Compulsory covid-19 vaccination for care home workers is unnecessary, disproportionate and misguided, experts argue

BMJJul 8 2021

In The BMJ today, experts argue that mandatory vaccination is “unnecessary, disproportionate, and misguided.”

The government decision to remove the right of care home staff in England to choose whether or not to be vaccinated against covid-19 is a profound departure from public health norms. The intended next step is a rapid and massive expansion of compulsory vaccination to legally require covid-19 and flu vaccination of all frontline health and social care workers, subject to consultation.

But Lydia Hayes, Professor of Law at Kent University and Allyson Pollock, Professor of public health at Newcastle University, say vaccination “is not a panacea for safety” and “will not remedy the serious shortcomings of the care sector in England.”

They note government consultation documents and subsequent media reports have claimed that mandatory vaccination is necessary because of low vaccination take up rates in some care homes.

But figures show that by 20 June 2021, over 90% of care home residents in England had received two doses of a covid-19 vaccine, 84% of care workers in England had received a first dose, and 72% of care workers had received a second dose - in line with Scientific Advisory Group recommendations.

Their closer scrutiny of the data shows that uptake of the first dose of covid-19 vaccination among care workers is below 80% (68-74%) in only three English local authorities but these numbers are an artefact of very low numbers of staff employed by care homes in these London areas.

Moreover, they highlight that the government’s own methodology note warns that reliable information on vaccination uptake cannot be directly derived from the data the government is using.

According to regulatory law, safety in care homes “is achieved through adequate staffing levels, training, equipment, cleanliness, personal protective equipment, risk assessment, and consultation with staff and residents,” they write.

Vaccination protects individuals from covid-19 and reduces the risk of transmission of disease to others, but neither duration of protection nor efficacy against new variants are known.

Wales and Scotland have rejected compulsory vaccination for care workers and invested in systems of mandatory registration for care workers designed to professionalize the sector, increase access to training, and embed a culture of continuous professional development, they add.

But in England, successive ministers have rejected national care worker registration. “Hence, the Department of Health and Social Care and the CQC don’t know who England’s care workers are and training of the care workforce is woefully inadequate.”

“Civil liberty is a necessary component of strong public health. Mandatory vaccination is unnecessary, disproportionate and misguided, they warn. “Safety can be assured only by taking steps to build trust and to mitigate outbreaks.”

“Care workers need paid time in which to access vaccination and good training, decent wages (including sick pay), personal protective equipment, and strong infection control measures,” they conclude.