In the absence of an impact assessment, Parliament has recently voted to mandate COVID vaccinations for care home staff. Consequently, it was anticipated that a consultation would commence regarding introducing mandatory vaccinations for healthcare staff and other care workers. That moment has now arrived, and the proposals also include the mandating of influenza vaccinations.

As a healthcare worker who chooses not to be vaccinated this will impact me personally. However, the implications of mandatory COVID and influenza vaccinations are much broader and raise moral and ethical question for policy makers. Below I set out reasons why I oppose these proposals.

By anonymous NHS Manager, DomJazzSoul

Workforce implications

It is worth reminding ourselves that the staff in question are the same ones heralded as heroes for sacrificing themselves and caring for COVID-19 patients during the height of the pandemic. They did this work in the absence of sufficient knowledge regarding the risks posed by this virus.

Now the very same staff are being penalised and vilified for wishing to refuse or delay receiving the COVID-19 vaccination. There are already high take-up rates – exceeding levels recommended by SAGE – of the covid vaccine in the health and care sectors. 92% of NHS trust staff have, at the time of writing, had one dose of the covid-19 vaccine and 88% have had both doses. The uptake of influenza vaccination has been high in NHS providers in recent years. Proposing to mandate the flu jab in a year where flu has been eradicated seems illogical.

Although there was no ‘proper impact assessment’ regarding mandating the vaccine for care home staff, there was an ‘impact statement’ which forecast a potential loss of up to 70,000 care staff in a sector already experiencing high vacancy and turnover rates. If a similar impact is anticipated for healthcare, then this will have a detrimental impact on the patients and residents we are duty-bound to protect.

Status of the vaccine

A key point to make here is that, in the UK at least, these drugs are still not licensed. The vaccines were given temporary authorisation for one year after an extremely rapid period of development. Prior to COVID-19, vaccines have taken years to be developed.

The track record of some of the vaccine manufacturers is either dubious or non-existent and furthermore they are exempt from liability. The current UK vaccine compensation scheme is both insufficient and under-staffed (there are four people working in the department dealing with vaccine damage applications).

Effectiveness of the vaccine

The vaccines were initially hailed as a ‘miracle of science’. However, it later transpired that the vaccines are not able to stop transmission of the virus or prevent recipients from having COVID-19 symptoms. The quoted 90+% efficacy of the vaccine was based on the relative risk reduction (RRR) between the vaccine trial cohorts, whereas a more accurate but less convenient measure is the absolute risk reduction (ARR) which is less than 1% for the Pfizer vaccine and just under 2% for the Oxford vaccine.

In terms of its impact and the vaccine being our ‘route to freedom’, the results appear unsatisfactory and inconclusive. It has been claimed that the vaccine breaks the link between COVID-19 cases, hospitalisations and deaths. However, data presented at the latest coronavirus press briefing indicates that all metrics were higher this year than at the same point last year.

More deaths have occurred so far this year than expected (when comparing to the pre-pandemic five-year average), and we have observed almost the same level of COVID deaths in 2021 as in 2020. The most recent Public Health England technical briefing on variants of concern indicates that there has been a greater proportion of deaths from the Delta variant in the vaccinated than in the unvaccinated. Individual freedoms are still restricted in terms of international travel. The on-off proposal to introduce vaccine certificates to enter venues appears more like a route towards tighter social control than a return of our freedoms.

Dangers of vaccination

All vaccines, including the new ones for COVID-19, carry a small risk of serious side effects. Historically, and more recently, we have seen this with birth defects associated with the Thalidomide drug and narcolepsy resulting from the H1N1 swine flu vaccine. Adverse reactions to the COVID vaccine are to be reported to the Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card scheme from which the results are published weekly.

The latest publication reported almost 1.2 million reactions and 1,645 deaths related to the COVID-19 vaccine and these numbers are likely to be under-reported. Recent data published by Public Health Scotland indicated 5,522 deaths had occurred within 28 days of a COVID-19 vaccination.  

Although they have been requested in Parliament, such statistics are yet to be made available in England. If we were to model the same data for England based on the number of vaccine doses administered, we can expect to have witnessed 55,840 deaths within 28 days of the COVID vaccine. During that same period, 57,271 deaths were reported in England within 28 days of a positive COVID test.

Much of the above information is not easily accessible or widely publicised, bringing into question how informed the consent is for vaccine recipients; informed consent being a key tenet of the Nuremburg Code.

Alternative approaches

Considering the vast number people who have tested positive for COVID-19 and recovered, one of the many elephants in the room is how many people are already protected from this illness. A recent study by Oxford University claimed that:

• the vaccinated are less severely infected but are more likely to become infected
• they can transmit COVID more easily than those who recovered from infection naturally
• natural recovery is more wide-ranging and lasts longer than vaccine-induced immunity

Given the low risk to healthy, working age adults there is an argument that it is safer to build upon the natural protection that already exists to such illnesses than it is to vaccinate.

Even the government has struggled to decide which is the most effective action against this disease. Earlier this year the Prime Minister claimed that it was the lockdown, not the vaccine, which curtailed the impact of the second wave. Whereas, a week earlier he had claimed the vaccines had prevented over 10,000 deaths.

The recent announcement that the MHRA had approved the first treatment for COVID-19 must also bring into question the status of the vaccine.

Despite the ethical questions and contradictory evidence surrounding the safety and efficacy of the COVID-19 vaccine, the government appears intent on making its receipt a condition of deployment in a health and care sector that is already struggling.