Table 1.

Synthesis of publications from the 2011–2019 period regarding some arguments in favor of or against (mandatory) Seasonal Influenza (SI) vaccination of Healthcare Workers (HCWs).

Year	Author(s)	Reference	Arguments Pro/Contra	Mandate for Vaccination	Remarks
2011	Caplan	[14]	“A duty” for HCWs, “Set an example” as HCWs, “To do the right thing”	Yes	“New ethics” point of view
2012	Abramson	[24]	“major methodological errors and wishful thinking”	No
	Orient	[17]	“the SI vaccine mandate is authority-based, not evidence-based”	No
2013	Galanakis et al.	[12]	“professional obligation” of the HCWs, “moral obligation” of the health institution, and “preventing infectious diseases is top priority in public health”	Yes
	Thomas et al. (Cochrane Database Systematic Review)	[26]	“no reasonable evidence to support the SI vaccination of HCWs”	No
2014	Born	[29]	“evidence linking HCW vaccination to patient outcomes in the absence of a mandate is limited”	No
	Cortes-Penfield	[10]	“professional fiduciary responsibility for well-being of patients”	Yes	Healthcare institution bears an ethical obligation to ensure and enforce universal SI vaccination among their staff
	Pitts et al.	[28]	“prospective studies across multiple facilities would likely be needed to obtain sufficient power to evaluate HCW clinical outcomes”	-	Further studies on clinical outcomes are necessary
	Wicker & Marckmann	[11]	“2 conditions for mandatory SI vaccination must be full-filled: (1) SI vaccination must be effective, and (2) sufficient empirical evidence”	-	In any case, mandatory vaccination policies should be based on a transparent and fair decision-making process
2015	Biondi et al.	[9]	“should so much time, effort, and money be dedicated to flu vaccination while other healthcare priorities remain on the back burner”	No	“healthy user bias”
	Dubov et al.	[20]	“mandatory vaccination causes disturbances in medical ethics of HCWs”	No	unaware, unbelieving, unmotivated, and unconcerned HCWs
	Kelly	[22]	“HCWs can be considered as healthy working adults” “HCWs are not the only source of influenza for patients” “there are no good quality studies”	No
	Lee	[15]	“neither the clinical nor the public health ethics frameworks resolve the question ‘fully’” “HCWs have an obligation to protect the vulnerable” “’this moral is especially salient in the healthcare relationship” “an obligation to implement a comprehensive approach to ensure that medically vulnerable patients are protected”	Yes	Components of justice
2016	Najera et al.	[13]	“when a person chooses to go into healthcare, that person makes an autonomous choice to work in a service profession, serving the interests of vulnerable patients” “with such choices come certain obligations”	Yes
	To et al.	[23]	“ethical principles of autonomy, non-maleficence, and altruism together with the professional and legal framework are needed to be considered before implementation of a mandatory policy” “there is a need to build stronger and more extensive scientific evidence for supporting the development of practice guidelines”	No	“omission bias”
2017	DeSerres et al.	[4]	“the effect of the clinical studies, the CRCTs, on the benefit of patients and residents is overestimated”	No