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There have been several media reports suggesting that mandatory COVID-19 vaccination will be introduced for NHS staff in England from next year.
Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, Immediate past Chair of the BMA Public Health Medicine Committee, said:
“Many people acquire their Covid-19 infection from somebody who had few (if any) symptoms, and probably had no idea they were infectious. Vaccination reduces the likelihood of infection. If you aren’t infected, you can’t be infectious.
“Healthcare workers (HCWs) are more likely to be exposed to infectious patients. They are also more likely to be in contact with vulnerable susceptible patients.
“For the sake of their patients, HCWs have a duty (enshrined, for example, in the General Medical Council’s guidance for doctors) to ensure they have taken all necessary steps to minimise their risk of infecting their patients – including, where appropriate, vaccination. Health and safety legislation creates similar duties on employers and employees. So you could argue that there is already a duty – possibly even a legal duty – on HCWs to be vaccinated, and on their employers to ensure that they are vaccinated.
“Whether creating additional legal requirements will help is another matter. Most HCWs already choose to be vaccinated (and, as long as they are given the time required to get vaccinated, they do so – sometimes the barrier is excessive workloads and inadequate accessibility – I recall having to drive 60 miles each way for a flu jab), they do get vaccinated.
“Some are vaccine-hesitant, and, like the rest of the population, a small minority have irrational, faith-like antivaccine beliefs. You are unlikely, in the short-to-medium term, to shift the latter’s beliefs, but you may be able to persuade the hesitant.
“The risks of introducing legal mandation include hardening beliefs, so fewer HCWs, rather than more, will get vaccinated.
(I think we saw something similar a few years ago when it was considered extremely likely that asymptomatic or presymptomatic people – including HCWs – could transmit flu to others. We now know for certain that they can. The Department of Health used a study demonstrating this, to encourage HCW flu vaccine uptake. But it turned out that the study was a laboratory study on ferrets. Some HCWs – well able to locate and read the study – felt this was deceitful propaganda, and were consequently less willing to be vaccinated. It reduced their trust; and trust – and thus openness, honesty, and accountability are essential if you want to persuade people.)
“Mandation risks meaning that even fewer HCWs will be vaccinated, not more. And it also risks losing HCWs (if they refuse to get vaccinated) at a time when we are already short of thousands of doctors, nurses, and other HCWs.
“That said, it may be that (as it turned out in New York), while many will threaten to quit if they otherwise have to vaccinated, very few will do so in reality.
“There is also a risk that some thus-far-unvaccinated and hesitant HCWs will see that the deadline is not until Spring, and wait until the last minute before getting vaccinated, even though the time it’s most important is now and over the coming winter.
“I know that there has been a consultation process – I fed into the BMA’s response. I hope that the government has listened to advice, and to the right experts. I fear that this could be a misplaced response to the ‘politician’s syllogism’: something must be done; this is something; therefore we must do it [in a bid for public approbation, even if it does more harm than good].
“This might work. But I am not certain it isn’t a risky gamble.”
Dr Ben Kasstan, a medical anthropologist at the University of Bristol, said:
“Recent media reports have suggested that COVID-19 vaccinations will be required for NHS healthcare workers, potentially from April 2022. While we are waiting for official UK government confirmation, this policy would be in line with the positions taken by French and US governments. We need to remember that scores of healthcare professionals were put at considerable risk of contracting COVID-19, and according to Amnesty International, rates of healthcare professionals dying from COVID-19 in the UK were among the highest in the world. Requiring COVID-19 vaccination is designed to protect healthcare professionals, especially as the UK still has varying levels of COVID-19 vaccination coverage.
“It has been suggested in The Guardian that the policy has been delayed until April 2022 out of concern that healthcare staff could stage an exodus during winter, the busiest time of the year for healthcare services. Rates of COVID-19 are rising in the UK, at the same time as the flu season picks up so it would be in the interests of public health for all people who can be vaccinated to get vaccinated. If vaccinations will not be required until April 2022, there is time to understand why healthcare professionals do not want to accept COVID-19 vaccinations, which might inform communication strategies.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Peter English: “Dr English is on the editorial board of Vaccines Today: an unpaid, voluntary, position. While he is also a member of the BMA’s Public Health Medicine Committee, this comment is made in a personal capacity. Dr English sometimes receives honoraria for acting as a consultant to various vaccine manufacturers, most recently to Seqirus.”
None others received.