Multilevel Model of Health-Covid-19, Vaccinations and Mandates for Health Care Professionals in B.C.

Using a multilevel model of health, this paper intends to bring forth the socio-ecological model for promotional adherence to the health-mandated vaccination against the coronavirus (COVID-19) policy for all healthcare professions. Differential health decisions for vaccinations intertwine in each model segment, influencing individuals to become vaccinated or not against COVID-19. The use of best practices of health care is being vaccinated against COVID-19. Regulated health professionals in British Columbia, currently employed or returning to work, must adhere to the public health authorities’ guidelines and policies within their regulators to maintain their client’s ethical continuum of health care and needs.

COVID-19 affected the population worldwide with ripple effects from the lack of healthcare access, low vaccination, and high mortality rate (WHO, 2023). This contributed to higher instances of prices in food, unemployment, border shutdowns, financial burdens for families, malnutrition, hospitalizations, and premature deaths (WHO, 2023). In the statistics report, in 2022 there were 16, 151 reported deaths due to COVID-19 in Canada, making it the third leading cause of death (Statistics Canada, 2023). In B.C. there were a total of 5, 218 deaths as of today March 7, 2023 (Google News, 2023).

In the province of British Columbia in Canada, the vaccination requirements were mandated for all health professionals to have been vaccinated with at least one dose before March 24, 2022 (Government of B.C., 2022). As many as 2,500 healthcare workers lost their jobs before March 2022, due to non-compliance with getting vaccinated, as mandated by healthcare officials (Vancouver Sun, 2023). This contributed to the shortages of healthcare workers in B.C., though many were on an unpaid leave of absence until they were able to be vaccinated (Government of B.C., 2022).

In contrast, RMTs were entirely out of work temporarily in 2020. In addition, RMTs were at risk of financial burdens from having not worked during COVID-19 due to the mandated lockdowns, and their income has been reduced due to many factors. For example, fewer patients were seen by RMTs due to time allotted to cleaning and disinfecting, patients weary of physical contact, not obeying local protocols such as wearing a face mask, and not being protected against COVID-19 with mandated vaccinations. Therefore, according to Ayukebong (2021), the government of Canada must uphold human rights and keep that balance in public health by protecting the healthcare needs of Canadians from the transmission of COVID-19 with vaccinations.

According to data, 14,227,695 people from British Columbia have received at least one dose of an approved COVID-19 vaccine making it approximately 97% of the B.C. population and 85% of B.C. residents have had two vaccinations (COVID-19 Tracker Canada, 2022). In addition, in a data report published on the B.C. government news, the public health officials informed the public about the percentage of health-regulated professionals who are not vaccinated due to being medically exempt; for example, massage therapists are approximately 87% vaccinated (BC Gov News, 2022).

Health influences from the four levels in the socio-ecological model are all interrelated, starting with the individual to interpersonal, institutional, community, and government policy (Jang, 2022). This socio-economic model examines the determinants of health and behavior that influence people to get vaccinated against COVID-19 and to cooperate with the mandate changes in healthcare post-COVID-19 in B.C.

Multilevel Model of Health-Socio-Ecological Model

https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

Individual

Health care is constantly changing, and reforms are currently in progress to address the needs of Canadians. In conjunction with the socio-economic health model levels, health begins with the individual and ends at the government level to promote healthy changes. This includes a person’s age, race, ethics, education, employment status, ethnicity, behaviors, and attitudes that can influence whether to get vaccinated or obtain employment in the healthcare setting.

Massage therapists working in a regulated college must adhere to the code of ethics, take funded specialized training, and take safety measurements in their workspaces to provide holistic care to clients (CMTBC, 2021). Many healthcare professionals are mandated by the Provincial Health officer in the Province of B.C. to be vaccinated against COVID-19. This is in place to ensure employment, stay healthy, and prevent the spread of infection and transmission of COVID-19. Unfortunately, some healthcare workers did not comply and lost their jobs Individual autonomy, experience, education, race, ethics, religion, sex, beliefs, friends, community, and government policy influence individuals choosing vaccinations against COVID-19.

Interpersonal

Interpersonal relationships can have a positive or negative effect according to one’s religion, beliefs, values, and how others perceive vaccinations. A significant influence for individuals to not be vaccinated was false information through social media platforms.

Anti-vaccinators verbalize their protests regarding their beliefs about the unsafety of vaccines and concerns that the vaccines do not provide immunization and refuse to be vaccinated or let their children be vaccinated (Benoit & Mauldin, 2021).

In addition, many individuals decided not to be vaccinated due to fear, and the news media made misconceptions about the vaccine deemed unsafe and contributed to more deaths (Palmer, 2022). Marginalized groups facing discrimination were influenced the most post-COVID-19, with inequity in employment opportunities, poor living conditions, and poverty (Paramoer, 2021). Other determinants influencing the deciding factors for being vaccinated are discrimination, stigma, lack of access to health care, and fear of doctors. In B.C., the mandate for health care regulated professionals is that they must be vaccinated, as stated by the provincial health officer (Government of B.C, 2022).

Community

There are five different regional districts, and different health authorities manage each section throughout the region of B.C. (Government of B.C, 2021). The Regional Health Authorities are Fraser Health, Interior Health, Island Health, Northern Health, and Vancouver Coastal Health (Government of B.C, 2021).

The community that I belong to is Interior Health, B.C. There is one general hospital and a few urgent care medical clinics that patients can walk in without an appointment. As well, any pharmacy at most stores has a walk-in policy for vaccinations for flu and COVID-19 (British Columbia Pharmacy Association, 2023). Each community follows the health authority per the public health policies directed by the Health Minister of B.C.

To be an employee in the Interior Health, the Provincial Public Health order released a mandatory COVID-19 vaccination policy on October 14, 2021 (Interior Health, 2023).

