Yes, says John Harris. Vaccinations should be as much a qualification for health professionals as passing exams
Free people and free societies don’t like compulsion, and for good reasons. We all value autonomy, choice and equality of concern, respect and protection for all. But in the vaccination debate, compulsion walks both sides of the street.
NHS and care home patients effectively have no choice as to the professionals they encounter and who care for them on a daily basis. They have to trust that the best standards of care and protection will be delivered to them, and they deserve to know that their vulnerability to the virus will be guarded against, including by ensuring that the people looking after them have been vaccinated.
A spokesperson for the British Medical Association said yesterday that while medical staff already have to have some vaccines for certain roles, a blanket policy “would raise new ethical and legal implications”. This is true, but it is not necessarily an argument against compulsory jabs when we also consider the ethical implications of exposing vulnerable patients to unvaccinated staff.
The Royal College of Nursing was also against the idea. “It’s essential,” it said, “that staff have the opportunity to fully understand and have autonomy over what goes into their bodies.” Well, one would expect nurses to understand the vaccines, and they can certainly refuse to have one. But it does not follow that their refusal should not disqualify them from nursing in particular contexts.
I find myself in agreement with the Equality and Human Rights Commission’s conclusion that it is “reasonable” to require care home staff to be vaccinated while including safeguards to minimise discrimination, such as exemptions for staff who can’t be vaccinated for medical reasons. Whether it is also “reasonable” to let these unvaccinated staff care for vulnerable patients is far less clear.
Compulsion is a blunt instrument which should be used sparingly. But so also is exposing patients to unvaccinated staff when vaccines are available and as safe as they clearly are. Patients in the NHS and in UK care homes surely have a right to expect, and indeed to demand, that in addition to other routine protection measures – qualified staff, face coverings, hand gel, gloves – they should be protected by vaccination, and that the staff who treat them should be similarly protected.
Vaccination against Covid-19 should be as much a qualification for the work of a health professional worthy of the name as is the training they have had, the examinations they have passed and the professional standards they must meet.
John Harris is professor emeritus in bioethics at the University of Manchester
No, says Julian Savulescu. We must respect the autonomy of care workers
Vaccines are our way out of the Covid-19 pandemic. They are effective and safe. But the proposal to make vaccination mandatory for care home workers is muddle-headed.
It seems so simple: it’s good for the workers, and they won’t pass Covid on to their elderly charges. But it is not that straightforward. First there is the question of whether the benefits of the jab outweigh the potential risks for the individual, in terms of extremely rare side effects. Covid-19 deaths are predominantly among the elderly. The very rare side effects are mostly in the young. For most individuals, these low-probability risks won’t change the risk-benefit ratio. But for some, they might. Importantly, it should be up to the individual to decide on the basis of all the information. That is perhaps the most basic tenet of medical ethics: respect for autonomy.
Of course, care workers have taken on responsibilities for others. But to justify removing someone’s livelihood, and exacerbating shortages of care workers, we need to be sure of two things: first, that this is an effective measure, and second, that it is necessary – that the protection afforded to residents by the vaccine isn’t sufficient, and therefore their carers must be vaccinated too.
At the moment, our confidence is the other way around. While we know the vaccines are excellent protection against hospitalisation and death, there is little data about their role in preventing transmission. The data we do have (following one dose) shows a fairly muted success in reducing transmission: as low as 35 per cent and up to 50 per cent. Even if vaccines were perfect preventers of transmission, Covid-19 is going to continue to stalk the corridors of care homes. Family and friends will bring it in. Coercing one group and leaving the rest of society to decide for themselves will be divisive.
There are also other, less coercive options to protect residents. Risk can be minimised by coordinating care of residents unable to be vaccinated by vaccinated carers. The official target is 80 per cent of staff vaccinated. Half of care homes are already at this level through voluntary means. Care home workers could be offered incentives, including money, to be vaccinated. This may tip the balance for those who are merely avoiding needles or the inconvenience of mild side effects.
We want to reduce the risk for our most vulnerable. But we have to take some consideration of the well-being and autonomy of those who risked their own lives caring for them. I think the vaccine is in most people’s best interests. But that’s a decision people need to come to for themselves.
Prof Julian Savulescu is Uehiro Chair in Practical Ethics, University of Oxford
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