Five Common Objections to Mandatory Vaccination for Healthcare Workers: A Medical Ethicist's View

Daniel Sokol, PhD, is a medical ethicist and clinical negligence barrister and the author of "Tough Choices: Stories from the Front Line of Medical Ethics" (Book Guild, 2018). In this commentary, he presents a legal view on five common objections to the Government's mandatory vaccination policy for NHS healthcare workers.

The policy of mandatory vaccination for healthcare workers goes against 'bodily autonomy'

Calling the policy 'mandatory vaccination' is a misnomer. The policy is more accurately described as 'vaccination as a condition of deployment'. In brief, the policy requires all persons over 18 with direct, face-to-face contact with patients to provide evidence that they have received a complete course of approved vaccines against Covid-19 by no later than April 1, 2022. Those who fall foul of the policy will either be redeployed to roles that are not patient-facing or dismissed.

In no circumstances will a healthcare worker who declines vaccination be forced to accept it. There will be no infringement of bodily autonomy.

The policy is contrary to the ethical principle of informed consent

No. This would only be the case if healthcare workers were vaccinated without their permission or without sufficient information about the known risks and benefits of the vaccine. Neither scenario should happen.

Healthcare workers who refuse to be vaccinated are coerced to have the vaccination

The policy puts pressure on unvaccinated healthcare workers to decide whether to get the vaccine or abandon their current, patient-facing role. It is doubtful whether this pressure is so overpowering as to constitute coercion, especially if alternative roles or employment are available with no significant reduction in pay.

Determining what counts as coercion is not straightforward but even if the policy is described as 'coercive', the question remains: is it morally justified?

The policy will lead to a mass exodus of staff, which will damage the healthcare system and patient care

No one knows for sure what effect the policy will have on staffing levels. However, no mass shortage has been observed elsewhere, despite similar concerns. The policy is already in place in many countries, including France, Germany, Italy, Greece, Finland, Poland, and New Zealand.

Daniel Sokol

In France, as of November 2021, 1350 clinicians out of 374,000 have been prohibited from practising for failing to comply with the law on mandatory vaccination. Of these 1350 clinicians, 160 were doctors (0.07% of doctors in France). These are small numbers.

Many of the 73,000 or so unvaccinated, patient-facing NHS workers will be waiting until the last minute to see if the government backs down.

Since 2020, the NHS has acquired 5000 more doctors and 11,000 more nurses.^[1] Even if thousands leave, the health service is unlikely to collapse (the NHS has had staff shortages for years), although it is possible that parts of the system may be so understaffed that patient care will suffer.

There is no evidence that vaccination stops infection or transmission

The jury is still out on the effectiveness of the vaccine against Omicron infection and transmission. According to the latest COVID-19 vaccine surveillance report from the UK Health Security Agency, published on January 20, 2022, "several studies have provided evidence that vaccines are effective at preventing infection" and that, since uninfected people cannot transmit the virus, "the vaccines provide some protection against transmission". The report noted: "There may be additional benefit, beyond that due to prevention of infection, if some of those individuals who become infected despite vaccination are also at a reduced risk of transmitting (for example, because of reduced duration or level of viral shedding)." The report referred to a number of studies providing evidence of reduced risk of household transmission from vaccinated cases compared to unvaccinated ones.^[2]

There is strong evidence that the vaccine is effective against serious illness and hospital admission. New data from the Centers for Disease Control and Prevention revealed that unvaccinated adults aged 18 to 49 are 12 times more likely to be admitted to hospital than those who are immunised. For unvaccinated adults aged 50 to 64, the likelihood of hospital admission is 44 times greater.^[3]

Most recently, research by the Office of National Statistics showed that double-vaccinated adults had a 41% lower likelihood of developing long COVID than the unvaccinated.^[4]

Vaccinated healthcare workers who get infected with COVID are, therefore, less likely to be absent from the 'front line' for a prolonged period than their non-vaccinated counterparts, easing pressure on the health service.

Final thoughts

Most of the decisions during the CoVID pandemic, whether about lockdown, social distancing, travel restrictions or anything else, involve trade-offs between competing values, such as personal liberty and protecting the medically vulnerable.

The decision regarding mandatory vaccination is no different. The policy will cause distress to some healthcare workers and may strain the health service by creating staff shortages, reducing morale, and affecting patient care. On the other hand, it could afford greater protection to patients, staff and all those who work in or visit healthcare institutions, will uphold the high ethical standards of the medical professions, and send the right message to the public about the value of vaccination.

On balance, I believe the benefits of the policy outweigh its risks and harms.

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