July 19, 2021 - 10:20am

It is a decision that would have been unthinkable 18 months ago. Last week, Parliament voted to legally mandate Covid vaccines for those in care homes, meaning that carers who refuse a vaccine are now at risk of losing their jobs. How long did the debate over such a consequential piece of legislation take? 90 minutes. Today, the House of Lords will be voting on the measure.

Many have pointed to the current Hepatitis B vaccine requirements for healthcare workers and the legal mandation of the Smallpox vaccine in 1853 as a reason for why this decision is not as significant as it appears. In other words, there is a precedent. But this is not quite true — the Hepatitis B vaccine is not mandated in law for healthcare workers and it remains a part of guidance and occupational health policies only. As for Smallpox, medical rights have progressed quite a bit since 1853 — do we really need to be going back to the Victorian era to justify 21st century policies?

Indeed, the legal mandate for Covid vaccines is a massive turning point in the state’s relationship to individual healthcare. No other vaccine rollout has been given this much legislative attention, even in previous cases wherein fears over vaccine hesitancy made national news — as was the case with the notorious Wakefield Scandal.

Until now, governments have tended to prioritise individual choice in medical decision making, even if this has meant some risk to collective society. The move towards lockdown-policies at the beginning of the pandemic shows how this traditional framework has been eroded, even taking into account the massive impact Covid has had on our society. The ease with which our individual freedoms have been suspended and complex ethical discussions glossed over is disconcerting.

The question also remains as to whether this sort of legally mandated coercion is actually helpful. Research has suggested that those who feel pressured into getting a vaccination by their employers are less willing to do so. It has long been understood within the medical profession that communication and explanation are far more preferable to paternalism and pressure. However, these tried-and-tested strategies seem to have been totally forgotten when it comes to Covid.

What’s more, considering the increased rates of vaccine hesitancy among BAME groups, this policy risks being divisive and discriminatory. Targeting those reticent to be vaccinated is likely to have the unintended consequence of also targeting minority groups, which could in turn further increase vaccine hesitancy within BAME communities frustrated at racialised discrimination.

Ultimately the Covid response has, once again, favoured coercion over good communication. Why bother to understand someone’s vaccine hesitancy, to reassure and inform them, when you can simply mandate them to take it on fear of losing their job? The care home sector is already overstretched, with staff often under paid and under appreciated. Putting in yet another disincentive to become a care worker may well prove highly damaging to recruitment and retention.

Amy Jones is an anonymous doctor who has a background in Philosophy & Bioethics.