Do doctors have to have the covid-19 vaccine?

Dear Editor,

We face a public health crisis. This is a crisis sparked by a virus, but increasingly now of our own making. Despite lack of correlation between lockdowns with COVID-19 mortality outcomes, we continue to acquiesce to, if not support, these measures that are reducing access to essential care, cancer diagnosis, cardiovascular screening, and the ability to earn a living that is closely linked to long-term health outcomes. The crisis we face is primarily one of truth, it arises from a failure to follow evidence-based practice in public health.

COVID-19, while high risk to the elderly with co-morbidities and obesity, is rarely severe or life-threatening in healthy people under 65, very rarely so in young adults and children, less so than influenza. Once infected, a person develops broad immunity through B-cell and T-cell activation that is demonstrated to be prolonged and effective. It is almost certainly more effective than vaccine-induced immunity that, though useful, is directed at the spike protein alone. Vaccine-induced immunity, however, is shown to be protective to the person vaccinated, stopping over 85% of symptomatic cases once immunity is established. These are facts, the type we would normally rely on as a basis for policy.

Public trust is built by evidence-based policy, not by moving goalposts and changing opinion. On the above criteria, it would be illogical to insist on vaccination of (1) young adults and children, (2) anyone already having had COVID-19, (3) anyone at all once the most vulnerable people have been offered protection. As the vaccines are currently regulated as experimental treatments, it is also highly questionable whether any form of coercion, rather than free and informed consent, complies with the basics of medical ethics derived from the Helsinki Declaration and Nuremberg codes.

On this basis, the question perhaps we should be asking, as a medical and public health community, is how we ever came to be even considering such issues in the first place.

Sincerely,

David Bell. MBBS, PhD, FAFPHM, FRCP.

Dear Editor

I read with interest the views of the experts. I agree with Rob Henry and the quoted sections of the GMC’s Good Medical Practice, which are pretty unambiguous in stating that we should be vaccinated against common communicable diseases. As a profession, we have long accepted mandatory screening, testing, prophylaxis and treatment for other infectious diseases. All doctors in the UK are required to provide an immunisation record (including BCG, MMR and Hepatitis B vaccinations) as part of occupational health screening. There is clear guidance that failure to produce this evidence and/or vaccine refusal results in further investigation and restrictions being placed on a doctor’s practice. This principle may be extended to medical interventions other than vaccination; a doctor who is HIV seropositive must consent to blood tests to check their viral load. It is mandatory that these individuals are on effective combination antiretroviral therapy. Failure to meet these requirements results in restrictions being placed on the doctor’s practice.

While Covid-19 differs from the aforementioned infections, the fundamental principle remains that this is a highly communicable disease and there is a risk that an infected healthcare worker might transmit the infection to vulnerable patients who may then come to significant harm. There is increasing evidence that the available vaccines reduce person-to-person transmission as well as protecting the vaccinated individual. Are those health professionals who are refusing this fairly low risk, low-burden intervention, failing our patients? Some invoke their rights and freedom to choose but this fails to appreciate that a rights-based ethical theory must still strike a balance between the interests of the individual and the wider public interest. Furthermore, our professional rights come with responsibilities too; when we entered the profession, we made an informed choice that we would follow a code of conduct that includes protecting the vulnerable.

This discussion does though raise challenging questions around how personal choices may influence overall trust in the profession. It also explores the issues of probity and liability – is there a duty to disclose vaccination status to our regulators, employers and patients? The answers to these questions will have a significant impact on the future doctor-patient relationship and the debate will likely outlast the pandemic.

Dear Editor

Alot of wild accusations and hyperbole about vaccinations in these comments.

Dear Editor,

The outcry in Italy about compulsory COVID-19 vaccination for physicians and practitioners, should not have any sound context, as a vaccine works as a shield to prevent sickness going ahead, not against the ability to spread virus outside with one’s own breath. Therefore, it is particularly strange stressing the issue of “vaccine duty” as a gun to protect patients if following vaccination a physician can still infect anyone.

The oddity is a cultural matter, yet: it is awkward if a physician does not believe in the vaccine, its safety and usefulness. Therefore, physicians must be clearer and clearer in their clumsy outcry. Vaccination does not protect patients from viral spreading but protects hospitals from being hugely crowded. Therefore, as we were locked down and underwent freedom restrictions because of hospital crowding, this “niet” from physicians is guilty, as we accepted to stay home, dismissed affective relationships with siblings and friends and wearing a mask all the day to make hospital and healthcare units relaxed from crowding. A silly attitude is polluting minds and is widespread in our highly technological and modern world, a behavior that recalls a teenager’s way of thinking, more than a wise look at our present.