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A majority of healthcare workers surveyed in Alberta, Canada, expressed negative sentiments about vaccine mandates during the COVID-19 pandemic and said they experienced coercion, emotional distress and moral injury as a result of being pressured to get vaccinated, according to a new peer-reviewed study.
The paper, published Tuesday in Open Medicine and authored by three researchers from York University in Canada, involved a survey of 80 healthcare workers. The study sought to ascertain how the workers experienced COVID-19 vaccine mandates and how they viewed the legitimacy of those policies.
The study also sought to determine whether the workers who complied with workplace vaccine mandates did so out of support for those measures or because they felt pressured or compelled.
The results of the survey, conducted online last year, showed that 82.5% of respondents expressed “negative sentiments” about vaccine mandates. Only 17.5% of respondents expressed “positive sentiments.”
Almost all — 14 of 15 — vaccinated healthcare workers who participated in the survey expressed negative views about vaccine mandates, as did half (seven of 14) of the workers who received two or more boosters.
All 41 unvaccinated respondents said they viewed vaccine mandates negatively.
“This distribution indicates that compliance with mandates did not necessarily equate endorsement and that opposition to these policies extended across vaccination statuses,” the researchers wrote.
The negative sentiments highlighted by respondents included “coercion, institutional betrayal, silencing, ethical conflict, and moral injury” — defined by the researchers as “the distress that arises from participating in, witnessing, or being unable to prevent actions that violate deeply held ethical principles.”
Respondents who viewed vaccine mandates positively highlighted “patient care, role expectations, and public safety, often framing dissent as illegitimate.”
No respondents expressed “neutral” views toward vaccine mandates — an indicator of the polarized and emotionally charged nature of the vaccine mandate issue.
Dr. Danice Hertz, a retired gastroenterologist from California injured by Pfizer’s COVID-19 shot, said the moral injury for healthcare workers and anyone who refused to comply with COVID-19 vaccine mandates “has been profound.”
“It had a permanent mark on government trust and future pandemic responses,” Hertz said.
Main takeaway from study ‘should be humility’
For the authors, the workers’ “accounts of coercion, exclusion, silencing, and moral injury did not arise in a vacuum.”
Instead, their feelings “emerged in a policy environment in which vaccination status was treated not merely as a clinical or administrative category, but as a marker of professional responsibility, patient safety, and moral worth.”
Christopher Dreisbach, legal affairs director of React19, an advocacy group for the COVID-19 vaccine injured and their families, said the main takeaway from the study “should be humility.”
“Public health depends upon trust, and trust cannot simply be demanded during an emergency. It has to be earned before the emergency and preserved throughout it. That means acknowledging uncertainty, permitting legitimate scientific disagreement, and respecting informed consent,” Dreisbach said.
For Dreisbach, respect for informed consent should extend beyond healthcare workers to patients, including the vaccine-injured.
“It … means taking people who report adverse outcomes seriously rather than merely viewing their experiences as inconvenient to a broader public-health message,” Dreisbach said. “A public-health system that cannot tolerate questions will soon produce a public that does not trust its answers.”
‘The guilt rots away at my head’
The researchers — Claudia Chaufan, M.D., Ph.D., Natalie Hemsing and Rachael Moncrieffe — have “over four decades of combined experience in medical practice, medical sociology and anthropology, bioethical analysis, and health policy.”
“Longstanding concerns about the impact of COVID-19 policies on the health and postsecondary sectors in Canada” prompted the researchers to perform the study. They focused on Alberta, a province “marked by lower vaccine uptake, pronounced political polarization, and public conflict over the legitimacy of mandated vaccination.”
The polarization was evident in the results, including in the written responses the participants provided. According to the authors, the “most salient theme” emerging from these responses was the “rupture in moral orientation” and “experiences of moral injury, evident in a number of entries from across vaccination statuses.”
According to the study, several participants “described being forced to act against their professional or ethical convictions, to remain silent in the face of perceived wrongdoing, or to watch patients or colleagues suffer avoidable harm while feeling powerless to intervene.”
“I was forced to inject an experimental substance or lose the ability to provide for my family… I wish I had been stronger and refused,” one participant wrote.
Other respondents described a chilling effect, where they were reprimanded if they spoke openly about their concerns or those of their patients — or were reluctant to speak for fear of retaliation.
“When I had concerns about my own patients’ negative reactions… I was told to keep quiet,” another participant wrote.
Respondents also expressed disagreement and guilt over having to vaccinate patients who they believed should not have received the COVID-19 shot.
