The pros and cons of compulsory vaccination

Government reviewing policy to mandate Covid vaccines for frontline NHS staff

A nurse prepares a dose of the Oxford/AstraZeneca Covid-19 vaccine
A nurse prepares a dose of the Oxford-AstraZeneca Covid-19 vaccine
(Image credit: Dominic Lipinski/Pool/AFP via Getty Images)

Ministers are meeting today to decide whether or not to scrap plans to mandate Covid vaccinations for frontline NHS staff, with the deadline for health workers to have their first jab just days away.

Unless they have a medical exemption, patient-facing health and care workers in England “risk being redeployed or losing their jobs altogether” if they have not had two doses of the vaccine by April, reported Nursing Times.

With the final date for the first dose on 3 February, nursing leaders and unions have urged the government to delay the policy “amid concerns of the impact it will have on the workforce”, said the magazine.

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Last week, Health Secretary Sajid Javid said the principle of patient safety remains “unchanged” but revealed that the government is “reflecting” on its policy of compulsory Covid vaccination for NHS staff now that the Omicron variant has taken hold in the country.

“No jab, no job” rules have become commonplace in some parts of the world as countries fight Covid-19, said the i news site. Vaccine passports are also being used for international travel or for access to large events and public spaces in different nations.

Boris Johnson has previously acknowledged that there are “moral complexities, ethical problems that need to be addressed” around compulsory vaccination and certification. Here are just some of those key issues.

1. Pro: reducing risk of infection

More than 11,600 people caught Covid in hospital and died after being admitted for a different reason, according to an exclusive report in The Telegraph last November. Jeremy Hunt, the Conservative chairman of the Health and Social Care Select Committee, said the “truly shocking” data “surely strengthens the case for mandatory vaccination for frontline healthcare staff”. An NHS spokesperson said staff had “rigorously” followed infection prevention guidance and blamed the infection rates in hospitals on the rates in the community. While vaccinated people can still spread Covid, a jab provides “some protection” against infection and transmission, according to the UK Health Security Agency. For some, this is not enough to justify enforced vaccination.

2. Con: unnecessary interference

One of the biggest arguments against any form of compulsory inoculation is the idea that it represents government encroachment on personal freedoms. Human rights campaign group Liberty has urged the government to support people using education and wider access to vaccination rather than through “pressure and punishment”. Its director, Gracie Bradley, warned that a “coercive approach” will “damage trust between employers, patients and key workers”, while Liberal Democrat MP Tim Farron said mandatory shots were “utterly illiberal, utterly wrong and a challenge to our freedoms”.

3. Pro: protecting the vulnerable

Sajid Javid has said compulsory vaccination for NHS frontline workers is imperative to “avoid preventable harm and protect patients in the NHS”. Announcing the policy in November last year, he told the House of Commons: “The weight of the data shows our vaccinations have kept people safe and they have saved lives. This is especially true for vulnerable people in health and care settings.” Care home workers and volunteers are already required to show proof of full vaccination against Covid-19 unless they have a medical exemption. Johnson has previously said the idea should not feel “alien”, pointing out that surgeons are expected to have a vaccination against hepatitis B. In the BMJ, Daniel Sokol, a medical ethicist and clinical negligence barrister, said that for healthcare workers refusing the vaccine would be “contrary to the ethics of their profession”.

4. Con: staff shortages

Health bosses are “increasingly concerned about the risk of losing a large number of staff when the NHS is struggling with both the Omicron variant and backlogs”, reported The Times. The Royal College of GPs, the Royal College of Nursing and Royal College of Midwives have called for a delay in the deadline for NHS staff to be vaccinated. The newspaper estimated that nearly 80,000 NHS staff are yet to be vaccinated, 5.4% of the total. However, in the BMJ, Sokol argued that unvaccinated healthcare workers “can also cause indirect harm from staff absences and disruption to the health service caused by severe disease”.

5. Pro: a route to normality

Vaccine passports have been touted as one way to revive sectors where it is harder to keep a social distance, such as travel and hospitality. Israel was one of the first countries to use a vaccine passport system. Its “Green Pass” permits fully vaccinated individuals to access indoor venues. Meanwhile, Emmanuel Macron’s decision in July to bring in a vaccine passport scheme in France was a “jaw-dropper”, Politico said. But it proved to be the “best moment” in the president’s handling of the coronavirus crisis – “maybe even of his tenure”, said public health consultant Martin Blachier. France, “one of the most vaccine-sceptical nations on earth”, became “one of the most vaccinated countries in the world” over the summer, said Wired. Similarly, since the consultation on the vaccine mandate for NHS staff last September, around 100,000 unvaccinated health staff have come forward for their jabs, said Nursing Times.

6. Con: the Omicron factor

Last week Javid said that although the principle of patient safety remained “unchanged”, the NHS mandate was announced when Delta was the dominant variant. Now that the typically “less severe” Omicron variant accounts for “almost all cases” across the country, it is right that “we reflect on all this and keep all Covid policies properly under review”, Javid told MPs. Another argument related to Omicron is that two vaccines are now less effective than they were against Delta, although some argue that this is a reason to expand the NHS vaccine mandate to three doses.

7. Pro: conflict of freedoms

Alberto Giubilini, an ethics researcher from the University of Oxford, suggested that there is a “conflict of freedoms” when it comes to mandatory vaccination. While people should be free to choose whether or not they receive medical intervention such as an inoculation, vulnerable people who are unable to have a jab should also have the freedom to live a normal life. “Which infringement of freedom is the largest burden and which one is justified? That’s what we should ask,” he wrote for The Conversation.

8. Con: divide society

In New Zealand, where Covid policies grant more freedoms to vaccinated citizens, Prime Minister Jacinda Ardern has admitted that she has created two classes of people with different rights. The Institute for Government has warned of the “potential ethical implications” of using vaccine passes. “Passports could further exacerbate existing inequalities, particularly as vaccine take-up has varied among different groups,” said the think-tank. Internationally, entire countries may also be waiting years to travel if they are unable to access a vaccination programme.

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