One of the abiding memories of the early days of the pandemic was care homes ravaged by coronavirus. A year on, the government has launched a consultation that could lead to staff in facilities for older people in England being required to have a Covid-19 vaccine in a bid to protect vulnerable residents.
This would have been a last resort for ministers. It is uncomfortable to mandate any form of healthcare, and more so when you consider it’s disproportionately people of colour and those from deprived backgrounds who are hesitant about the jab. Yet several months on since the vaccine rollout started, evidence shows outreach to reluctant carers isn’t getting through: staff vaccination rates are still below 70% in 27 different local authorities in England despite care workers being in the highest priority category for the jabs. Only about half of care homes have enough people vaccinated to provide minimum protection against the virus. That’s the equivalent of 150,000 older people who are currently unsafe.
It has been striking, then, to see the ease in which the proposal is being dismissed in some quarters. Unison, the UK’s largest union for public service workers, described the idea of compulsory vaccines as “sinister” and a form of “bullying”. Boris Johnson’s spokesperson previously called the proposed move “discriminatory”. Meanwhile, the GMB union has warned compulsory vaccines will impose “unnecessary anxiety” on care staff.
We are hearing much less about the “sinister” sight of elderly people being exposed to potentially infected care workers. Similarly, we have heard little about the “anxiety” residents would suffer if carers were left unvaccinated, be it the grandmother living in fear each day, not knowing if her carer is infectious, or the 80-year-old with dementia, hospitalised with coronavirus, pulling his oxygen mask off in distress because he doesn’t understand what’s happening.
Care workers – who have sacrificed so much during the pandemic – deserve to have their concerns listened to, and unions have a duty to protect them, particularly those who can’t be immunised for medical reasons. Employers and the government must take all practical steps to help already pressured and underpaid care workers take up the jab voluntarily, including paid time off for any side-effects. But compulsory vaccinations are surely a valid last resort to protect clinically vulnerable people. Allowing staff to walk into a care home unvaccinated in the middle of a pandemic is, by any definition, a form of neglect.
It is telling that this debate is being centred on the right of care staff to refuse a vaccine and not the right of older people to live. Culturally, we perceive people in care homes as passive recipients of treatment rather than autonomous adults with rights, just as we routinely see the lives of older and disabled people as holding less value. The same prejudices that saw some older and disabled people wrongly given “do not resuscitate” orders at the start of the pandemic now sees them as collateral damage to care staff’s “rights” and “choices”.
Many of the arguments defending unvaccinated care staff are, in fact, deeply flawed. For example, it’s often said that it’s unnecessary to vaccinate staff if all residents have the jab. But elderly people are most likely to produce a weak immune response to the jab, meaning staff being inoculated as well as residents offers easy and vital added protection. A new study shows a single dose of a coronavirus vaccine can reduce transmission of the virus by up to half. Besides, carers v residents is a false binary; staff with asthma or low immunity will want to know their colleagues are vaccinated too.
There are warnings that compulsory Covid jabs would “threaten standards of care” in an already strained sector by hindering recruitment. But this has the issue backwards. Letting underpaid and overworked carers avoid vaccinations will not improve staff numbers – better working conditions and higher pay will.
Compulsory jabs have also repeatedly been called “unprecedented” but this doesn’t provide the full picture. Some leading care providers have already issued their own “no jab, no job” policy. While there are no existing mandatory vaccines for staff in the UK, some healthcare workers are contractually obliged to get the hepatitis B jab and other vaccines, particularly if they work in high-risk settings. There is no inalienable right to every job; if you want to work with vulnerable people, you must accept the duty of care that comes with it.
Rather than resisting mandating vaccines for care workers, we should be asking why the move won’t be applied to other workers in the sector. The government is only considering compulsory jabs for staff in care homes for older people, meaning younger disabled people would not be protected. This is despite the fact people with a learning disability in England are dying from Covid at six times the rate of the general population. Compulsory vaccines would also only apply to care workers and not health sector staff; nearly 15% of NHS workers in England remain unvaccinated, and the numbers coming forward for a jab have decreased sharply in recent weeks.
These are not easy conversations to have, but this difficulty is no justification to turn away. Almost 29,000 people in care homes in England have lost their lives due to Covid – each of them human beings with names, sons and daughters and grandchildren. The existence of safe, accessible vaccines means ministers have every chance to avoid such horrors from repeating themselves. It is not an exaggeration to say lives depend on it.
This content first appear on the guardian