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Debate: should Covid vaccination be compulsory for healthcare workers?

three months

Being a GP brings a responsibility to protect and set an example to patients

I can understand the views of some GP colleagues who do not wish to have Covid vaccination mandated for themselves or their staff. However, there is no doubt that a significant source of Covid infections, and unfortunately some deaths, has been health and care settings, in particular hospitals and care homes. I remember having to have a raft of vaccinations before entry to medical school, for my own as well as my patients’ protection. The hepatitis B vaccine is of course mandatory. 

Ours is a public service and we are there to make people well, not ill. So we have to accept that there must be some sacrifices if we are to protect our patients, including our freedom to decide whether or not to be vaccinated. We also need to set an example to our population if we are to encourage more of them to get vaccinated so that we can achieve herd immunity, which is probably the only way that we are ever going to return to normal as Covid-19 continues to circulate.

Care home colleagues have already had Covid vaccinations mandated – why is general practice any different? It reminds me of car seatbelt legislation in the 1980s. Many complained when they were made compulsory, but we soon accepted the need as the number of deaths and serious injuries from car crashes fell significantly.

We all know unvaccinated friends and acquaintances who caught Covid and went on to infect relatives or others close to them, sometimes with serious consequences. While they are not perfect, the vaccines may have prevented this.

Any serious risk from Covid vaccines is incredibly small, and as scientists we should see the value of us all getting vaccinated and that this tiny risk is worthwhile if we are protecting our patients and families.

While some will say compulsion is a breach of human rights, I do not believe this trumps our responsibility to protect our patients, family and friends.

The views expressed are Dr Ridgway’s own

It would be neither practically nor ethically sound

Compulsory Covid vaccination for doctors fails both practical and ethical tests.

Many people believe it would infringe their human rights. Indeed, Article 8 of the 1998 Human Rights Act does protect the right of individuals – and doctors are people – to refuse medical intervention. Similarly, religious beliefs, like anti-vaccine beliefs, may appear irrational to others but are also protected by the act.

And GMC guidance is clear that consent is not valid if obtained under compulsion or duress, and that doctors must respect patient autonomy. No doctor could ethically prescribe or administer a vaccine without valid consent, so where would this leave the process of obliging doctors themselves to accept a vaccine? 

Even where the wider public interest is invoked, compulsory vaccination is a slippery slope. History offers many examples of the greater good argument leading to appalling acts by doctors.

We have a shortage of GPs – do we want to risk reducing numbers further by   adding more barriers to GPs and their staff practising? 

For those who believe malign, powerful organisations wish to control their lives, compulsion will only confirm and entrench their paranoia. Doctors are likely to be particularly effective proponents of anti-vax propaganda if outside, rather than inside, the tent.

Compulsion is disproportionate. Refusers are likely few and many will be immune anyway through natural infection. Most importantly, an effective alternative strategy exists – testing. Testing services will need to continue as infection will occur despite high vaccine uptake, and is likely to remain acceptable to those who decline vaccination.

I feel the often-quoted hepatitis B analogy is flawed. That vaccine offers 98% to 100% protection, whereas Covid vaccination just reduces the risk although, given the volume delivered, many potential deaths have been avoided. 

We should treat colleagues with respect and find ways to work together rather than fomenting avoidable conflict. Today’s truths may become tomorrow’s falsehoods and, while it is highly unlikely some great harm of mass vaccination will emerge, it was introduced in haste and we have only months of data. Even the wisest may err if lacking humility.

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Decorum Est 8 October, 2021 12:58 pm

Dislike of coercion is part of human nature. But I still don’t wish to work alongside those medics who have disengaged from contemporary medical science and pose a risk to their colleagues and vulnerable patients (e.g. a colleague declining statins is not a danger to others).

Dylan Summers 8 October, 2021 1:14 pm

The headline is a bit misleading – the measure proposed is not compulsory vaccination. It is removal of unvaccinated workers from patient facing roles.

So the question under discussion is in fact “should unvaccinated healthcare workers be removed from patient facing roles?”

Decorum Est 8 October, 2021 2:44 pm

@ Dylan Summers
That’s true. But why should unvaccinated healthcare workers be paid the same for doing less risky (and likely less arduous roles)?
A ‘can of worms’?

Dylan Summers 9 October, 2021 9:09 am

@Decorum Est

Agreed – and I’m no employment lawyer but I imagine that “removal from patient facing roles” may involve loss of employment for some (many)?

The reason I make the distinction is that the media tend to present this issue as if vaccine-hesitant health workers were going to be bundled into the back of a van and forcibly driven to vaccination centres… thus resulting in a fully vaccinated frontline workforce – “hurray!”

Whereas in fact the policy proposed will almost inevitably reduce the number of frontline health workers. Not “hurray” at all.

Dylan Summers 9 October, 2021 9:15 am

(To put it another way, the question which supporters of the “compulsory vaccination” policy should ask is not just “would I like to be treated by an unvaccinated doctor or a vaccinated one?”

It is also “would I like to be seen by an unvaccinated doctor or no doctor at all?”)

Azeem Majeed 13 October, 2021 10:29 am

Question for the editor: Why has the GP making the “No” argument remained anonymous? Being against compulsory vaccination is not a controversial position (I argues the case against in a recent BMJ editorial).

Keith M Laycock 13 October, 2021 5:12 pm

Agree re the ‘anonymity of the ‘No’ opinion. The points made are valid and supportable – and if it were a Debate Society’ challenge, I think the ‘No’ would prevail.

‘Mandatory’ cannot be aligned with ‘Informed Consent’.