“A greatest and most representative demonstration against the Vaccination Acts ever witnessed in this country” – The Daily Post, UK. The year was 1855, and the United Kingdom’s first vaccine mandate for smallpox held parents in contempt, subjecting them to fines and imprisonment if the infants were not vaccinated. However, the procession proved to be a success in that it reformed the mandate into a conscientious act. History is never long ago. Today the year is 2022. The UK is set to impose the COVID-19 vaccine mandate on the frontline NHS workers in England.
A way to compel people to get vaccinated, the current mandate demands that unvaccinated workers get two vaccine doses by 1 April 2022. The staff members are thus expected to have their first jab by 3 February. A failure to get vaccinated could result in moving back to office roles or a dismissal letter. Such a measure, at first glance, seems necessary and well-intentioned, especially since the vaccine rollout the highest peak in NHS staff’s absence occurred in January 2022. The mandate also moves to protect the patients, ensuring the vulnerable are safe. The COVID-19 outbreak at a nursing home in Kentucky, USA, where one unvaccinated health worker infected 22 residents and employees, seems to justify the mandate. But is this the last resort for British healthcare workers? Have other policy interventions such as public education and meaningful engagement proved inconsequential in producing the unequivocal public health benefits?
Expected to be a proportionate policy response, the forthcoming vaccine mandate also holds the potential to cause significant disruption of healthcare services. The impact statement by the Department of Health & Social Care outlines the outcomes and risks of the condition of deployment policy. Counterfactually, 92.5% of the NHS healthcare workers will get vaccinated without intervention. Due to the policy intervention, 1.5% of the unvaccinated staff will get vaccinated. At the same time, 73,000 workers may remain unvaccinated, excluding those without any exemptions. Dismissing many such workers can certainly bring havoc to the already burdened NHS, which has also got sizeable vacancies (93,0000) to fill. The policy is also likely to impact domiciliary care more than healthcare settings, creating additional troubles for the patients and their families.
If the unvaccinated and unwilling individuals are dismissed, then the workforce recruitment and retention fund, meant to support the sector, will be spent on retaining the existing workforce or paying for the additional hours put in by those who stay behind. That not only compromises the envisioned use of taxpayer’s money but also puts undue pressure on the existing workforce, even disrupting their work-life balance. A burnt-out workforce compensating for the policy measures could further increase the turnover rate, incapacitating the sector.. A pre-print publication looking into reasons for low vaccination uptake among health and social care workers in the UK showed that those pressured by their employers to get vaccinated were more likely to deny vaccination. Such pressure exacerbated their concerns about vaccination and distrust.
Besides the hostility to pressures, black African and mixed black African were less likely to be offered vaccination than white British and Irish participants. The ethnicity-based disparities also led to distrust in vaccination, healthcare providers and policymakers, resulting in vaccine hesitancy. BMA also pointed out to the ‘enormous’ structural racism in the NHS in response to the Sewell report published by the Commission on Race and Ethnic Disparities in March 2021. The palpable doubt coupled with pressure from the government to get vaccinated or dismissed might not paint a pretty picture for vaccination rates among healthcare workers from ethnic minority backgrounds.
