The decision to force NHS staff in England to get vaccinated against Covid-19 was always going to generate controversy, but it was also understandable. Sajid Javid’s professed motivation – to protect patients from unjabbed frontline personnel – was sincere, especially given the many thousands of people who have died after becoming infected while in hospital. The health secretary argued his case publicly and passionately, seeking to convert the many sceptics.
But it was also a policy that was flawed from the start and which then encountered many obstacles along the way before meeting an increasingly inevitable demise. It will be little mourned.
For good policymaking to work, it needs the change being ushered in to have the backing of both those who will implement it and those affected by it, or at least a grudging willingness to go along with it. But while 58% of hospital bosses supported compulsion, 32% did not. The same survey by NHS Providers of 172 chiefs in 114 health service trusts did find near-unanimity on one question, though: 94% agreed that it would exacerbate already-widespread understaffing.
More importantly, there was always going to be a hardcore of NHS staff who for whatever reason simply refused to set aside their own opposition to being vaccinated, even at the cost of losing their jobs. The 73,000 estimated to be in that position by the government’s own impact assessment was a big number, even in a workforce of 1.4 million people, and especially given that the health service has been hobbled for several years by almost 100,000 vacancies. The 40,000 care home staff who have quit since vaccination was made compulsory in that sector was a reminder of real-world consequences.
Concerns about the policy took a while to emerge but then piled up quickly. Medical royal colleges representing nurses, midwives, GPs and obstetricians and gynaecologists voiced anxiety about the potential loss of staff in their areas of care; the Royal College of Nursing called the policy “self-sabotage”. An intensive care doctor challenged Javid about the edict with Sky News cameras rolling and other staff began legal action to try to overturn it.
And, crucially, as the Guardian recently revealed, civil servants at his own department told Javid privately that fast-waning immunity from having two Covid jabs – NHS staff were not told they had to have a booster too – meant the policy was no longer “rational” or “proportional”.
Confirming the late, late U-turn to MPs on Monday evening, Javid insisted that mandatory vaccination was the “right policy at the right time”, given it was conceived last year, when Delta was the dominant variant of coronavirus. However, high take-up of Covid boosters and fact that the recent Omicron strain is much less severe meant “it is only right but responsible that we revisit the balance of risks and opportunities that guided our original decision last year.” As a result, he said, “I believe it is no longer proportionate to require vaccination as a condition of deployment in health and all social care settings.”
Javid’s backtracking will help hospitals maintain normal care. But it will also come at a price. A senior executive in a trust where 15% of staff were vaccine refuseniks said: “Undoubtedly it will help protect services by avoiding a significant loss of unjabbed staff. But there’s a balance between having staff in post to care for patients and having unjabbed staff in post treating vulnerable patients who are mostly frail, elderly and with compromised health.”
The vaccination drive for the population as a whole that Boris Johnson trumpets as one of his key successes could also become another unintended casualty. As another senior NHS executive said: “It potentially undermines the public messaging around the importance of people getting vaccinated. There are still lots of people who haven’t been jabbed at all or who haven’t had their booster. This change will only make our efforts to get the final few million vaccinated harder.”
