When it comes to the power of immunisation to prevent disease and death, I’m a believer – as we all should be. I have written time and time again about the need for our population to get the Covid-19 vaccine.
However, in the wake of the government’s announcement that it will make it mandatory for all care home workers, and people who enter care homes, to have the Covid vaccine, I find myself balking at ministers’ audacity as they seek to enshrine this latest vaccine development into law.
Given my background as an ethicist I expect you’re waiting to hear the moral reasons why I object to mandatory Covid vaccination – and there are many arguments that have, can and will be in the coming days totted out by my contemporaries. So, it may come as a surprise that my main concerns are not moral ones, but practical ones. Practical, but very real concerns that 15 months into the pandemic the government has still not prioritised one of the most important aspects of preventing Covid-19 infection: enabling risk assessments for health and social care staff.
Health and social care workers, including care home workers, have always been exposed to the risk of infection because of what they do. Working with predominantly ill people means that both parties in that relationship can make each other ill too, which is why the best defence in health and social care is a good offence. That comes in the form of risk management carried out by an occupational health service.
Good risk management is about finding ways to reduce risk to employees and patients wherever possible, assessing not just the risks in the workplace, but in the role and those specific to the individuals too. This is because when it comes to infection risk management, contrary to several reports, vaccination alone is no silver bullet.
Many have already started to argue that a precedence for mandatory vaccination has been set in the form of hepatitis B vaccination. In actual fact the hep B vaccine serves as a great example of how good risk management relies on more than vaccination. Instead it is the combination of several important measures working together such that it can reduce risks for patients and staff that keep people safe.
To start, it is important to understand that hep B vaccination is not actually mandatory for health care workers in law. It is recommended – individual employers can make it mandatory – and most health care workers are immunised when they start their health careers, but it has never been a legal requirement.
While the hep B vaccine is helpful in cutting infection, what really works is vaccination combined with individual risk assessment and safe working practices with regards to possible sources of infection, like good needle practice and sharps disposal. Vaccines alone are not what keep our hospitals relatively hep B free; risk assessment and safety procedures are. Vaccines are a big part of the solution, but certainly not the whole solution.
In mandating Covid-19 vaccination for care home staff, and opening discussions about whether this applies to all health and social care staff, the government is ignoring the importance of understanding risk in the workplace and the combined role that safety measures play in cutting infection rates across all communicable diseases.
At a time when more health and social care staff then ever are needed to get through the pandemic and beyond, the government is spinning its wheels in looking to make vaccines mandatory in the hopes that it can avoid the bigger, more expensive routes that risk management offers to target and mitigate the different risks to Covid-19 that exist across individuals, roles, workplaces and the sector in general.
Instead of figuring out how to holistically protect staff and patients, it is hoping a one-jab-cures-all approach, enforced by law, will see the lingering and important consequences of the pandemic disappear into the glow of a Pfizer sunset. It is a waste of time and effort.
So how should the government be spending its time instead? First, it would do well to better support and enable occupational health practitioners to individually risk assess all health and social care workers, across all sectors, including care homes. As part and parcel of this, access to the resources required to maintain infection control procedures are what actually need to be enshrined into law.
Measures and procedures such as consistently providing appropriate PPE regardless of vaccine uptake, enabling social distancing for care home occupants and hospital patients, facilitating hand washing in workplaces, continuing to provide reliable testing and financially supporting those who need to self-isolate. Combined together, with voluntary vaccination, these measures can see our population through this pandemic.
My passion for risk management doesn’t change my beliefs or my message about vaccination. If you are eligible for the vaccine, I urge you to get it. If you are unsure about the vaccine, I urge you to speak to your health care provider to get your questions answered. Maybe this will help you make the decision to get vaccinated.
However, I am no risk management fool; vaccination alone is not enough to stop the spread. Until we can safely say we are in the post-Covid era, what we need are robust occupational health services and strong risk management strategies to help curb infection for everyone.
Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health at Aston University, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, and a trustee of the Institute of Medical Ethics
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