Intended for healthcare professionals

Rapid response to:


Covid-19 vaccination should be mandatory for healthcare workers

BMJ 2021; 375 doi: (Published 02 November 2021) Cite this as: BMJ 2021;375:n2670

Rapid Response:

Re: Covid-19 vaccination should be mandatory for healthcare workers

Dear Editor

Daniel Sokol's arguments for mandatory Covid-19 vaccination for healthcare workers fails to take into account a whole host of relevant issues. Dr Sokol makes no mention of pre-existing and acquired immunity to Covid-19, which we understand to be potentially broad and long-lasting. He does not quantify the alleged absolute reduction of risk to patients of contracting SARS COV-2 from vaccinated healthcare staff in comparison to those who have not had the Covid-19 vaccination. There is no mention of the development of treatments or improvements in outcomes over the past 18 months for patients who develop Covid-19, which places Covid-19 vaccinations as one of an array of responses.

In praising the increased uptake in vaccination in France among healthcare staff who otherwise faced losing their job, Dr Sokol's article doesn't include a question of what it is like for both patients and staff to have clinicians who (one assumes) have accepted a medical intervention that they did not want. What might the consequences be to the respect for patients' bodily autonomy, if the clinician has felt pressured into an action experienced by them as an undermining of their own bodily autonomy?

Dr Sokol tells us there's no time to wait and see. Like so many, he expounds an approach that may be described as fight-flight. There's little real-life evidence across the world that, in November 2021, or indeed projecting into April 2022, fight-flight is a wise approach to take in response to Covid-19, given that SARS COV-2 is now in wide circulation, among both vaccinated and unvaccinated people.

Dr Sokol does not ask himself what the loss of healthcare staff who have not so far accepted the Covid-19 vaccination might be on healthcare delivery and on the systems they're a part of. This cohort of clinicians is more likely to question the status-quo, not just in relation to the purported benefits of the Covid-19 vaccination, but also in other areas of practice. Dissenting and questioning voices are essential to the healthy functioning of any organisation. These members of staff often act as advocates for patient care by making proposals for change or raising alarms that may ultimately prove to be of significant benefit to all. To remove these clinicians from our organisations may lead to a disastrous impoverishment.

Overall, it's my impression that, in his article, Dr Sokol takes a reductionist approach, as so many have been doing over the past 18 months, where Covid-19 and data in relation to it have dominated almost all aspects of healthcare, with little room for the acceptance of complexity and the proposal of more nuanced responses.

A single-minded approach to medicine (and indeed to ethics) can quickly turn it into a coercive and cruel practice. It attacks professional and personal relationships which are so needed to help us all accept aspects of the complex reality of health, illness and society.

Yours sincerely

Dr Matteo Pizzo

Competing interests: No competing interests

14 November 2021
Matteo Pizzo
Consultant Psychiatrist, Specialist in Medical Psychotherapy