Compulsory Covid jabs is a disastrous idea
There is a simple way to avoid a staffing crisis in care homes and the NHS, writes ethicist
We are approaching a looming crisis in our health and care services, one which, to some degree, may be largely of our own making. The health secretary, Sajid Javid, is expected to confirm this week that Covid 19 vaccinations will be made mandatory for all NHS staff. The policy is already being imposed upon England’s care homes with this Thursday, November 11, the deadline for all care workers to be double vaccinated against Covid.
As many experts have been warning in recent months, making vaccinations compulsory may force people out of an industry instead of changing their minds.
Unions have estimated that as many 70,000 care home workers will not be fully vaccinated by this week’s deadline, with care homes now facing a major staffing crisis. According to the industry body Skills for Care, there are currently 105,000 care vacancies. Such are the shortages that some care homes are refusing new admissions from hospitals, while in recent weeks two care homes in Cumbria have even been forced to close due to the lack of available qualified staff.
Mr Javid has reportedly heeded calls from the NHS to delay the plans for NHS workers until March, to avoid an exodus of staff from the health service during winter, its busiest period. The likes of Dr Chaand Nagpaul, council chair of the British Medical Association, have warned that losing healthcare staff through mandatory vaccination would have a “big impact” on services which are already under “immense pressure”.
There are two key questions to be considered when trying to work out whether a vaccine mandate is ethical.
First, is it proportionate to the harm we are trying to avoid, and second, is it necessary? In my view it is proportionate to require care home and NHS workers to have the vaccine – after all, these vaccines are extremely effective and may help prevent workers from passing on the virus to some of those in our community who are most vulnerable and at highest risk from Covid. But is it necessary?
The government policy is overly simplistic in focusing only on vaccination, when what matters most is the risk of passing on the virus. We know first of all that many NHS and care home staff will have contracted the disease during the pandemic. As a guide, recent figures indicate that 25 per cent of blood donors in London have antibodies from a past Covid infection.
And there is also now evidence to suggest that natural immunity confers comparable protection to vaccineinduced immunity (at least in the short term). Studies have found a durable immune response in individuals eight months after infection, as well as low infection rates among those who have previously had Covid-19.
One paper published in the journal Science in January this year found antibodies against the spike protein of SARS-COV-2 (which enables the virus to infect human cells) in 98 per cent of participants one month after initially developing symptoms.
In the same study researchers also found that their levels remained fairly stable over time, declining only modestly between six to eight months after infection.
Recent data also suggests that the antibodies elicited by vaccination have less potency and breadth than those generated by natural infection. However the science remains far from certain. For example, a study released in August by the US Centre for Disease Control and Protection of Covid-19 infections in Kentucky found unvaccinated individuals were more than twice as likely to have confirmed re-infection with Covid-19 than those who were fully vaccinated after initially contracting the virus.
What does this mean? Along with several colleagues in medical ethics at the University of Oxford, I argue that based on what is now known, individuals with sufficient proof of natural immunity should be granted a medical exemption to the vaccine mandate being placed on care home and NHS workers. This would be a simple ethical policy adjustment. It would prevent the loss of valuable workers who do not pose an increased risk of transmitting coronavirus to vulnerable residents.
It can be justified to limit people’s freedoms to prevent harms to others. We have all had to make sacrifices in the last 18 months to reduce spread of this virus. But it is not justified to significantly restrict people’s freedoms if it wouldn’t make a difference. Unless there is compelling evidence that immunisation is considerably more effective than natural immunity at reducing spread of the virus, the case for a vaccine mandate (for those who are immune) cannot be convincingly made. While there are gaps in our knowledge about both vaccine acquired and natural immunity, the evidence does not support the current form of mandated vaccination.
This is an issue that remains heavily contested. In September in what appears to be the first legal ruling on the subject, a US judge upheld a decision by the University of California’s Irvine School of Medicine to enforce a Covid-19 vaccine requirement on a professor who claimed he had immunity due to a prior coronavirus infection. In his verdict the US District Court Judge James Selna said the university system acted rationally to protect public health by mandating the vaccine and not exempting individuals with some level of immunity from an infection.
However, in another US state, George Mason University agreed to provide a medical exemption to a law professor who claimed in a lawsuit that he should not be required to have the vaccine because he had evidence of natural immunity.
It should also be stressed that this is not to take the side of the erroneous arguments adopted by the anti-vaccination movement. Natural immunity is not somehow better than vaccine acquired immunity just because it is ‘natural’. In fact it is far, far more risky to gain immunity through infection. There are extremely strong ethical and health reasons to have the Covid vaccine.
But for health and social care workers who have been unfortunate enough to have already had coronavirus (and fortunate enough to have recovered), their naturally acquired immunity is likely to make them at low risk of passing on the virus. Ethical, evidence-based public health policy should reflect this.
We are already seeing evidence of some governments adopting this more flexible approach. The Italian government has introduced some of the toughest anti-covid measures in the world by requiring all workers to
Workers with natural immunity from previous infection should be exempt
show proof of protection against the virus. However, as well as proof of vaccination or a negative test, the rules also allow for evidence of recent recovery from infection (including for care and health workers).
And indeed the UK Government already recognises the protective effect of natural immunity, for travel. It is possible to obtain an NHS Covid pass with proof of natural immunity, shown by a positive PCR test result lasting for 180 days from the date of the positive test and following completion of the self-isolation period. Why could we not introduce something similar for care workers?
Patient safety is the abiding principle of those who work in the care sector and NHS. But a policy that leads to unnecessary loss of valued members of our workforce will threaten, rather than protect, patient safety. It needs to be urgently reconsidered.