Recently the UK Government created controversy by announcing mandatory Covid-19 vaccination for all care home staff in England. This move drew attention to the fact that as of last month, only 64.7% of care homes for older people in England (and only 44.1% in London) had met the one-dose per staff member minimum requirement to reduce the risk of outbreaks in these high-risk settings, and that only 40.5% of England’s care homes had fully vaccinated staff (dropping to 23% in London).
These statistics are concerning, particularly given how vulnerable care home patients are. Also concerning are the higher levels of vaccine hesitancy among social care staff compared to other NHS staff (a difference of approximately 15%). Mandatory vaccination among social care staff would undoubtedly reduce the risk of COVID-19 transmission and illness among patients, visitors, other staff and broader communities, so why has this policy been met with such vehement disapproval by so many?
The reason is mainly because this policy strikes at a value we treasure so dearly in the UK: individual liberty. By making vaccination mandatory, are we not denying such staff their right to make their own individual choice? And what does this mean for the rest of us? Could our right to choose to receive a vaccination or not be threatened in the future?
Ultimately, the value of liberty cannot supersede our other core values under all circumstances, particularly when the circumstance is a deadly pandemic that threatens public safety - another core value we ascribe to. A line has to be drawn somewhere and done so reasonably in a way that weighs up the individual and social benefits and costs.
Indeed, if COVID-19 vaccination rates for care home staff were higher, a mandatory vaccination policy would not have been invoked. How much higher they should have been is unclear, but what is clear is that the current rate is not high enough, especially as the Delta variant has increased community transmission and reduced the efficacy of current vaccines. As such, thinking preventatively (key to public health policy), a mandatory approach now will yield substantially greater protection against the next inevitable COVID-19 variant that enters our shores until we have a global stranglehold on this virus.
However, this policy comes with risks. Firstly, there is the danger that care home staff who have been hesitant to vaccinate will experience raised anxiety – an outcome that we desperately wish to avoid given the distress and trauma they have already experienced, particularly during the earlier stages of the pandemic when so many care home residents and staff tragically died. However, the prospect of raised anxiety will, to some extent, be offset by the likelihood that many other vaccinated staff will feel more at ease with the knowledge that their colleagues are vaccinated. There is also the risk that some staff will resign in protest, leaving an already stretched social care system in even further trouble. To help prevent this, the Government could – and should – reward the entire NHS social care population with a meaningful boost in salary, something that is already long overdue.
Dr Chris Papadopoulos, Principal Lecturer in Public Health, University of Bedfordshire