The Italian law on mandatory COVID-19 vaccine: Recommendations from the Italian Association of Psychology and Occupational Health (AIPMEL) on the role of occupational risk assessment and health surveillance on healthcare workers with medical exemption from the COVID-19 vaccine, during pregnancy or affected by 'Long COVID' syndrome

The Italian law no. 76/2021 on COVID-19 mandatory vaccine in certain occupational categories such as healthcare workers (HCWs), police officers, military personnel, first aid providers, teachers, and other cadres of workers, has ethical implications that pose several challenges for occupational stakeholders. In case of COVID- 19 vaccine rejection, these workers are temporarily suspended from their job for the duration of the emergency period. In this position paper, the authors and a designated task force of the Italian Association of Psychology and Occupational Health highlighted the crucial role of the risk assessment and the fitness for work formulated by occupational physicians (in Italy, the so-called “medico competente”) for evaluating the interaction between work and health in HCWs with medical exemption from the COVID-19 vaccine, as well as the challenges determined by this law in HCWs affected by “Long COVID” syndrome or during pregnancy. Fitness for work (FFW) is the final task of both risk assessment and health surveillance, aimed at protecting workers’ health and working capacity. During the COVID-19 pandemic, therefore, FFW formulated by occupational physicians in HCWs may be justified by a new risk assessment of the SAR-CoV-2 related biological risk and is a good evidence- based solution to balance the rights of workers, employers, and third parties at workplace in the best way possible. The intervention of occupational physicians should be aimed to address psychological distress and anxiety in HCWs caused by the COVID-19 pandemic and prevent from workplace bullying or violence that a bad hospital management may cause in HCWs exempt from the COVID-19 vaccines.