“Initially, the vaccines were not approved for pregnant women… then all of a sudden, we were told to vaccinate pregnant women… When I asked for the evidence, I was told there was NONE, and it wasn’t my job to ask questions… I left my job not long after that,” one participant wrote.
“The guilt rots away at my head,” another participant wrote.
‘I felt completely manipulated and toyed with’
The researchers described such accounts as evidence of a “deeper and more enduring rupture,” with healthcare workers experiencing “institutional betrayal and moral dislocation.”
Some participants said they felt compelled to choose between their personal beliefs and their professional standing.
“I felt completely manipulated and toyed with… I suffer from PTSD and depression from the mandates and subsequent vaccination,” a fully vaccinated respondent said.
Some vaccinated healthcare workers also expressed disagreement with the consequences their unvaccinated colleagues faced. “There was a significant lack of support for healthcare professionals that chose not [to] be vaccinated,” one vaccinated participant wrote.
Other participants detailed “a pronounced sense of violation of bodily autonomy and principles of medical ethics,” with several respondents saying the vaccine mandates were “antithetical to the values that healthcare is meant to uphold.”
One unvaccinated nurse described the mandates as “inhumane and unethical… a breach of patient confidentiality, informed consent and bodily autonomy.”
A vaccinated nurse said, “We were hypocritical with our medical ethics… We tell a woman she has a right to abortion… but that same woman should then have no choice in taking a vaccine.”
Nurses were warned not to report COVID vaccine injuries
Several participants said they were warned by their employers not to report vaccine injuries — or were disciplined if they raised concerns.
“Any discussion around vaccination status or adverse reactions resulted in disciplinary action,” one respondent wrote. Another cited “active discouragement of reporting vaccine side effects.”
The authors wrote that the responses “constitute a coherent critique of the mandates as unjust, harmful, and at odds with professional ethics and democratic norms.”
“They also underscore that the boundary between compliance and dissent was not as clear-cut as institutional policies presumed: many respondents complied, but under protest — and with lasting emotional and moral consequences,” they wrote.
Among respondents who expressed positive views toward mandates, several highlighted a sense of professional duty and alignment with what they described as public health ethics. Others described frustration with unvaccinated colleagues.
“The lack of accountability as a professional to keep patients safe was deplorable,” one participant wrote. Others challenged the legitimacy of the study, suggesting that the survey questionnaire “assumes negative experiences.”
“These responses indicate that for this subset of mandate supporters, the very act of asking about adverse experiences and ethical concerns was interpreted as an unacceptable departure from professional or ethical norms,” the authors wrote, noting that for mandate supporters, there was a “narrowing” of “what counted as legitimate inquiry.”
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People will ‘think twice’ about complying with future mandates
For the authors, the polarized responses — and the feelings of coercion and moral injury expressed by the majority of the study’s participants — “highlight the power of institutional messaging to shape the moral landscape.”
The authors suggested that pandemic-era framing of compliance with vaccine mandates was not done in a neutral manner. Instead, “the empirical warrant and ethical legitimacy of a policy objective — in this case, increasing vaccination uptake among healthcare workers” was “taken for granted.”
Conversely, “barriers to that objective — beliefs, emotions, social networks, and so on — are treated as obstacles to be managed.”
According to the researchers, this framing has continued in the years since the COVID-19 pandemic. They cited several studies that, even if sympathetic toward people who did not comply with the mandates, still presented the policies as being driven by a legitimate interest in protecting public health.
The authors suggested the study’s most significant contribution is “to position moral injury as a critical lens for understanding the long-term ethical consequences of public health policy.” This perspective has been overlooked in previous studies and analyses of the COVID-19 response, they said.
The potential long-term consequences of this response, in the context of public trust toward official health narratives, were the subject of an interview by U.K. news outlet The i Paper this week with London School of Economics behavioral scientist Paul Dolan, Ph.D.
According to Dolan, the public likely “won’t blindly obey the rules of another pandemic.” He said:
“Next time around, we will remember the cancelled weddings and missed funerals. We will remember children learning through laptop screens and students isolated in university rooms. We will remember grandparents separated from grandchildren and months of uncertainty about when normal life would return.
“We might disagree about whether some restrictions were justified, but there can be little disagreement that they came at a very high cost.”
According to Hertz, the experience “has created mistrust in our governments and will no doubt have a great impact on future pandemic responses. Now that we know the pitfalls and harms of these mandates, the public will think twice about abiding by these forced requirements in the future.”
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