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Despite their education, health workers are susceptible to the same fear-mongering and misinformation spread by anti-vaxxers as members of the general public.Paul Chiasson/The Canadian Press

Diane Sims has lived with multiple sclerosis for decades.

Now, at age 63, the author and former journalist is dying. She has accepted that stoically.

As she strives to eke joy out of her final weeks and days, Ms. Sims just doesn’t want her death hastened by COVID-19.

Yet, the health care workers who come to her home in Stratford, Ont., daily to provide palliative care – toileting, bathing, dressing etc. – don’t have to be vaccinated against the pandemic illness.

According to the home-care agency that employs the workers, no one is even allowed to ask them their vaccination status – not even a dying woman who is at high risk of infection.

This is nonsense. The so-called privacy rights of workers are not absolute. And they are more than offset by a patient’s right to not be put in harm’s way.

“I feel violated and betrayed,” Ms. Sims told me. “I don’t want to have to choose between getting care and putting my life at risk.”

Ontario has slowly and reluctantly mandated that health care workers be vaccinated. (Other provinces have also done so, to varying degrees.)

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First, there were “mandatory” vaccination rules for those who work in hospitals – rules that vary from institution to institution. Then the province got around to mandating vaccination in long-term care homes, where thousands upon thousands of elders died gruesome deaths from COVID-19.

But there is no vaccine mandate for home-care workers, or in other non-institutional parts of the system.

Just because our health care system is a mess of disconnected institutions and programs doesn’t mean our rules and regulations need to be equally obtuse. Vaccine mandates are essential in health care, but they can’t be vague. To be effective, they have to be universal, unambiguous and have clear deadlines and punishing consequences if violated.

Quebec got it right.

The provincial Health Minister, Christian Dubé, said all workers, form clerks to physicians, must be vaccinated, without exception. Those who don’t want to get their COVID-19 shots have a clear choice between the jab or their job. Quebec’s deadline is Oct. 15, a little more than a week away. Those who are not fully vaccinated by that time will be suspended without pay and potentially fired if they don’t meet the vaccination requirement promptly.

At last count, 17,624 health care workers in the province have not received even one dose, almost half of them front-line workers. That’s a lot of essential workers to lose, especially in the midst of a worsening health human-resources crisis.

But Quebec can’t blink. If there is one thing that will cause staff shortages in the short term, it’s an outbreak of COVID-19 in a hospital. The larger human-resources issue can’t be resolved by neglecting patient safety.

Like New York State, Canadian jurisdictions need hard-core vaccination mandates. And, as is happening in New York, the vast majority of health workers will come around, rolling up their sleeves for shots, even if it is at the last minute.

It’s unclear why a small minority of health workers are reluctant to be vaccinated.

Despite their education, health workers are susceptible to the same fear-mongering and misinformation spread by anti-vaxxers (many of whom have financial interests in flogging “alternative medicine”) as members of the general public.

Many health workers, burned out and angry at their work conditions, are simply tired of being put upon and told what to do. Their anger is justified, but refusing vaccination and putting patients at risk is not the way to express frustration.

Ms. Sims, who has a rotation of 12 home-care workers, says four of them have told her explicitly they refuse to be vaccinated. One said the vaccine was “poison,” and another feared it contained a microchip. (Both are common, nonsensical claims circulating on social media.)

When the unvaccinated workers are scheduled, Ms. Sims tells them they are not welcome in her home. She goes without essential care. The agency refuses to provide other, vaccinated workers.

That is the antithesis of patient-centred care.

The time for encouraging, persuading, cajoling and educating workers has passed. There needs to be a stark choice presented to anyone who wants to work in the health system: Get a COVID-19 vaccine or find another line of work.

As Ms. Sims so eloquently stated, workers who refuse to be vaccinated during a pandemic are violating and betraying the most fundamental ethical principle that must guide their work: First, do no harm.

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