醫師對新興傳染病疫苗強制接種政策之態度 —以 COVID-19為例

Abstract

背景與目的：COVID-19疫情肆虐全球，社會經濟問題亦隨之而來，故各國對疫苗寄予厚望。但當疫苗到位時，由於因為對疫苗安全性、有效性等產生猶豫，進而造成疫苗施打狀況不佳，故強制施打疫苗的政策掀起討論。許多國家先後施行針對醫護人員的強制施打疫苗政策，台灣也不例外。然國內尚無針對醫護人員強制施打疫苗之實證研究，因此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，並了解其支持或反對的原因。 研究方法：本研究採用一對一半結構式訪談，透過滾雪球的方式招募16位在北部地區醫院以上工作的臨床醫師參與研究。利用主題分析法分析訪談資料，進行編碼、關聯性比對、分析。 研究結果：(一)大部分受訪者認為疫苗強制接種政策會侵害自主權，部分受訪者認為僅針對醫護人員執行強制政策的針對性太高，但亦有受訪者表示身為醫護人員可以接受更高規格的強制施打疫苗政策。(二)疫苗安全性、有效性為受訪者非常在意的因素。(三)政策強制程度過高，例如：罰款、吊銷醫療執照，則無法接受。(四)政策強制對象的不同、政策與自身的關切程度皆可能影響態度(五)受訪醫師在意工作權，若疫苗強制接種政策影響其工作權則無法認同。(六)與國外研究不同，政黨在此議題上影響力不大。(七)鼓勵性政策較強制性政策接受度高。(八)可以考慮採用由未施打疫苗但染疫的人員自行負擔風險責任的方式替代疫苗強制接種政策。 討論與建議：本研究初步探索台灣醫師對於疫苗強制接種政策的態度以及決策因素，亦發現即使是倫理意識較高的受訪醫師仍傾向不支持醫護人員疫苗強制接種政策。建議應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，但執行時應由各地區之醫院評估其區域風險、科別、病患類型等，實行適合醫院的強制疫苗接種政策。本研究之結果可供未來擬定政策或實務執行時參考，透過更了解台灣之醫師對於影響其對此政策的態度之因素，在政策擬定上能更完善的顧及，減少執行的障礙以提升政策成效。

Background and Objectives: Covid-19 pandemic has been raging all over the world and has resulted in serious socio-economic problems; vaccination has been deemed an effective means to tackle the pandemic. Due to hesitation regarding safety and efficacy of vaccines, vaccination coverage was often less than ideal even with adequate vaccine supplies. As a result, mandatory vaccination policy was well discussed. Many countries, including Taiwan, had implemented vaccine mandates, particularly targeting at healthcare workers. Yet, there were few empirical researches on vaccine mandates for healthcare workers in Taiwan. The study focused on Taiwanese physicians' attitude toward mandatory vaccination policies with different degrees of coercion, and explored their ethical reasonings. Methods: Using semi-structured interview method, the study recruited 16 physicians working at hospitals in northern Taiwan. Thematic analysis method was applied for data analysis, including coding and correlation comparison and analysis. Results: (1) The interviewees believed that mandatory vaccination policies would infringe autonomy and are too targeted, but some said that as healthcare workers, they could accept mandatory vaccine mandates of higher standards. (2) Vaccine safety and efficacy are the factors that the interviewees highly concerned. (3) When the degree of coercion was too high, such as fines and revocation of medical licenses, the interviewees would consider it unacceptable. (4) Different coercion authorities and targets may affect attitudes. (5) The interviewees showed much concern about the right to work. Once the mandatory vaccination policy affects their right to work, they cannot agree. (6) Unlike other studies, political partisanship has little influence on this issue. (7) Incentive policies are more acceptable than mandatory policies. (8) The interviewees suggested that the government could consider replacing mandatory vaccination policies with one that holds those who did not get vaccinated but are later infected more accountable to bear the responsibility themselves. Conclusion and suggestions: This study explored the attitudes and decision-making factors of Taiwanese physicians towards the mandatory vaccination policy. Even with high ethical awareness, the interviewees tended not to support the mandatory vaccination policy. The study suggests that the government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. When implementing, hospitals in each region could evaluate their regional risks, departments, patient types, and chose the most suitable mandatory vaccination policies for the hospital accordingly. In the meantime, the government should also formulate compensation measures, requiring each hospital to give appropriate compensation to affected healthcare workers. To sum up, the results of this study can be used as a reference for future policy or practical implementation. By better understanding the factors that affect Taiwan's physicians' attitudes towards this policy, the findings of the study could help reduce barriers to implementation and improve policy effectiveness.