Making vaccination compulsory for NHS frontline workers likely to make patients suffer

The NHS has been struggling for years with chronic underfunding and staff shortages.

COVID has only made matters worse. Health Secretary Sajid Javid is now warning that NHS waiting lists for non-emergency operations and procedures could grow to 13 million up from 5.3 million in July 2021 while increasing numbers of patients wait in ambulances outside hospitals.

Last week, NHS bosses warned that patients’ lives are at risk because NHS staff are overstretched and exhausted from working through the pandemic. The NHS is still at least 84,000 healthcare workers short. That’s 6.5% of its workforce.

The last thing the health service needs right now is to lose tens of thousands of NHS staff, but under a new government policy that will make COVID vaccines compulsory for frontline health workers, that is likely to happen.

Research shows healthcare workers are an important source of information about vaccines for patients, family, friends and wider society. But, unfortunately, our recent research shows not all NHS staff feel confident being vaccinated.

Let me be clear: I strongly believe everyone should get vaccinated against COVID if they can. I’ve spent many weekends volunteering as a vaccinator, and over the last 18 months I’ve been studying the effect of the pandemic on healthcare workers as part of the UK-Reach study.

NHS staff were among the first to be offered COVID vaccines, in early December 2020. That month we surveyed nearly 15,000 healthcare workers and found almost a quarter were hesitant about receiving a vaccine. As in the general population, hesitancy was driven mainly by lack of trust in the safety and effectiveness of vaccines, in employers, and in authority more widely. Healthcare workers who were pregnant were seven times more likely to be hesitant.

Younger workers still worried

Younger healthcare workers were more likely to be hesitant. Staff identifying as white but not British or Irish were 1.5 times more likely than the white British ethnic group to be hesitant, those from Black African ethnic groups were twice as likely to be hesitant, and those from Black Caribbean ethnic groups were three times as likely to be hesitant.

The Reach study found many healthcare workers who were initially hesitant in the first few months of the vaccine rollout became more confident, but around one-third of healthcare workers who were hesitant between December 2020 and March 2021 remained so when we asked them again between April and July 2021.

Those who remained hesitant at this later date tended to feel less informed about vaccines, be less likely to trust vaccine information from official sources, and to have been advised against vaccination by family and friends. We’re currently following up our cohort of healthcare workers again to find out their attitudes towards compulsory vaccination.

Of course, staff who are vaccinated are much less likely to fall seriously ill or die from COVID, and take fewer days off sick. It also reduces the risk that staff will infect patients.

But the research makes me concerned that mandatory vaccination will further erode trust in vaccines among some healthcare workers. There is some evidence including a large survey of more than 17,000 members of the UK public in April 2021 to explore attitudes to vaccine passports, that policies that require vaccinations for certain activities can reduce willingness to get vaccinated. The uptake of boosters is already slow, so I worry a policy of mandatory vaccination might actually end up making that slower.

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Mandatory vaccines prompt push back

A study that is yet to be peer-reviewed or published in a scientific journal, suggests that making COVID vaccinations compulsory could also lead to hesitant people being more likely to refuse flu vaccines or adhere to other protective measures. We’ve found that healthcare workers can be reassured with accurate information, particularly from trusted co-workers. To help this happen, we’re working with healthcare staff to develop a short online game NHS workers can play on their phones to improve knowledge and trust in COVID vaccines.

We can also do more to keep patients safe including regular staff testing, making sure sick staff take time off and providing more personal protective equipment ([only a third of healthcare workers] in the UK-Reach study could access PPE consistently in the first lockdown.

Compulsory COVID vaccination for social care workers is already causing serious staffing problems. The government set a deadline of November 11 2021 for all social care staff to be vaccinated, and last week it was announced that 32,000 would lose their jobs. Care homes are turning away residents coming out of hospital because they don’t have staff to look after them. The whole healthcare industry will feel under pressure as staff leave and others are put off from joining or are prevented from training by a “no jab, no job” policy.

While a policy of compulsory vaccination for frontline healthcare workers may seem sensible, I believe the government needs to rethink its strategy before our NHS becomes even more chronically understaffed, and more patients cannot access healthcare when they desperately need it.

Katherine Woolf receives funding from the National Institute for Health Research and the Medical Research Council, via the following:
UK-REACH is supported by a grant from the MRC-UK Research and Innovation (MR/V027549/1) and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19.
KW is funded through an NIHR Career Development Fellowship (CDF-2017-10-008).