The government has completed a U-turn over mandating covid vaccination for frontline NHS staff. It is worth reflecting on the effects this will have.
The first thing to point out is that most staff came forward for vaccination as soon as the vaccine was available; it was one of the most successful vaccination programmes we have had in our trust (York and Scarborough Teaching Hospitals NHS Foundation Trust). Around 90 percent of staff were vaccinated in those early phases – compare that to a normal flu vaccine uptake of 75 percent.
Government U-turn on mandatory vaccination
There is no doubt that the announcement that it was to be mandated for NHS staff brought more staff forward, especially as it got nearer to the 3 February deadline for their first dose. The last figure I had for my hospital was that 94 percent of staff have had their first vaccination.
Sadly, one of the first effects of the announced U-turn is that those who attended reluctantly will feel they have been duped into being vaccinated – and this may harden their resolve against vaccination in the future.
I am not a fan of mandating issues such as vaccination. I would have valued an approach that encouraged each staff member who hadn’t had the vaccine to discuss this with a knowledgeable vaccinator one to one. This would have given them the opportunity to ask questions, highlight any concerns, and receive the support they required. This is the approach we took locally, spending time identifying the individual staff members and providing that support.
Trust me, trying to do this in a large organisation is a laborious exercise.
Why are some NHS staff still reluctant to have a covid vaccine?
It is worth considering why some staff have chosen not to get vaccinated, or have done so only reluctantly. Experience has shown that there are three main groups for vaccine hesitancy:
- Staff who have not had vaccinations due to previous issues with them as a child
- Staff who have complex history of allergies or anaphylaxis to medications
- Staff who distrust the vaccine
The first two groups are important to identify, as they have often been given the wrong advice by a health professional with little or no knowledge of the national guidance on vaccination. We have been able to help these staff have their vaccinations safely and by doing so, we have given them confidence in their ability to be vaccinated in the future.
Identifying those who distrust the vaccine is important. Having the opportunity to chat through the issues can help considerably and some have been reassured. However, there remains a group who will continue to resist.
Managing those who continue to resist
It is vitally important that these staff are identified and managed as part of an ongoing process. There are several reasons for this.
Firstly, we know that covid is not going away and sadly, we also know that further mutations will lead to variations that escape the immunity we have from vaccination and prior infection. Currently we are expecting that there will be a need for yearly vaccination.
We also know that when the vaccine is effective against the current strain then those vaccinated are less likely to spread the disease. Hence, as a health professional, being vaccinated helps us protect patients, our colleagues, and our families.
It is important to know who is not vaccinated, as their testing regimen and where they can be deployed might well be affected. I would have no problem working side by side with an unvaccinated colleague while we were in PPE, however I would not wish to share the coffee room!
The second reason it’s important to identify these individuals is perhaps more contentious. As I have explained, most of those who have not been vaccinated do not ‘trust’ the vaccine. Yet these staff will have interactions with patients who need advice on vaccination. One important example is midwives and pregnant women. We know it is important for pregnant mothers to be vaccinated so imagine them being advised by a midwife who has not been vaccinated. Do we really believe that a health professional who does not trust the vaccine will give impartial advice?
NHS under tremendous pressure
Finally, I must admit I understand why the government is currently backtracking on mandating vaccination. The NHS is under tremendous pressure and each trust in England is already understaffed due to a decade of austerity and lack of human resources planning. Each trust losing several hundred staff on top of this could lurch many into a crisis.
On top of this, the latest variant is so far removed from the original that though the vaccines still appear to prevent severe disease that requires hospitalisation or an ICU admission, they are less effective at preventing the spread of the disease. This removes one of the drivers for staff to be vaccinated.
It is important to remember that this issue will return when the next strain and the next vaccine appears. Government messaging U-turns and confused messaging will not make this any easier.