Compulsory vaccination for NHS staff back on the agenda?

Despite emerging short-term and unknown longer-term side effects

A number of professional bodies — such as the Royal College of General Practitioners and the Royal College of Nursing — have already rejected the notion that COVID-19 vaccination for staff should be compulsory. Nevertheless, the government signalled its intention to consider mandating vaccination for NHS staff.

Contrary to all prior norms, and riding roughshod over any semblance of informed consent, this is a surprising position to take for unapproved products still under Emergency Use Authorisation; moreover, scientifically, it is nonsensical for a number of reasons, including:

Firstly, there is no convincing evidence that Covid vaccines reduce transmission (as reflected in government-mandated isolation policies and travel requirements). The manufacturers have never made such claims and the original trials were not designed to measure transmission. None of the “real-world evidence” papers emerging recently correct for declining natural prevalence or testing differences between vaccinated and unvaccinated subjects; see here, for example, a critique of the Lancet paper on the Israel study.

Secondly, all vulnerable groups have now been offered vaccination which, the government tells us, is highly effective, thus eliminating any concerns about who else may or may not have been vaccinated, even if the above is incorrect.

Thirdly, there is no real evidence that asymptomatic transmission plays a significant part in the pandemic, as stated both by the CDC and the WHO in 2020, and specifically by Dr Fauci in this email (see page 3074). No evidence suggesting otherwise has emerged, and from this major meta-analysis of more than 77k subjects in 54 studies the contrary appears to be the case, with symptomatic cases having a secondary attack rate of 18% vs 0.7% for asymptomatic (including presymptomatic) cases; hence symptomatic staff merely staying off work — as would be the usual expectation — should be sufficient.

Fourthly, there is evidence that — as with other viral exposure — immunity acquired by infection, is durable and robust; it is also flexible enough to deal with variants, as shown by a deep analysis of this study; hence exposing any individual previously infected to the (now rapidly emerging) risks of vaccination is perverted logic.

Fifthly, it is highly likely that the vast majority of frontline health care workers will have been repeatedly exposed to the virus already, and it is logical to assume that at this point nearly all will have had prior immunity, asymptomatic exposure leading to immunity, or symptomatic COVID-19 also leading to immunity.

Sixthly, the COVID-19 risks for the majority of staff will be extremely low; for example, the risk of being hospitalised over a 90 day period during the peak of the pandemic (for a 30 year old female of average height and weight) was in the region of 1 in 5,000, and the risk of dying was 1 in 250,000; it will be much lower still now, due to substantial community immunity and better treatment options.  Given this, it seems difficult to justify rushing to expose any non-vulnerable individuals including NHS staff (who are best placed to make personal decisions which balance risk / benefit with a view to protecting their patients) to the (emerging) short-term safety concerns such as clotting, myocarditis and Guillain-Barré syndrome, and potentially unknown longer-term side effects; it should be emphasised that there is only 6 months of data available, and much of the usual data (for example biodistribution) is as yet unavailable.

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