Advice on clinicians refusing Covid-19 vaccination

THE recent decision by government to abandon the proposed requirement making Covid-19 vaccination a condition of deployment of healthcare workers in England will come as a relief to some healthcare staff and planners.

However, a recent joint statement on the decision by the General Medical Council (GMC) and the Academy of Medical Royal Colleges confirms that doctors still have a “professional duty to protect patients from risks posed by their health, and to be immunised against common serious communicable diseases, unless contraindicated” – although the GMC added that it “does not consider that solely turning down vaccination would in itself form the basis of a fitness to practise referral”.

Ian Brack, chief executive and registrar of the General Dental Council (GDC) also commented on the decision: “This does not change our COVID-19 vaccination guidance for dental professionals, in which we continue to encourage everyone in all settings in all four nations of the UK who can be vaccinated to be vaccinated. This is in keeping with our standards, designed to protect dental professionals, their patients, and everyone in the dental team. Our primary purpose is to protect patient safety and maintain public confidence in dental services, and our vaccination guidance is in support of this.”

MDDUS experience

Over the course of the pandemic MDDUS has advised members of potential medico-legal and regulatory risks on a range of scenarios around Covid-19 vaccination. These include clinical leads/managers with concerns over their responsibilities to mitigate risk to patients when a colleague declines the vaccine, and individual members who have declined Covid-19 vaccination for a variety of different reasons.

In the majority of settings, a risk management approach has been adopted, with those unable to receive or refusing the vaccine required to participate in an assessment, balancing specific risks to themselves, colleagues and patients, in turn leading to necessary changes in roles to preserve safety.

Dealing with vaccination refusal

MDDUS advises that clinical leads should be prepared to have a one-to-one with a clinician refusing a vaccine in order to understand the reasons behind refusal and whether further reassurance or information could be provided to alter that decision. NHS England has found that uptake has been shown to improve by 60-70 per cent following such discussions. “Reasonable” justification for refusing a vaccine might include:

• vaccine is contraindicated for them
• wish to assert the right to bodily autonomy
• religious beliefs that prohibit the consumption of an element of the vaccine, which may amount to a protected characteristic under the Equality Act.

A documented and thorough risk assessment is necessary in any of these cases, with the outcome determined by the clinician’s role and the prevailing work environment.

Refusing vaccination, without a “reasonable” justification, could in some cases leave a clinician vulnerable to having their role redefined after risk assessment and/or their employing organisation giving serious consideration as to whether this constitutes a conduct issue.

NHS England has published guidance for HR directors on how to support Covid-19 vaccine uptake in frontline staff and this may also be instructive for other employers, by way of a general approach to having sensitive conversations with hesitant or reluctant staff.

Action points

• Consider ongoing potential risks to patients in your area of work from healthcare staff working without Covid-19 vaccination.
• Healthcare professionals refusing vaccination should participate fully in any risk assessments and adopt reasonable mitigating controls deemed necessary for patient safety.

Liz Price, senior risk adviser, MDDUS