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      From a voluntary vaccination policy to mandatory vaccination against COVID-19 in cancer patients: an empirical and interdisciplinary study in bioethics

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          Abstract

          Background

          At the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.

          Methods

          Between April and November 2021, the Ethics and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint (= quality of life/survival). We used a mainly qualitative methodological approach based on questionnaires and interviews.

          Results

          In April 2021, 29 cancer patients refused or were reluctant to be vaccinated (5.6%; 29/522). Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal (1.9%; 10/522). One of the main reasons for the decrease in refusals was probably the introduction of the “ pass sanitaire” (health pass) in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.

          Conclusion

          We identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” (a new clinical practice) and “free will” (a moral value), and the duty to “protect each other” (a moral standard). Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life (i.e. happiness), or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished.

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          Most cited references70

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          A global survey of potential acceptance of a COVID-19 vaccine

          Several coronavirus disease 2019 (COVID-19) vaccines are currently in human trials. In June 2020, we surveyed 13,426 people in 19 countries to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 61.4% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so.
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            COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

            Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.
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              COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment

              Given the results from early trials, COVID-19 vaccines will be available by 2021. However, little is known about what Americans think of getting immunized with a COVID-19 vaccine. Thus, the purpose of this study was to conduct a comprehensive and systematic national assessment of COVID-19 vaccine hesitancy in a community-based sample of the American adult population. A multi‐item valid and reliable questionnaire was deployed online via mTurk and social media sites to recruit U.S. adults from the general population. A total of 1878 individuals participated in the study where the majority were: females (52%), Whites (74%), non-Hispanic (81%), married (56%), employed full time (68%), and with a bachelor’s degree or higher (77%). The likelihood of getting a COVID-19 immunization in the study population was: very likely (52%), somewhat likely (27%), not likely (15%), definitely not (7%), with individuals who had lower education, income, or perceived threat of getting infected being more likely to report that they were not likely/definitely not going to get COVID-19 vaccine (i.e., vaccine hesitancy). In unadjusted group comparisons, compared to their counterparts, vaccine hesitancy was higher among African-Americans (34%), Hispanics (29%), those who had children at home (25%), rural dwellers (29%), people in the northeastern U.S. (25%), and those who identified as Republicans (29%). In multiple regression analyses, vaccine hesitancy was predicted significantly by sex, education, employment, income, having children at home, political affiliation, and the perceived threat of getting infected with COVID-19 in the next 1 year. Given the high prevalence of COVID-19 vaccine hesitancy, evidence-based communication, mass media strategies, and policy measures will have to be implemented across the U.S. to convert vaccines into vaccinations and mass immunization with special attention to the groups identified in this study.
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                Author and article information

                Contributors
                c.herve@hopital-foch.com
                Journal
                BMC Med Ethics
                BMC Med Ethics
                BMC Medical Ethics
                BioMed Central (London )
                1472-6939
                28 August 2022
                28 August 2022
                2022
                : 23
                : 88
                Affiliations
                [1 ]GRID grid.414106.6, ISNI 0000 0000 8642 9959, Department of Ethics and Scientific Integrity, , Foch Hospital, ; Suresnes, France
                [2 ]GRID grid.414106.6, ISNI 0000 0000 8642 9959, Department of Oncology and Supportive Care, , Foch Hospital, ; Suresnes, France
                [3 ]GRID grid.418596.7, ISNI 0000 0004 0639 6384, Department of Supportive and Palliative Care, , Institut Curie, ; Saint-Cloud, France
                [4 ]GRID grid.414106.6, ISNI 0000 0000 8642 9959, Department of Clinical Research and Innovation, , Foch Hospital, ; Suresnes, France
                [5 ]Medical School, Paris Cité University, Paris, France
                [6 ]GRID grid.12832.3a, ISNI 0000 0001 2323 0229, Medical School, , Versailles Saint-Quentin-en-Yvelines University, ; Montigny-le-Bretonneux, France
                [7 ]Veterinary Academy of France, Paris, France
                [8 ]GRID grid.457361.2, International Academy of Medical Ethics and Public Health, , Paris Cité University, ; Paris, France
                Article
                827
                10.1186/s12910-022-00827-3
                9420182
                36031621
                4d8c6dd5-4e42-4b78-9ca1-d0db8eacef49
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 25 January 2022
                : 22 August 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Medicine
                pandemic,covid-19,cancer,vaccine,oncology,bioethics,hospital,france
                Medicine
                pandemic, covid-19, cancer, vaccine, oncology, bioethics, hospital, france

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