COVID-19 vaccination decisions and impacts of vaccine mandates: a cross-sectional survey of COVID-19 in Alberta, Canada

Background: Vaccination mandates for healthcare workers (HCWs) in Alberta, a Canadian province, unfolded within a broader environment of highly polarized political discourse and contested public health responses during the coronavirus disease 2019 (COVID-19) period. While most research on COVID-19 vaccination among HCWs has focused on uptake and hesitancy, far less attention has been paid to these workers’ experiences of mandate enforcement and its implications for professional ethics, autonomy, and workplace functioning. We aimed to examine HCWs’ experiences with COVID-19 vaccine mandates in Alberta, including the relationship between vaccination decisions, workplace impacts, and perceptions of mandate enforcement.

Methods: We conducted a cross-sectional online survey of 189 HCWs, examining vaccination decisions, experiences of mandate enforcement, and perceived impacts on professional practice and patient care. The survey was administered from March to April 2025 using convenience and snowball sampling. The survey was designed to capture a range of perspectives regarding COVID-19 vaccination and mandate policies, explicitly including views that may be less frequently represented in existing research. Accordingly, the survey instrument included evaluative statements and allowed respondents to express agreement, disagreement, or neutral responses.

Results: A substantial minority of respondents were unvaccinated (39.3%), while vaccination status among remaining participants was heterogeneous. Nearly one-third (29.7%) identified workplace mandates as the primary reason for vaccination decisions. Among vaccinated respondents, a small minority reported experiencing an adverse reaction after COVID-19 vaccination and still being required to receive additional doses (12.6%). Overall, one quarter reported having been terminated or laid off due to their decision not to receive the COVID-19 vaccine, whether a first or subsequent dose (25.4%). A small but concerning proportion reported experiencing suicidal thoughts due to employer vaccination requirements (7.4%). Across vaccination statuses, respondents reported professional, economic, and psychological impacts. Most reported experiencing or observing workplace conflict following the introduction of vaccination policies, including conflict among colleagues (64.2%) and between employees and management (58.2%). A similar proportion reported awareness of colleagues who took early retirement or left their positions due to COVID-19 policies (65%). About one fifth reported intending to leave their occupation or the healthcare sector due to their experiences with the COVID-19 policy response (21.2%). Over one quarter of those experiencing employment disruptions indicated that they would not return to their previous roles if mandates were dropped (29.5%). A majority also reported observing differential treatment of patients based on vaccination status (56.6%).

Conclusions: Consistent with prior findings from Ontario and British Columbia, this study contributes to a growing comparative body of evidence indicating that COVID-19 vaccination mandates were associated with reported patterns of workforce destabilization and ethical strain within healthcare settings. Taken together, these findings raise fundamental questions about the evidentiary and ethical foundations of mandate-based interventions. Public health authority depends not only on scientifically sound evidence but also on adherence to core ethical principles, including professional autonomy, voluntary medical decision-making, and informed consent. Policies that override these principles risk undermining the institutional integrity on which effective healthcare systems depend.