that provincial health authorities can and should mandate COVID-19 vaccines for health-care workers, and believe doing so would stand up to charter challenges. 

Hardcastle said with the current limited supply of doses, she doesn't think AHS needs to make a final decision yet.

"I think the hope is that as more people receive it, and as those who are willing to receive it get it, that others will come around and change their minds," she said. 

An informed approach

The head of the United Nurses of Alberta, which represents more than 30,000 Alberta nurses, said that if the COVID-19 pandemic prompts AHS to apply the same rules that are in place for health-care workers who decline influenza vaccine, the union will look at the circumstances.

"If there's justification for doing it, then that's what will happen," UNA president Heather Smith said.

Smith echoed Williamson in saying that her organization encourages its members to get vaccinated.

The union is not making a call for COVID-19 vaccine to become mandatory for health-care workers.

"We think that the better approach is to inform people and have them voluntarily recognize the value to them, their families, their patients," Smith said.

She said UNA is working with other nursing unions on a national digital initiative to promote getting the vaccine.

"This is an important vaccine and the benefit outweighs any risk," she said. 

Beyond AHS

Once the vaccine is widely available, Edmonton employment lawyer Dan Bokenfohr thinks there will be a spectrum of rules when it comes to workplaces requiring staff to be immunized.

Private long-term care facilities might be more likely to require it, he said.

"There have been a number of class-action suits that have been filed which exposes these operators to huge liability if they're found not to have done enough to prevent and stop outbreaks," Bokenfohr said.

"A vaccine for employees is a pretty effective tool in helping avoid those types of situations."

Bokenfohr said other industries that might pursue mandatory vaccinations for workers could include warehousing and manufacturing facilities where distancing is a challenge, or retail environments where staff work face-to-face with the public.

Some employers may not make vaccination mandatory, but might still impose consequences or temporarily sideline staff who are unvaccinated where there are heightened safety risks.

"I do think we'll see employers in the same industry looking over the fence and seeing what their cohorts are doing and comparing notes," Bokenfohr said.

ABOUT THE AUTHOR

Paige Parsons is an Edmonton-based reporter. She can be reached at paige.parsons@cbc.ca.

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