An Ethical-Legal Analysis Mandatory Influenza Vaccination for Healthcare Workers in China

Healthcare workers (HCWs) face a high occupational risk of influenza infection. Accordingly, the World Health Organization has identified HCWs as a priority group for influenza vaccination and established a target coverage rate of 75%. However, coverage among HCWs in China remains far below this target. Although mandatory vaccination may offer an effective means of increasing coverage, whether China should implement such a policy, and how it could do so, require careful ethical and legal analysis. This study conducted an ethical analysis of mandatory influenza vaccination for HCWs using a decision algorithm and a comparative legal analysis of influenza vaccination policies in five jurisdictions with mandatory vaccination policies—the United States, Canada, Finland, Australia, and Saudi Arabia—as well as of China’s voluntary influenza vaccination framework. The analysis suggests that mandatory influenza vaccination for HCWs may be ethically justified in principle. Influenza constitutes a significant public health threat, influenza vaccines have demonstrated safety and effectiveness, mandatory vaccination may prove more effective than less restrictive alternatives, and the resulting coercion may satisfy the requirement of proportionality. International experience further illustrates a range of mandate models, including administrative assessment, administrative offering, administrative ensuring, and mask-wearing requirements. Nevertheless, China currently lacks the legal framework necessary to implement such a policy. Although the Chinese government has introduced measures to increase influenza vaccination coverage among HCWs, including designating them as the highest-priority group, coverage has remained low. This persistent gap highlights the need to consider stronger policy measures, including mandatory vaccination. Given the absence of a sufficient legal framework to implement a mandate, a context-sensitive reform pathway could begin by establishing assessment criteria for influenza vaccination coverage among HCWs, providing free and convenient access to influenza vaccines, and ensuring high vaccination coverage in high-risk departments and units.