Recently, Dr Steve James – a critical care consultant – hit the headlines after he voiced his concern and distaste for mandatory vaccines in the NHS. Vaccination is a condition for employment in the NHS, as it is in other settings such as care homes. Dr James has subsequently gained a large following of antivaxxers, who are threatening to refer all those challenging the doctor to the General Medical Council (GMC). If that is the case, I ought to be referred.
For many years, I was clinical director of anaesthesia, theatres and ITU at York and Scarborough Teaching Hospitals NHS Foundation Trust. Although I’m now retired, when the pandemic hit, along with many of my colleagues I volunteered to help the NHS with the vaccine rollout. I wanted to do my bit to help people – including those with coexisting diseases – survive and get through the pandemic.
Dr James has every right to stamp his feet and say he is against compulsory vaccination for NHS staff. But he doesn’t have the right to allow his opinions to affect the treatment and health outcomes of his patients. If I were his clinical director, I would have already been chatting to him about his long-term plan. At least 98% of the staff in my Trust are vaccinated or en route to being so.
Medical challenges to vaccination
Over the last year, I have encountered people with tremendous medical challenges to vaccination, but have assisted them in completing their courses. These challenges have included idiopathic anaplylaxis, exercise-induced anaphylaxis, anaphylaxis in response to other vaccines, Mast Cell Activation Syndrome (MCAS) and others. These people, although scared, wanted to have the protection that vaccines provided. They also understood that if they didn’t have the vaccine, the consequences could be much worse.
Dr James, on the other hand, appears to be fit and healthy, has witnessed most of his colleagues be vaccinated, yet still chooses to avoid it. GMC guidance in Good medical practice states doctors should be vaccinated against common serious communicable diseases unless contraindicated, the GMC have indicated this includes Covid-19. This is to protect both patients and staff who may have a health reason that prevents them from being vaccinated. His stance against this was that due to reducing antibody levels staff would need vaccinating every month to achieve this.
Dr James’ bold statements need fact checking
Dr James spoke about his personal experience working on ITU, suggesting he had not seen any patients admitted who were as fit and healthy as he is. He suggested it was only those with risk factors such as coexisting diseases that were being treated. Obesity was one of the ‘diseases’ he listed, but he failed to mention that members of the BAME community are more vulnerable to obesity and other co-existing diseases, largely due to societal factors. By personalising to his own experience, he also did not reference national figures for ITU which sadly demonstrate how even young fit people have been affected.
He raised the issue of risk factors and so coexisting diseases in his interview on Radio 4 on Sunday. It is important to highlight that this does not mean these people were going to die anyway. The Health Foundation estimates that there has been a potential loss of 1.5 million years of life due to Covid-19. They estimated that those who died had lost an average of 10 years of life.
Dr James made a number of other bold statements that have been picked up by the anti-vaxxers, including claiming that vaccines only reduce transmission for around eight weeks, and suggesting that he already has natural immunity. These are important when trying to argue that the GMC guidance should not apply for this vaccination. I believe Dr James was selectively quoting from research done on vaccines looking at effect after the second dose. He was using the results for Astra Zeneca vaccine. Fortunately we know most NHS staff have had Pfizer, which performed much better in this study.
But remember, this was after only two doses and so there is no way to equate to current position with staff having had boosters. Currently we are studying the effects of the booster dose and that appears to be holding well but of course the effect of Omicron on this remains to be seen.
You can find more about this as the BBC published a fact check article reviewing the evidence and debunking his damaging claims.
Support for Dr James
The doctor has suggested that he has support from a group of over 40 midwives from one hospital unit, begging the question as to what advice these midwives are giving to pregnant women. One must hope it is unbiased, sound, and truthful advice. Since his claims circulated online, a great many healthcare professionals have made public statements debunking his views, including midwives and obstetricians. The NHS advice on getting vaccinated for covid while pregnant or breastfeeding is clear: it is safe, and is the best way to protect you and your baby.
For the record, beliefs such as those expressed by Dr James are extremely rare among hospital and NHS staff. The majority of NHS staff have received their vaccinations – the first in January 2021, the second in March 2021, and the booster in September time. Currently, the booster is holding up well and fundamentally, it is protecting people against hospital and ITU admission.
And for those working in the NHS who haven’t yet been jabbed, I work with colleagues in supporting and helping them get vaccinated especially as there is a national requirement for all healthcare staff who are involved in patient care to be vaccinated by 31 March. HR departments across England are currently identifying the unvaccinated and are taking a rigorous approach to enforcement. I, like most colleagues, believe the GMC guidance is right and vaccination against Covid-19 is part of our ‘social responsibility’ to colleagues, our patients and to our families. It is sad, but experience does demonstrate that a small percentage of the workforce will argue against this and so though I am not a fan of the mandatory approach, this does make life easier for those who manage these individuals.
Differences in NHS roles
The fate of those who choose to remain unvaccinated will depend on what role they have in the NHS. If they are patient-facing, there is a huge problem. In some of the larger hospitals, a consultant anaesthetist or intensivist, for example, could be assigned to teaching or university roles. But in other smaller trusts, this becomes a lot more problematic. As a colleague said to me recently, Dr James and his antivaxxer colleagues are essentially, “expensive teaboys”.
Feel free to report me to the GMC.
