Vaccinating healthcare workers against covid-19

Best practice

Existing guidelines from the Department of Health and Social Care recommend that healthcare workers provide evidence of immunity against measles, mumps, rubella, and varicella zoster virus and comply with vaccination and pre-employment screening for tuberculosis and bloodborne viruses.1011 This is not a “no jab, no job” policy: when vaccination is contraindicated or declined, a risk assessment follows to determine whether redeployment is necessary for the safety of patients or co-workers. Unvaccinated people usually continue to work in healthcare, though their practice may be restricted. In the absence of prescriptive guidance from the government, the same process can be followed when covid-19 vaccination is contraindicated or declined.

Redeploying unvaccinated healthcare workers may reduce staffing in some services, but compulsory vaccination can have the same effect. In the recent consultation on mandatory vaccination for care home staff, 61% of respondents were concerned that the policy would undermine the ability to maintain a safe service.12 Possible difficulties include loss of non-compliant staff through redeployment, dismissal, or leaving the sector.

Equality and opportunities

Some private care homes introduced compulsory covid-19 vaccination for staff in patient facing roles in April 2021.13 This predated the parliamentary vote in July, which mandates vaccination of care home workers from October 2021.1 No NHS providers have done the same. Although the new policy in care homes should standardise practice across the sector, people declining vaccination now have restricted employment options, which will be further restricted if the policy is extended throughout social care.3 In the consultation, 64% of care home managers said they would dismiss unvaccinated staff compared with 18% who would redeploy them.12 If covid-19 vaccinations become a condition of employment in healthcare, refusing the vaccine could become a career defining decision for clinical staff.

Compulsory vaccination also has implications for employees with protected characteristics under the Equality Act 2010. In the consultation on care homes, an equality impact assessment identified that the policy could disproportionately disadvantage workers from ethnic minority groups,12 who are over-represented in the social care workforce and have a lower rate of vaccine uptake than the general population.1214 Another risk identified was that compulsion and resultant erosion of trust in government (already low) could further increase vaccine hesitancy among minority groups. These concerns are also relevant to healthcare.

Employee autonomy and support from managers are known to protect against work related stress. Reducing either could damage wellbeing in an already disillusioned workforce.1516 Many of the concerns emerging within adult social care are translatable to healthcare, where redundancy and unemployment come with serious and potentially lifelong consequences, including risks to health 17.

As we understand more about the protection offered by covid-19 vaccination, the arguments for increasing uptake become even more compelling.18 Yet vaccination of healthcare workers must be viewed in the context of current best practice in occupational health. The Faculty of Occupational Medicine does not support mandatory covid-19 vaccination as a condition of employment but endorses an “inform and consent” approach.19 If vaccination becomes mandatory in healthcare settings the occupational fallout could be substantial.