Expert advice

Could coronavirus vaccination become compulsory for nurses?

Mandatory vaccination and the rights of individuals and employers

COVID-19 throws focus on the sometimes fraught issue of mandatory vaccination of healthcare professionals and the rights of individuals and employers

This article has been updated to reflect latest government announcement

Picture: Alamy

What are the plans around making the COVID-19 vaccination compulsory for nurses?

COVID-19 vaccinations will become mandatory for nurses working in care homes in England from October, the government announced.

The move is intended to drive up vaccination rates and follows a public consultation on the issue which recieved 13,500 responses.

An amendment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 means care home providers will only be able to use those staff who have received the COVID-19 vaccination (or those with a legitimate medical exemption).

From October, subject to parliamentary approval and a 16-week grace period, anyone working in a Care Quality Commission-registered care home in England wil have to have had two doses of a coronavirus vaccine unless they have a medical exemption.

This will apply to all nurses employed by care homes, agency nurses deployed to care homes and any nurses who enter care homes as part of their work.

Despite oppostion from health unions and sector leaders who warned such a move could threaten already-stretched staffing levels, health and social care secretary Matt Hancock said the change in the law was necessary to protect vulnerable people living in care homes.

Mr Hancock told the House of Commons: ‘The vast majority of staff in care homes are already vaccinated but not all, and we know that the vaccine not only protects you but protects those around you.

'Therefore we will be taking forward the measures to ensure the mandation as a condition of deployment for staff in care homes and we will consult on the same approach in the NHS in order to save lives and protect patients from disease.'

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What about nurses working elsewhere, in the NHS and social care?

The government has said a consultation on mandatory coronavirus and flu vaccinations for NHS staff as a condition of deployment will take place in due course.

Are any vaccinations currently mandatory for NHS staff?

According to media interviews in March, Mr Hancock claimed a precedent was set when doctors were required to have hepatitis B vaccination.

But while this vaccine is strongly recommended for healthcare staff by the General Medical Council and the Public Health England Green Book, it is not mandatory. The Green Book states: ‘Hepatitis B vaccination is recommended for healthcare workers who may have direct contact with patients’ blood or blood-stained body fluids.’

But some employers appear to insist that employees at risk of exposure-prone procedures have the jab before being offered employment.

Are COVID-19 vaccines mandatory for healthcare staff anywhere else in the world?

Italy has become the first country in Europe to make vaccination against coronavirus mandatory for healthcare workers.

Health professionals who refuse to have the vaccine will have the option to be transferred to duties that do not risk transmission of the virus, otherwise be suspended without pay for as much as a year.

The move was backed by the Order of Doctors, Surgeons and Orthodontists at a time when Italy, which was severely affected by the virus, faced its third wave.

What does exsiting NHS England say about nurses who decline the COVID-19 vaccine?

Guidance from NHS England in March says that staff who refuse the vaccine could be redeployed to a less exposure-prone setting.

The guidance suggests conversations about vaccine hesitancy could be undertaken with a line manager or another ‘person of trust’ such as a vaccinator, peer or chaplain.

What does the RCN say?

While the RCN does not support mandatory vaccination for nurses, it does strongly encourage all healthcare staff to get the injection.

‘Professionals… should take all reasonable personal precautions to avoid potential health risks to colleagues and people receiving care’

Nursing and Midwifery Council

Vaccination should not be a condition of employment or part of employment contracts and nurses should not be coerced into receiving the jab, the college said when the consultation began earlier this year.

It supports the principle of employers taking a proactive approach and ensuring there is easy access for staff to get the vaccine at work.

What do nurses think about mandatory vaccines in general?

Surveys by Nursing Standard have found that a significant minority would not support mandatory vaccination.

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More than a third (36%) of more than 2,000 nurses said they would not support a move to make the flu vaccine mandatory, in a 2019 survey that revealed the strong feelings healthcare professionals hold on this issue.

It is a deeply polarising issue for nurses, with many saying being vaccinated is a fundamental part of protecting vulnerable patients. But some said they would quit if forced to have a vaccine, and others said while they always received the flu jab, they did not agree with it being made mandatory.

What does the Nursing and Midwifery Council (NMC) say?

The NMC says it would expect the majority of registrants to be vaccinated because of the risk of inadvertently spreading coronavirus to vulnerable people.

‘Although there aren’t any mandatory vaccines in the UK, the code and our standards make clear that professionals have a responsibility to maintain their own level of health. And that they should take all reasonable personal precautions to avoid potential health risks to colleagues and people receiving care,’ the regulator says.

What do legal experts think?

The current approach with hepatitis B vaccination and the use of employers’ health and safety policies has not been tested legally, and does not necessarily represent legally-binding precedent, Isra Black, lecturer in law at the University of York, says.

Mandatory vaccination interferes with the right to private life protected by the European Convention on Human Rights, so the relevant authorities would need to show that the interference is justified, he says.

Public bodies must also show that they have taken into account the Public Sector Equality Duty, including that they eliminate unlawful discrimination, harassment and victimisation and other prohibited conduct.

They must also show that mandatory vaccination policies comply with the requirements of the Equality Act 2010. The situation is more complex for private providers.

‘The human rights and equality dimensions of mandatory vaccination cannot be avoided by the use of health and safety law,’ he says.

‘We might question the wisdom of the government’s proposal to use health and safety regulations, as proposed in consultation, to enact mandatory COVID-19 vaccination, rather than pursue primary legislation that would enable a robust justification for controversial policy to be offered in parliament.’

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