COVID-19 vaccination decisions and the impact of vaccination mandates: An exploratory cross-sectional survey of healthcare workers in British Columbia, Canada

British Columbia implemented some of Canada’s strictest COVID-19 workplace vaccination mandates in the healthcare sector. Despite opposition from some healthcare worker (HCW) unions, most health establishments, policymakers, and academic researchers supported these mandates, which remained in effect until July 2024. While the perceived problem of vaccine hesitancy among HCWs has generated much research, HCWs’ experiences and views on vaccination mandates have been relatively neglected. Our study, conducted between June and July 2024, explored these experiences and views. We surveyed 166 HCWs recruited through social media and snowball sampling, regardless of vaccination status, age, gender, ethnicity, socioeconomic background, or health profession. Nearly half of the respondents had over 16 years of work experience, most were unvaccinated, and most had been terminated for non-compliance. Both unvaccinated and vaccinated respondents expressed concerns about vaccine safety, coercion, and mental health impacts, including suicidal thoughts. Most unvaccinated respondents were satisfied with their vaccination decision, but they reported financial losses, mental health struggles, and conflicts with colleagues and loved ones. The vaccinated respondents – a minority in our sample - were largely unsatisfied, with most experiencing post-vaccination adverse events, and over half feeling pressured by their employers to accept further doses despite these effects. Regardless of vaccination status, HCWs observed concerning changes in practice protocols and discrimination against unvaccinated patients. We argue that even if neglected by the literature, the multiple negative impacts of vaccination mandates identified in our study – on HCWs’ well-being, patient care, and ethical healthcare practices – are extremely worthy of consideration. They indicate the importance of prioritizing informed consent, engaging competing scientific evidence, and ensuring healthcare sustainability, particularly during emergencies.