According to the College of massage therapists of British Columbia, on March 21, 2020, public health officer Dr. Bonnie Henry ordered all massage therapy professions to shut down. However, the college did not order massage therapists to stop working. However, they strongly recommended not to practice and access funding through the Canada Emergency Response Benefit (CERB) or other government financial benefits (CMTBC, 2021). Doctors are integrated into the health care programs and provide a wealth of information regarding the safety of vaccines and abide by evidence-based care practices to ensure the public is informed of vaccination safety (Benoit & Mauldin, 2021).

Through the community, depending on where a person resides, workplaces in a healthcare setting are set up to have a mandatory vaccination policy in place. According to B.C.’s published data, most health professionals are vaccinated with massage therapists at 87.9%, physicians at 98%, and physical therapists at 95.2%; this has contributed to the population who registered and are practicing their occupations (Government of B.C., 2022).

Policy

Each health authority in the community in B.C. has a website with information on COVID-19 regarding facilities, employment opportunities, prevention and self-care, vaccination and booster information regarding COVID-19, and other commonly asked questions.

When the public health officer lifted the province-wide restrictions on March 11, 2022, there were still some mandatory restrictions. Proof of vaccination is not required to enter Canada but must be shown in some long-term care centers, and masks are still required in all clinical and healthcare settings (Interior Health, 2023).

Public policy has mandates through the provincial government and how to become vaccinated regarding COVID-19 (Government of B.C., 2023). The mandates were influenced by the provincial health officers (PHO), politicians, privately owned businesses, the provincial and federal government, the media, the Canadian health center for disease (CDC), and the World Health Organization (WHO). On a policy level, to reduce COVID-19 for the dignity and respect of all human beings, accessing healthcare services in B.C., Canada, relies on funding, advocating, education, and creating opportunities for access to primary healthcare doctors.

In conclusion, individuals have autonomy in deciding to be immunized against COVID-19. However, unless medically exempt, healthcare professionals are influenced through interpersonal relationships and their influences, the community, and public policy that is mandatory for all healthcare workers to be immunized to help keep communities and families safe from the spread of COVID-19. More research must be conducted to fully understand the reasoning of anti-vaccinators and continuously update resources regarding the safety of vaccines to promote healthier communities and lives.

References

Ayukebong, J. (2021). Public health and human rights during a pandemic- An unresolved

dilemma concerning mandatory vaccination against COVID-19 for healthcare workers. Canadian Journal of Infection Control, 36(2), 74-76.

BC Gov News, (2022 May 10). Data published on the vaccination status of regulated health

professionals. British Columbia. Retrieved March 07, 2023. https://news.gov.bc.ca/releases/2022HLTH0138-000737

British Columbia Pharmacy Association. (2023). 2022 Flu Vaccines in B.C.

Pharmacies. https://www.bcpharmacy.ca/flu

CDC Centers for Disease Control and Prevention (2022, January 18). The social-ecological

model: a framework for prevention. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

CMTBC (2022). CMTBC interim guidelines for return to practice.

https://www.cmtbc.ca/registrants/interim-guidelines-for-return-to-practice/

COVID-19 Tracker Canada (2022 February 03). British Columbia vaccination data. Retrieved

March 07, 2023. https://covid19tracker.ca/provincevac.html?p=BC#:~:text=50.721%25&text=British%20Columbia%20does%20not%20use,calculations%2C%20but%20rather%20internal%20estimates

Google News (2023). Coronavirus (Covid-19). British Columbia.

https://news.google.com/covid19/map?hl=en-CA&mid=%2Fm%2F015jr&gl=CA&ceid=CA%3Aen

Government of B.C.(2021 June 09). Regional Health Authorities. British Columbia.

https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities

Government of B.C.(2022). Update on vaccination requirements for health professionals. BC

Gov News. Retrieved March 07, 2023. https://news.gov.bc.ca/releases/2022HLTH0047-000195

Government of B.C. (2023 Feb 11). B.C.’s response to COVID19. Province of British Columbia.

https://alpha.gov.bc.ca/gov/content/covid-19/info/response

Government of Canada. (2020 Mar 03). What we heard: Indigenous Peoples and Covid-19:

Public Health Agency of Canada’s most companion report. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid-19-report.html

Interior Health (2023). COVID-19. British Columbia.

https://www.interiorhealth.ca/health-and-wellness/disease-outbreaks/covid-19

Jang. S.(2022). Social- ecological factors related to preventative behaviors during the COVID-19 pandemic in South Korea. PLoS ONE 17(3): e0266264. https://doi.org/10.1371/journal.pone.0266264

Palmer.R.(2022). Covid 19 vaccines and the misinterpretation of perceived side effects clarity on the safety of vaccines. BioMedicine: Vol. 12 : Iss. 3 , Article 1. DOI: 10.37796/2211-8039.1371

Paremoer. L., Nandi. S., Serag. H., Baum. F. (2021). Covid-19 pandemic and the social

determinants of health. BMJ Publishing Group Ltd. BMJ 2021; 372. https://www.bmj.com/content/372/bmj.n129

Statistics Canada (2023 Mar 06). Leading Causes of death, total population by age group.

Government of Canada. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401

Vancouver Sun (2022 March 20). Covid-19: About 2,500 B.C. healthcare workers lost jobs over

refusal to vaccinate. Postmedia. Retrieved March 07, 2023. https://vancouversun.com/news/local-news/about-2500-health-care-workers-lost-jobs-over-refusal-to-vaccinate

World Health Organization (2020, October 13). Impact of COVID-19 on people’s livelihoods,

Health and food systems. WHO. Impact of COVID-19 on people's livelihoods, their health, and our food systems (who.int)