September 9, 2021

expert reaction to launch of consultation by government on mandatory vaccination for frontline health and care staff

The government have announced the launch of a consultation on mandating vaccination for frontline health and social care staff in England.

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:

“The government has today (9 Sep 2021) announced a consultation on mandatory vaccination of healthcare workers against influenza and Covid-19.

“This is not a novel concept – I published on it back in 2008, for example¹.

“It can be argued that vaccination may reasonably be mandated when:

• There is good evidence that staff may transmit a serious disease to their patients;
• There is good evidence that vaccinating the staff may reduce that risk;
• All other means of ensuring that staff who may put patients at risk have been vaccinated have been tried without succeeding in getting enough staff vaccinated;
• Other means of protecting patients (such as appropriate PPE) cannot be used successfully;
• There is good evidence that mandating vaccination will actually improve vaccination uptake.

“The consultation will provide opportunities to debate these and other issues, and to take into consideration the views of patients, healthcare professionals, occupational and public health experts, and others.

“I am not sure that all of these conditions have yet been met.  Mandating vaccination can stimulate a backlash, and actually cause a drop in the actual number of people vaccinated.  Healthcare workers (HCWs) are generally very conscious of the evidence-base.  I recall a few years ago when new evidence that influenza could be transmitted from staff to patients was announced with a big fanfare.  It turned out to be research in a ferret model of infection, not in humans, and thus of questionable value; and when HCWs became aware of this, many who were unsure about whether to be vaccinated saw it as deceitful propaganda from the department of health.  Some consequently moved from questioning to opposition.

“It is actually surprisingly difficult to do research that provides solid evidence that staff can transmit flu to patients, so it took some time to be certain that they can.  In my view we have been certain of this for some time, now; but not all HCWs agree.

“The evidence that Covid-19 vaccination prevents infection and onward transmission is firming up now, too, which would support mandatory vaccination, although it may not be sufficiently strong for such a step as yet.

“There is precedent for requiring UK HCWs to be vaccinated.  Staff on paediatric wards, and wards with vulnerable patients, are generally expected to have evidence of vaccination against, or natural immunity to measles, mumps, rubella and chickenpox; and staff who undertake “exposure prone procedures” in which there is a risk of transmitting bloodborne infections (e.g. by pricking your finger with an instrument which then penetrates a patient’s tissues) are required to be immune to hepatitis B (which is highly infectious by these routes).  However, none of these requirements are specifically mandated by law – they are occupational health and/or health and safety requirements.  Using legislation to require healthcare workers to be vaccinated would be a step further than we have gone before, and could generate a strong backlash.

“I am one of a cadre of doctors who was vaccinated some years ago against smallpox, when there were concerned about this virus’ use in bioterrorism; there may be some law about this particular disease for historical reasons.

“There is also a professional duty on HCWs to be vaccinated or otherwise immune to some diseases that they could pass on to patients.  Doctors are bound by the General Medical Council’s “Good Medical Practice” guidance, which instructs doctors to²: ‘Protect patients and colleagues from any risk posed by your health

28 If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients.

29 You should be immunised against common serious communicable diseases (unless otherwise contraindicated).’

“The equivalent professional guidance for nurses and midwifes is a little less explicit, but nevertheless instructs practitioners to³: ‘19.3 keep to and promote recommended practice in relation to controlling and preventing infection, and

19.4 take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public’.”

References

1. English PM. Should we introduce compulsory vaccination? Vaccines in Practice 2008;1(2):1-3. (http://www.vaccinesinpractice.co.uk/).
2. General Medical Council. Good medical practice: risks posed by your health: General Medical Council, 2013;  (https://www.gmc-uk.org/guidance/good_medical_practice/your_health.asp).
3. Nursing and Midwifery Council. The code: Professional standards of practice and behaviour for nurses and midwives: Nursing and Midwifery Council, 2015 (29 Jan);  (https://www.nmc.org.uk/standards/code/).

https://www.gov.uk/government/news/consultation-on-mandatory-vaccination-for-frontline-health-and-care-staff

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.”