Vaccination against COVID-19 – should it be compulsory for homecare workers?

Authors: Colin Angel (Policy Director) and Jane Townson (CEO)

News reporting on 23 March 2021 revealed that government is considering introduction of compulsory vaccination against coronavirus for some, or all, members of the social care workforce.

Such a move would require careful thought.

Views among both members of the workforce and employers range from strong support to strong opposition.

United Kingdom Homecare Association (UKHCA) strongly supports vaccination of the homecare workforce against coronavirus.

Vaccination is a major part of ensuring the safety of members of the social care workforce and older and disabled people whose care and support needs are met at home.

How many homecare workers have already been vaccinated?

Data reported via Capacity Tracker to the Department of Health and Social Care (DHSC) indicate that, since the homecare workforce became eligible for vaccination, over 67 per cent of homecare workers (in England) have already acted on the invitation to receive their first dose of the vaccine on a voluntary basis.

This represents over 450,000 of the 656,000 workers in homecare and is nearly double the number reported in a UKHCA survey on homecare worker vaccination at the beginning of February 2021.

We note that a proportion of the homecare workforce is temporarily unable to have the first dose of the vaccine because they have had symptoms of coronavirus or a positive test result for coronavirus within the previous four weeks.

Vaccination of homecare workforce assisted by the National Booking Service

Excellent progress with vaccination was achieved when a decision was made to open the National Booking Service to social care workers; this made it much easier for homecare workers to access vaccination. Careworkers who had earlier expressed reservations regarding vaccination were able to book quickly and effectively, which assisted take-up.

Prior to this, access to vaccination was variable due to different approaches by local authorities in England. Live-in careworkers and homecare workers in some regions, particularly those serving the self-funded part of the market, struggled to book their first vaccination.

UKHCA is concerned about the potential impact of closure of the National Booking Service on social careworkers. This decision will almost certainly result in lower uptake of vaccination among some groups of careworkers, simply because they are unable to access vaccination appointments easily, or at all.

We urge NHS England and the Department of Health and Social Care to re-open the National Booking Service for social careworkers.

Vaccine hesitancy in the homecare workforce

Some members of our workforce are currently reluctant to have a coronavirus vaccination for a variety of personal reasons, in line with those reported elsewhere. We would like to thank employers who are having detailed conversations with members of the workforce about their individual concerns.

The Department of Health and Social Care has collated some useful resources for employers and careworkers to help address concerns related to vaccination.

In some areas, local public health teams have worked effectively with providers and their staff, running webinars to answer questions and concerns.

No data have been collected to date on the proportion of the homecare workforce who are likely to decline a vaccination, but employers have suggested that it may currently be around ten per cent. This is consistent with recent data from the Office for National Statistics, which described “vaccination hesitancy” among the general population at nine per cent.

This figure is likely to reduce as people reassess their reasons for being hesitant and see an increasing proportion of their colleagues receiving their vaccination without harm.

Views of homecare providers on compulsory vaccination against COVID-19

Preliminary conversations with some homecare providers in March 2021 suggested a degree of qualified support for a legal requirement for workers to be vaccinated against coronavirus in the future, particularly if current voluntary arrangements are less effective than we hope they will be.

UKHCA conducted a more comprehensive survey of UKHCA’s members between 23-26 March 2021.

Responses were received from 579 members, representing over 25 per cent of UKHCA’s nearly 2300 members.

Results are shown in the graph below:

70 per cent of employers responding to the survey stated that they support or strongly support some form of legal requirement for vaccination of the homecare workforce.

The most common reasons given for supporting compulsory vaccination were:

  1. Protection of recipients of homecare, including users’ expectations (by far the most frequent points raised).
  2. Protection of members of the workforce.
  3. Reduction of community transmission of the virus.

Of the remaining 30 per cent of respondents, 7 per cent are unsure; 11 per cent oppose; and 13 per cent strongly oppose compulsory vaccination.

Of the 23 per cent of respondents who oppose or strongly oppose compulsory vaccination, the most common reasons given were:

  1. Infringement of workers’ rights or choice.
  2. Workers’ reluctance to be vaccinated, anticipated side effects, etc.
  3. Negative impact on recruitment.

UKHCA’s position on compulsory vaccination

Given UKHCA’s strong support for vaccination of the homecare workforce, we have worked tirelessly to ensure easy access to vaccination for careworkers.

Publications from the World Health Organisation highlight that vaccine hesitancy is complex and context specific. It varies across time, place and vaccines, and is influenced by factors such as complacency, convenience and confidence.

As we are only two to three months into the COVID-19 vaccination programme for homecare workers, our preference for now is to continue to encourage voluntary uptake of vaccination.

Ensuring easy access to vaccination is key and we call on government and the NHS to re-open the National Booking Service for careworkers.

Addressing concerns of careworkers regarding vaccination is also important and we value the online resources available to assist with this.

Public health experts recommend that:

culturally sensitive and tailored risk communication and messaging, co-involving faith and influential community leaders, are required to continuously inform, update, and reassure the public.”

These principles apply equally to careworkers.

In many cases, the kind and patient approach adopted by employers, GPs, nurses and pharmacists when talking directly to those who have concerns, has been instrumental in influencing individuals to accept vaccination. We are grateful to them all and encourage continuation of this approach.

If, however, it proves difficult to achieve close to complete voluntary take-up of vaccination of the homecare workforce over time, our research indicates that a majority of our members would support a requirement for vaccination as a condition of employment in homecare in future.

Internationally, some jurisdictions have policies that require vaccination as a precondition for access to resources or activities tied to school or work or, in some cases, even travel or residency.

Australia, for example, requires parents to have their children fully vaccinated or to have obtained an approved exemption (medical or otherwise). Other countries, such as Slovenia, have highly comprehensive programmes, including requiring vaccination against nine diseases; people can submit medical-exemption requests to a committee.

The United States requires immigrants to have 14 vaccines but requires no vaccines of travellers and temporary visitors. Most U.S. universities require vaccination in some form and limit exemptions.

Some countries require a certificate to evidence vaccination against yellow fever before allowing entry.

Hospitals in various countries may require workers to receive certain vaccines as a condition of employment. Evidence from observational studies suggests that a vaccine mandate increases vaccination rates against influenza among healthcare personnel.

We understand that mandatory vaccination in social care is a controversial and polarising topic that must be handled sensitively, balancing the rights of people receiving care with those giving care.

There is no suggestion that people should be forced to have a vaccination against their will. Rather, people would have a choice about whether or not they work in a sector in future where vaccination could become a requirement. There is of course a risk that this could further exacerbate challenges of recruitment and retention in the care sector.

Finally, we want to express again our warmest thanks to all those who have led and assisted with the roll-out of the UK COVID-19 vaccination programme to the point we have already reached. It is a fantastic national achievement of which we can all be proud.