COVID-19: Should vaccination be compulsory in health and care?

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Few people in the health and long-term care industries would argue with the goal of vaccinating as many of their coworkers as possible to protect vulnerable patients from COVID-19. However, there are still significant disagreements about whether or not vaccination should be mandatory for non-medically exempt employees. To shield vulnerable patients from COVID-19, few people who work in health and long-term care would disagree with the ambition to vaccinate as many of their colleagues as possible. But there remain deep divisions over whether vaccination should be compulsory for staff who are not medically exempt.

Looking through hospital doors
Mandatory vaccination is a hot topic. In a recent special issue, the BMJ investigates. Boy_Anupong/Getty Images

Academics and a transplant patient argue the benefits and drawbacks of forced vaccination in a special issue of the BMJ. COVID-19 immunisation is already required by the Department of Veterans Affairs, some university hospitals, and some health systems, however many of them accept religious or philosophical exemptions. President Joe Biden of the United States has ordered that federal employees and contractors must be vaccinated or face new measures that include forced mask wear, weekly testing, and social isolation. The House of Commons in the United Kingdom has adopted legislation making COVID-19 immunisation mandatory for staff working in care homes in England unless they have a medical exemption. The government of the United Kingdom is conducting a consultation on whether the requirement should be extended to healthcare and other social care employees. Vaccination is already required for healthcare workers in Italy, France, and Greece. According to Prof. Parker, health and social care providers have a responsibility to hire workers who do not put patients in danger. He admits that the situation is more complicated for current employees because businesses have responsibilities to them, such as ensuring that they have decent working conditions and are not discriminated against. Employers, on the other hand, should move employees who refuse to be vaccinated or who have a medical contraindication to roles with little patient risk, according to him.

A ‘blunt instrument’

Academics argue in the BMJ that while health and social care professionals have a duty of care to be vaccinated, mandated vaccination is a “blank instrument” for dealing with a complex issue. According to Helen Bedford, a professor of children’s health at the University College London Great Ormond Street Institute of Child Health; Michael Ussher, a professor of behavioural medicine at St George’s University of London and the University of Stirling; and Martine Stead, deputy director of the University of Stirling’s Institute for Social Marketing and Health. Compulsory vaccination may appear to be a simple answer, but it comes with drawbacks, they argue. They add, “Notably, it may risk increasing vaccination resistance by eroding trust in the government and other institutions.” They continue, “This is of particular concern among ethnic minorities, who are overrepresented among health and social care personnel, have been disproportionately affected by COVID-19, are less likely to trust official sources of information, and are more likely to be vaccine apprehensive. “They also point out that if people opt to quit rather than get vaccinated, existing personnel shortages will be exacerbated.

Patients with reduced immunity

Michael Mittelman, who has a rare kidney ailment and has had three kidney transplants, argues for mandatory vaccination for everyone who comes into touch with patients, including cleaners and food service personnel, in an accompanying comment articleTrusted Source. Mittelman has been vaccinated, despite the hazards for patients like him who require immunosuppressive medicines to avoid transplant rejection. Antibodies against SARS-CoV-2, the virus that causes COVID-19, have been detected in his blood. Other immunocompromised people, on the other hand, test negative for antibodies following vaccination, indicating that they are still at high risk of infection.

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