Should care home workers lose their jobs if they are not vaccinated?

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Today’s headlines included reports that Sajid Javid has told care workers that if they won’t be vaccinated, they should move on and get another job. 

Next week we’ll be running a little series of articles concerning vaccine hesitancy including a guest post from Ash Cunningham who has a different perspective to mine.  Ash picks up on previous news reports concerning care workers losing their jobs.  He’ll argue that although we need to take seriously the risk within care homes, that there are ethical questions about people losing their jobs over vaccine status. In this context I agree with him.

Here’s why. The first reason is that resorting to threats isn’t a great idea if you are trying to persuade people to get the vaccines. This is so not least because often those in care professions often come from backgrounds where they feel they have good cause to be suspicious of authority behaviour, we’re talking low pay, battling the immigration system and racism.  You know, there’s a better approach to persuading people to get the jab when they are reluctant. Ask them why they are reluctant.

Secondly, I’m not convinced that forcing every care-worker to be jabbed is necessary to the strategy of protecting people from COVID and ending the pandemic.  Think of a care home as being a population -or to use immunisation language, a small herd if you like.  The aim for your Care Home is to achieve a form of herd immunity.  This is why.

You have residents who are particularly at risk, vulnerable to serious illness and death. You want to protect them. Their first line of protection is by being vaccinated themselves. We know that the vaccines provide about 60-80% protection against infection and 90-95% protection against serious illness and death.  This is good news but it also means that the residents don’t have 100% protection. Add into the mix that some will not be able to have the vaccine and others will still be vulnerable with it. So, we build up herd immunity, just as in the wider population by getting as many other people as possible to have the vaccine.

Having a majority of care workers vaccinated reduces the risk further of residents catching the illness. However, because the vaccine isn’t 100% effective, we cannot say that there is a like for like situation where someone vaccinated will not pass on the virus whilst someone unvaccinated will.  Now, in general, my argument to people for them taking the vaccine is that you cant sit back and say “it’s okay because everyone else will take it.” We need as many shots in the arm as possible and it’s worth considering what would happen if everyone took the same attitude. At the same time, it means that the issue in a Care Home is not whether an individual worker has been vaccinated but rather whether a significant majority of workers have in order to reduce risk.

Now, the risk will also vary dependent upon the prevalence of COVID19 in the wider population. At the moment it is still on the high side and that increases risk of transmission. It’s probably wise then for care contexts to take additional pre-cautions to further reduce risk of transmission.  In my opinion, it is wise to continue to ask care-workers either in homes or visiting in the community to take regular Lateral Flow Tests and to comply rigorously with contact tracing, whether or not they have been vaccinated.  This coupled is probably the best short term defence against the virus in care contexts. The best protection over the longer term will be the transition from epidemic to endemic.  I suspect that the risk in these contexts will remain higher longer than in the wider populace.

In summary

  • The crucial issue is whether we have taken all reasonable steps to reduce risk in the care-sector
  • We cannot give a 100% guarantee that there is no risk from COVID
  • The best way to respond to vaccine hesitancy is to listen to and respond to concerns.

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