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expert reaction to news reports that the government is planning to make COVID-19 vaccinations mandatory for care home staff

There have been several news reports suggesting that the government is to make COVID-19 vaccines compulsory for care home staff in England, and are considering extending the policy to all NHS staff.

 

Sandra Mounier-Jack, Associate Professor in Health Policy, LSHTM, said:

“Covid-19 vaccination is here with us for the long haul, and social and health care staff are key prescriptors of the vaccine so positive engagement with them is essential.

“A survey1 conducted by LSHTM in Jan-Feb this year revealed that participants that reported greater agreement with the statement ‘I feel/felt under pressure from my employer to get a COVID-19 vaccine’ were significantly more likely to decline the Covid-19 vaccine even after demographic factors were controlled for.

“Interviews with health care staff and particularly social care workers suggested that placing staff under pressure to vaccinate may paradoxically entrench negative attitudes to vaccination.”

  1. https://www.lshtm.ac.uk/newsevents/news/2021/covid-19-vaccine-refusal-higher-among-health-and-social-care-workers-who-feel

 

Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:

“Although only a small proportion of care home workers are currently vaccinated, we have seen uptake increase in other age groups and population groups where there was initial hesitancy. This is a result of recommending, offering, and ensuring easy access to COVID-19 vaccine, as well as eliciting and responding to any concerns and questions. Encouraging vaccination is always preferable to a mandatory requirement. Indeed, evidence from a recent study of health and care workers suggests that where they felt pressured to have the vaccine, they were less likely to do so. Trust in the vaccine and in the organisation recommending it are vital to ensuring vaccine acceptance and any perceived pressure can undermine that trust and may make people more resistant.”

 

Dr David Elliman, Consultant in Community Child Health, said:

“I don’t think making vaccination compulsory for certain staff groups is likely to have a beneficial effect. While we would encourage all eligible adults to have the two doses of COVID-19 vaccine, particularly those such as staff in adult care homes and frontline health care staff, there are profound ethical issues in making it compulsory. In addition, I am not aware of any evidence to support it. To the contrary, if it were enforced, it would become a civil liberties issue and people who are hesitant may be persuaded not to have the vaccine for this reason – “I am not having the State tell me what to do”. Staff in health and social care have been working under extreme pressure during the pandemic. They are overworked, underpaid and in short supply. Rather than introduce compulsion, which could be counterproductive, we need to engage with hesitant staff, ideally on a one-to-one basis to try and allay their concerns. Apart from anything else, we cannot afford to lose any of these valuable members of staff, if they are forced out of their jobs.”

 

Prof Dominic Wilkinson, Professor of Medical Ethics and Member of UKRI Pandemic Ethics Accelerator, University of Oxford, said:

“In the earlier phase of the pandemic, some of the most medically vulnerable members of our community, patients in care homes and acutely ill patients in hospitals, ended up catching coronavirus from those caring for them. Some patients and care home residents died from infections that they caught from their caregivers.”

“That is a tragic and distressing situation that we must do everything possible to avoid repeating.

“First, we should ensure that all those who are high risk have access to vaccination. There are still approximately 10% of older adult care home residents who have not had a 2nd dose of the vaccine.

“Second, those who work in the frontline with vulnerable high risk patients have an ethical obligation to take all reasonable measures to prevent spread of the virus to those they are caring for. They must follow guidance about the use of measures like hand washing and PPE. They should take part in lateral flow testing schemes. And they should be vaccinated.

“In England, as of 10th June, 17% of adult care home workers have not had the COVID-19 vaccine.

“There is a strong ethical case that care home workers (and NHS staff) who have not had the COVID vaccine should be redeployed to areas other than frontline care.

“It would be ethical to make COVID vaccination (in the absence of a medical exemption) a condition of employment in the same way that hepatitis B vaccination is currently for some health professionals.

“If vaccines are made mandatory for health care and care home workers, they should be able to choose from available vaccines. Every effort possible should be made to address any concerns that they have about the vaccines.”

 

Prof Julian Savulescu, Uehiro Chair in Practical Ethics, University of Oxford & member of the UK Pandemic Ethics Accelerator, said:

“The proposal to make vaccination mandatory for care home workers is muddle-headed. Arguably it would make more sense for vaccination to be mandatory for the residents, not the workers. It is the residents who stand to gain most from being vaccinated as they are most at risk of severe disease.  Young care workers have a low risk of falling severely ill from COVID-19 and we are starting to see data on very rare side effects of the COVID-19 vaccines which show they are not risk-free. Indeed, because of this risk: benefit relationship, we are hearing that JCVI is considering recommending to government that those under 18 are not even allowed to have the vaccine. Yet the government wants to make it mandatory for a 21 year old care worker.  Care home workers should be offered incentives, including financial incentives, to be vaccinated, not coerced. Vaccines like hepatitis and influenza may be mandatory, but they have been around for years and have established safety profiles.

“It’s too soon to be talking about mandates. We’re still researching rare but potentially serious side-effects that have been thrown up by national monitoring, for example a possible link between Pfizer and myocarditis. We don’t have the full picture on how well they prevent transmission. Public Health England data about how transmission is only available for the first dose and it is currently at up to 50%. Meanwhile the level of protection afforded to vaccinated individuals themselves is holding up very well in terms of hospitalisation and death even against the new variants. With the level of confidence we have encouragement to vaccinate is warranted, and incentives are warranted. Mandates should only be made on the basis of bulletproof safety and efficacy data, including transmission data.”

 

Prof Gino Martini, Royal Pharmaceutical Society Chief Scientist, said:

“We actively and strongly encourage all pharmacists to take advantage of the COVID-19 vaccination programme and to get vaccinated unless there is a medical reason why they are unable to. We do not agree with making COVID-19 vaccinations mandatory, as informed and educated choices about health interventions would be more beneficial long-term than enforcing them.

“All members of the pharmacy team should have any vaccine deemed necessary to help protect themselves, their patients and the wider community. We consider this to be best practice and within the pharmacy regulator’s standards where pharmacists should make the care of the person their first concern and act in their best interests.”

 

 

Eg. https://www.theguardian.com/world/2021/jun/15/covid-jabs-to-become-mandatory-for-care-home-staff-in-england  

https://news.sky.com/story/covid-19-vaccinations-to-be-made-compulsory-for-care-home-staff-and-looked-at-for-nhs-workers-whitehall-sources-12333624

 

 

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

 

 

Declared interests

Prof Helen Bedford: “NICE committee member developing guidance on Vaccine Uptake in the General Population

Prof Dominic Wilkson: “No conflicts of interest

Prof Gino Martini: “no interests to declare.”

Prof Julian Savulescu: “No conflicts of interest.”

None others received

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