Is there a precedent for mandatory vaccines for care home workers?

On Monday the Telegraph reported that care home workers would be required “by law” to have the Covid-19 vaccination in “a historic legal change” that had been requested by the Prime Minister and health secretary Matt Hancock.

Mr Hancock has since claimed that although no decision had been made yet, current requirements for doctors to have the Hepatitis B vaccine sets a “clear precedent” for potentially changing the law in this way. 

This claim could do with some context. Although some frontline healthcare workers are required to have the Hepatitis B vaccine, this is not law but rather hospital trusts enacting workplace health and safety and occupational health policies.

In an interview with BBC Breakfast on Tuesday morning, Mr Hancock confirmed the government is considering making Covid-19 vaccinations mandatory for care home staff.

“Those who look after people in care homes have a duty of care towards them, and not every resident in an elderly care home can be vaccinated,” he said. 

He added: “It’s already the case in the health service that vaccines are required in certain circumstances. Doctors are required, for instance, to take the Hepatitis B vaccine, and we know [the Covid-19 vaccine] is both safe and effective.

“Some care homes have asked for us to change the law so they can require their care home staff to be vaccinated because of this duty of care.” 

In another interview that day with Radio 4’s Today programme, Mr Hancock said: “That sort of approach is already in place for doctors, they have to have the Hepatitis B vaccine, and so there is already a clear precedent.”

What rules do doctors have to follow?

The General Medical Council (GMC), in its official guidance, advises doctors to be vaccinated against Hepatitis B, alongside a range of other serious communicable diseases. 

A spokesperson for the GMC told Full Fact: “Our guidance, Good Medical Practice, is clear that doctors should be immunised against common serious communicable diseases unless medically contraindicated.

“If there are good reasons why vaccination is not appropriate in individual cases, we’d expect strong measures in place to minimise risk and protect vulnerable patients.”

Chapter 12 of the Public Health England Green Book, which provides the latest information on vaccines and vaccinations, states: “Hepatitis B vaccination is recommended for healthcare workers who may have direct contact with patients’ blood or blood-stained body fluids.” 

Staff immunisation policies where Hepatitis B is mentioned can be found online, explaining how staff undertaking exposure prone procedures (EPPs), where injury to the worker may result in the patient’s open tissue to be exposed to the blood of the worker, should have had vaccinations against communicable diseases.

This policy put together by the Southern Health NHS Foundation Trust, for example, states: “All staff who carry out Exposure Prone Procedures must be vaccinated and proven to be immune to Hepatitis B before commencing EPP. 

“Offers of employment will not be given for roles which include EPP unless immunity to hepatitis B can be demonstrated as well as evidence that the staff member is not infectious with hepatitis C or HIV. 

“Staff already employed by Southern Health must refrain from EPP unless they can demonstrate immunity to hepatitis B (HBV) and that they are not infectious with hepatitis C (HCV) or HIV.” 

But there’s no specific law laying this out for healthcare workers. 

Full Fact asked the Department of Health and Social Care (DHSC) if the Hepatitis B vaccine for certain healthcare workers is a legal requirement.

The department quoted Chapter 12 of the Green Book and explained that whether or not the Hepatitis B vaccine is compulsory falls to individual employers through their occupational health service. 

Can this really set a precedent for a mandatory vaccine for care home workers? 

Full Fact spoke to University of York law lecturer Dr Isra Black, who specialises in healthcare law. Describing the rules in place for healthcare workers to have the Hepatitis B vaccine, he said: “These policies exist and they may well be lawful but that’s not the same thing as it being a precedent for legally requiring people to have a vaccine. 

“The practice [Hepatitis B vaccine requirements] exists and may be in accordance with the law for EPPs but it is not an explicit legal requirement. 

“Whereas what Matt Hancock seems to be saying is we could require people as a matter of law to have vaccination because we already have this practice, and I’m not convinced that there’s enough legal similarity or basis to make that claim.” 

There are no laws that currently require people to be vaccinated, against any disease, as we have written before.