It’s not only the UK’s public sector that is mulling compulsory jabs. Often the carrot can be more powerful than the stick
Last week we learned of a government consultation expected to announce mandatory Covid-19 vaccinations for care home staff, and possibly NHS staff too. This sparked debate as to the ethics and legality of such a move, not to mention the strain it could put on an already beleaguered workforce. A number of stakeholders opposed the move, from NHS providers to the British Medical Association. But it is not just the healthcare sector that is weighing up such considerations: a recent survey in the US and UK found that 9 in 10 employers will encourage or require vaccination and 60% plan to make them mandatory.
Countries like the UK and the US have libertarian roots and value individual freedom. Those against mandatory vaccinations are not necessarily anti-vaxx or even unvaccinated. Rather, some are legitimately concerned about the mission creep of government and employers infringing into personal lives. But where do we draw the line between individual freedom of beliefs and the rights of others? You can choose not to wear a seatbelt and if you crash, you might die. But being unvaccinated and returning to a crowded workplace not only means you are driving without a seatbelt, but it removes the seatbelt of those around you. It exposes that 12-year-old who hasn’t been offered the vaccine, the young waiter who hasn’t had her second jab yet and the delivery driver who cannot be vaccinated for medical reasons.
There are precedents for mandatory vaccination programmes. New medical staff carrying out certain procedures are required to prove they are non-infectious for hepatitis B, C and HIV and are offered a hepatitis B vaccination. The US and Australia have long mandated vaccination for entry into school to increase and sustain vaccination rates. In 2016, six months after the Australian government brought in the “no jab, no pay” policy (no vaccination, no family tax benefits), there were record highs of vaccination of young children in previously hard-to-vaccinate groups. But financial disincentives are not always effective since many objectors have relatively high socioeconomic resources.
When France and Italy faced a measles outbreak, they made childhood vaccinations mandatory in 2017-18, although the Italian mandate was later repealed. A recent study found that mandatory vaccine policies for preventable diseases such as measles increased uptake and lowered measles incidence. In countries with no option for non-medical vaccination exemption (for example no ethical anti-vaccination clause), the incidence of measles was significantly lower.
Another consideration before implementing any kind of mandatory programme here in the UK would be the extent of the problem the solution is trying to address: we don’t want to use a metaphorical sledgehammer to crack a walnut. A recent study found that the UK has the highest vaccine confidence internationally at almost 90%. In a Royal Society report, we mapped seasonal flu vaccine uptake among healthcare workers in England in 2019-20. Around 75-80% of frontline workers, doctors, nurses, clinical and support staff were vaccinated, but in some smaller trusts, levels were only 40% even among doctors, and lower still among support staff.
These are all considerations that apply as much to the private sector as to the public. Goldman Sachs told US workers they must disclose their vaccination status to their managers. The publisher Bloomsbury will make vaccines compulsory for UK staff. As those able to work from home begin to contemplate their return to the office, it may prove unfeasible for private sector companies to demand mandatory vaccinations for employees.
Although many US companies are enacting these rules, according to English law, telling a member of staff they may be dismissed if they are not vaccinated could constitute unfair dismissal. An employer needs to provide a good reason for dismissal and it seems unclear whether vaccination constitutes a good enough reason. At the same time, employers must abide by health and safety requirements. If a workspace is cramped, with employees in close proximity to others, or unventilated, could vaccination be an effective safety measure to ensure the protection of those employees? These are opposing considerations employers must address.
Employers could also face a discrimination claim. Some workers might have legitimate medical grounds such as an allergy preventing them from being vaccinated. Employers have the duty of reasonable accommodation to protect that person. There are also younger age groups patiently waiting to get their first or second jab. Given that young employees populate some sectors, such as hospitality, this is not a trivial point.
Perhaps the thorniest issue of all is that discrimination claims can be made not only on medical grounds, but also on philosophical beliefs. An employment tribunal recently made the ruling that veganism is a philosophical belief protected under the Equality Act of 2010. Could anti-vaxxism be a protected philosophical belief? For a belief to be protected, it has to jump through a series of hoops such as being worthy of respect in a democratic society, compatibility with human dignity, but crucially – not be in conflict with the fundamental rights of others. Legal experts need to mull over whether anti-vaxxism could in some circumstances be a protected philosophical belief like veganism if someone is not hired or dismissed because of their vaccination status – or whether it conflicts with the fundamental rights of others and public health.
Even if it is possible and it works, should employers make vaccination mandatory? Or is a carrot more effective than a stick? Instead of always bringing out the stick, it might be more effective to cultivate carrot policies. Remember that we struggle to assess our own risk, from overestimating our risk of a blood clot to keenly buying lottery tickets. Experiments in the US found that giving someone a date, time, convenient location and saying “this vaccine is personally reserved for you” has improved results in terms of vaccinate uptake. Building carrot policies and incentives to help workers understand why vaccination protects might be more effective than the mandatory stick, while we cannot forget that the central crux of the vaccination conundrum is this: protecting the fundamental right of one might endanger the wellbeing of another.
- Professor Melinda Mills is director of the Leverhulme Centre for Demographic Science, University of Oxford & Nuffield College and a member of SPI-B, the behavioural science subgroup of Sage
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