Should mandatory vaccination for healthworkers have been a line in the sand?

Matt Hicks, a senior nurse, shares his personal views.

There’s a lot of social media chatter about mandatory vaccines, especially in the light of the government’s U-turn on the Covid-19 vaccine for healthcare workers. My original position up until recently was that mandatory vaccines had always been accepted as being a legal requirement in healthcare and that the Covid-19 jab would be no different. Never content with assuming I’m right, I checked up on this and have changed my view slightly.

First up is whether or not making Covid-19 vaccine mandatory is just a continuation of a previous, established practice of healthcare workers being made to have vaccinations against certain diseases. Well, it’s ‘yes’ and ‘no’.

There is not currently, and never has been, a legal precedent or requirement for healthcare and laboratory workers to have routine vaccinations such as Hepatitis B or MMR. There is, though, explicit guidance that health trusts and employees should do everything in their power to protect themselves and their patients. This is covered in the government’s Green Book Chapter 12. This, as stated, is guidance only and the onus is on local health trusts to develop their own policy.

Vaccination is a part of that effort to minimise risk of exposure. In some circumstances the employment or deployment of an unvaccinated individual could be refused on the grounds that this could cause a risk to patients and staff. Reasonable measures in the context of redeployment, or not offering employment, is covered by established legislation but, to date, would only ever be used in extreme circumstances. Much of the guidance is focused on the issue of clinical work where there is a high risk of exposure to infected bodily fluids. Obviously, that is slightly different with a respiratory virus.

Whilst we know that the Covid-19 vaccination significantly reduces illness in most sufferers, we know it doesn’t always prevent infection. In this context it stands to reason that any vaccine has to be one of several components of risk assessment and measures for protection, such as testing, adequate PPE and good hygiene. To that end, it probably shouldn’t always be the line in the sand for employment, and reliance on it as a measure of protection alone would be foolhardy and unsafe.

Mandatory Covid-19 vaccine, therefore, has a number of implications. It removes a small but significant number of healthcare workers from the NHS workforce. This may cause unnecessary problems for staff and patients as a consequence of staff shortage. Secondly, it alienates a small but significant population from ever having the vaccination at all, which then defeats the whole national effort. Thirdly, the enforcement of a clinical procedure on a person with full capacity against their wishes is unethical; no ifs and no buts.

So what’s the solution?

  • Good, robust supply of adequate personal protective equipment (PPE) and training in its use.      
  • Good, robust infection control policies and training for healthcare workers in their implementation. 
  • Good risk assessment by all in the workplace and the resources to implement appropriate measures with unlimited support from management, executive and, ultimately, government. 
  • A supportive, informative and transparent approach to vaccinations in the workplace for healthcare workers. Enable conversations, acknowledge differing points of view and challenge respectfully. Acknowledge the risk of vaccination that is worrying certain people, but enable those risks and any fears to be put in context and, hopefully, allayed.
  • Treat every case according to the clinical area in which the person works and the associated risks. At all times, the emphasis should be on support, and only in rare cases disciplinary.

My sense is that these suggestions are more likely to result in higher uptake of the vaccine than a mandatory order, which will create martyrs and reduce our workforce even further than we could ever have imagined or feared.

In light of the government’s change of policy this may now seem less relevant, however, the emphasis will be on local trusts to go all out on encouraging uptake of the vaccine. That’s no bad thing, but there’s a good approach and a bad approach. As qualified doctors, nurses and healthcare professionals it is our duty to stay well informed and to instill confidence in the vaccine hesitant.