醫師對新興傳染病疫苗強制接種政策之態度──以COVID-19為例

Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

目標：COVID-19疫情肆虐全球，許多國家先後施行針對醫護人員的疫苗強制接種政策，台灣亦同。本研究探討國內醫師對於不同強制程度的疫苗強制接種政策的態度，了解其倫理信念及邏輯。方法：採用半結構式訪談法，使用滾雪球方式招募受訪者，訪談16位在北部地區醫院以上工作的臨床醫師。結果：受訪醫師傾向不支持疫苗強制接種政策。研究結果分成五個主題：（一）個人權利，依受訪者回應分為二個類別：1.侵犯自主權；2.侵犯工作權；（二）疫苗表現，其二個類別為：1.疫苗安全性；2.疫苗有效性；（三）機構規範，依受訪者對於政策發布單位之看法和與工作機構之關係分為二個類別：1.政策發布單位與自身的關切程度；2.醫師與機構的雇傭關係；（四）社會和職場汙名，依受訪者對針對工作類別或科別之醫護人員的強制政策之看法，將結果分為二個類別：1.針對醫護之強制政策加劇社會汙名；2.針對高風險醫護之強制政策加劇職場汙名；（五）醫師的職業道德。結論：自主權和醫師的職業道德對於受訪醫師判斷是否接受疫苗強制接種疫苗有重要影響，並且在做決策時亦會納入疫苗表現、機構規範、汙名因素。另外，即使是較具備疫苗知識，且專業倫理、公共衛生倫理素養高的受訪醫師仍傾向不支持醫護人員疫苗強制接種政策。建議由政府訂定醫療院所可使用的針對醫護人員之疫苗強制接種政策手段，以維持一致性，但執行時由各地區之醫院評估後實行適合醫院的疫苗強制接種政策。

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights; (2) vaccine performance, including safety and efficacy; (3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions; (4) social and workplace stigma resulting from coercive policies in different job categories or departments; and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs.