Since the beginning of the Covid-19 vaccine rollout earlier this year, mandatory jabs have become a hotly contested topic.

In England, the Covid vaccine will be compulsory for all care home workers from the 11th November and the government is now debating over whether to extend this to healthcare workers and other social care staff. Similarly, in Italy, France and Greece the jab is mandatory for all healthcare workers.

In a recent article published in the BMJ, experts debate over whether frontline health and social care workers should be compelled to take up the vaccine.

Those who are unvaccinated should be “moved away from frontline roles”

Michael Parker of the University of Oxford argues that patient safety is ultimately the responsibility of health and social care institutions and they have a duty to employ workers whose presence would not place patients at unnecessary risk of serious harm.

He points out that staff also have responsibilities and should be willing to take up the vaccine in the light of evidence that it will help protect patients and poses only a low risk to themselves. Those who do not receive the vaccine, because of a medical contraindication or they are reluctant, should be moved away from frontline roles, ideally immediately, Parker says.

He says that recruitment problems are “not a justification of doing nothing” and therefore concludes that employers should make it compulsory for all remaining frontline staff without a serious medical contraindication to be vaccinated.

“A blunt instrument to tackle a complex issue”

Contrastingly, Helen Bedford and colleagues at Great Ormond Street Institute of Child Health, argue that mandatory vaccination is "a blunt instrument to tackle a complex issue." They continue: "It is not necessary, acceptable, or the most effective way to achieve high uptake, and it raises serious ethical issues about freedom of choice."

They argue that since vaccine uptake is already very high among NHS and care home staff (90% and 87% respectively), a mandatory vaccine is unnecessary and may in fact increase resistance by "damaging trust in the government and other organisations".

An active listening approach should inform the government’s decision, they say. Exploring the reasons for vaccine hesitancy among health and care workers (particularly among groups which have a low uptake, such as minority ethnic groups) allows trust to be built and should, in the long run, reduce hesitancy.

Such strategies may also help to improve vaccine confidence among the wider population, since healthcare workers, together with the NHS, are the public’s most trusted source of information when it comes to vaccinations.

A fragile sector

Patients who are particularly vulnerable to Covid-19, such as those who are immunocompromised, have also voiced their concerns. Michael Mittelman has undergone three kidney transplants for a rare kidney disease, and describes the risks unvaccinated staff pose to patients like himself.

He believes that mandatory vaccination should include all staff who have contact with patients, including doctors and nurses, people who deliver meals, staff helping elder care residents, emergency technicians, janitorial staff, and so on. “Not being able to trust the healthcare worker treating me, or the person bringing me a meal, breeds anxiety as Covid variants spread,” he said.

However, others believe that the UK care home sector is already in a fragile state due to recruitment problems and implementing such measures could see the sector in a crisis. Nadra Ahmed, chair of the National Care Association explains that if unvaccinated staff were to leave, an estimated additional 13% of care services could become unsustainable, and it is a "dangerous assumption" to think that "staff who walk out will be easily replaced".

She adds that community transmission remains high, and vaccinated staff can carry the virus as well as unvaccinated visitors including relatives, friends and healthcare workers.