Why Mandating Vaccines is Wrong for Midwives and Everyone

by | 31 Jan, 2022 | Blog | 0 comments

Vaccine mandate demonstration

Do vaccine mandates breach the NMC Code?

Saturday 22nd January 2022 saw large demonstrations of NHS staff and supporters, including midwives, through London and many towns and cities throughout Britain. Demonstrators were demanding the scrapping of vaccine mandates. Hundreds of people placed or threw their uniforms on the ground as part of the protest.

The legislation bringing in vaccine mandates was snuck in amongst a host of other Covid measures in mid-December, and there wasn’t a debate in either the House of Commons or the Lords about this before the law was passed. The proposed mandate law will commence on 1st April 2022, which means workers have been told they must have their first dose by 3rd February or be sacked (or lose their place on a university course). The 3rd February is not when the law changes, but this is the latest that someone could have two doses by 1st April. But at the time of writing, there is speculation in the national press that the mandate will be kicked into the long grass, partly because it is becoming crystal clear that NHS services will collapse if the law is strictly implemented, and partly because there are several legal challenges ongoing. One such challenge has been launched by Dr Steve James and seven other health professionals, with the support of campaign groups the Together Declaration and NHS 100K, and I’ve heard there are quite a few other groups instigating legal proceedings against the government, individual Trusts and Universities.
no vaccines, no mandates
Midwives have apparently been one of the groups most resistant to taking up the ‘offer’ of Covid vaccines, with rumours that as many as 40 percent of midwives in some London maternity units have not accepted vaccination. I believe this is because midwives are very used to analysing research evidence and applying this to individual circumstances, weighing up risks and benefits. So it is hardly surprising that midwives have made decisions that they feel are right for them and their clients, whether that is to receive a vaccination or to decline. Many midwives have not been persuaded by Sajid Javid that “it is critical to patient safety that health and care staff get the jab to protect some of the most vulnerable people who are in their care and keep the NHS workforce strong in the wake of Omicron.” We know that two doses at best provides limited protection for Omicron and even with a booster, immunity wears off within a few weeks. We also know that every new variant will mean more jabs. As Steve James, Consultant in Critical Care, points out in a recent Spectator article (James, 2022), there is increasing evidence that there is little difference in viral load (and therefore limited difference in infectiousness) between vaccinated and unvaccinated individuals. This level of scientific uncertainty, and the ever-changing scenarios, mean it is extraordinary to even consider removing the freedom of choice of NHS staff to decline or accept medical treatment.
Steve James

Steve James talking to Erika Thompson, midwife and ARM member

Erika Thompson, midwife and ARM member

Kathryn Weymouth, midwife and ARM member

vaccine mandate demo
Thousands of demonstrators in Trafalgar Square, London
There is also the small matter of current statutory regulation. I am persuaded that vaccine mandates violate human rights legislation, and mandates may even contravene the Nuremberg Code which pertains to informed consent for experimental treatments. However, in this article I want to focus on regulation closer to home. The NMC and other regulated bodies are governed by legislation that registered practitioners are obliged to follow. I question whether the requirements of documents such as the NMC Code and Standards, enforceable under the law, have been sufficiently considered by Sajid Javid and those MPs who voted for this legislation. It would be understandable if not, as Javid and most MPs are not health professionals. But it is strange that medical advisers have not drawn attention to contradictions between the legislation for mandatory vaccination and the current, legally binding, regulations drawn up by bodies such as the NMC and GMC.

I will speak of the NMC Code because as a midwife, that is the Code with which I am most familiar and which day in, day out, I strive to apply as a registered health professional in my interactions with clients – in my case, pregnant women and their babies. “The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary.” This means that any registered practitioner not applying the principles may be removed from the Register. It also, in my opinion, means that the new law cannot be applied without contravening the Code – a situation that is quite bizarre and unprecedented. Relevant sections of the NMC Code include:

  • 1.5 the requirement to “respect and uphold people’s human rights”
  • 2.5 “respect, support and document a person’s right to accept or refuse care and treatment”
  • 4.1 “balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment”.
All NHS workers (whether they are registered or not) on the receiving end of (or declining) a vaccine must be as protected as any other member of the public. Some NHS workers are also registered practitioners, legally bound to uphold the principles of the Code. In other words, everyone on the needle end of the jab has the right to be treated in accordance with the Code, and their right to decline treatment is protected by law. Those on the plunger end of the syringe are registered practitioners who must uphold the Code and respect the rights of people to accept or decline treatment.

The threat of losing one’s job if one does not accept vaccination is coercion

It is not only ethically wrong, it is against the NMC Code for any registered practitioner to coerce a person. Let me be quite clear that any form of coercion, by definition, prevents a person from giving true consent. As a midwife I cannot give as much as a paracetamol if the client declines it. If a midwife gave a paracetamol or pethidine or any other drug against a woman’s wishes, or carried out any treatment, even for good clinical reasons, the woman would have a case for complaint to the NMC and the midwife could be sanctioned and even struck off. She could also face criminal charges, including assault.

The threat of losing one’s job if one does not accept vaccination is coercion. The conversation between a manager and a “hesitant” worker, as suggested by the NHS England report (see references) is coercive if the worker will lose their job unless he or she complies. I contest that any registrant coercing a person, or vaccinating or supervising the vaccination of a coerced person, would be in breach of the Code and vulnerable to being reported to the NMC.

Demonstrators threw their uniforms on the ground as part of the protest

Hundreds of people placed or threw their uniforms on the ground as part of the protest

It has been difficult to write this article as a health professional surrounded by people I greatly respect who are convinced that only pharmaceutical solutions can bring us out of the threat of Covid. I have a different view, but I do not want to rehearse that view here. This is not about the merits of vaccination, or about the controversies surrounding the various Covid vaccines. I acknowledge the efforts of those who have poured their energies and hearts into the vaccination effort in good faith.  My focus is purely on whether or not it is legal to impose vaccine mandates. The argument on the other side would perhaps hold slightly more water if any of the vaccines against SARS-COV2 had been subject to the usual extensive, long term, research. All the current Covid vaccines available in England use novel technology. While I believe these products have been successful in reducing hospitalisations and deaths, long-term outcomes have not been assessed, and there seems to be little in the way of systematic assessment of adverse outcomes – indeed, any suggestion of adverse outcomes is met with censorship. Adverse and long-term outcomes really matter in research – well, they always have until now. This may be particularly relevant for young people for whom the risk/benefit calculations regarding vaccination with our current knowledge may be finely balanced. Another point to consider is that immunity is partial, appears to last for a relatively short time, and is always subject to new variants. What does “full vaccination” under these conditions even mean? But even in the case of the best vaccination in the world, conferring long-lasting immunity and with years of safety records, a person (even an NHS or health and social care worker) has the right to decline treatment and not be coerced under current UK law as it stands.

Data informs us that the Omicron variant is so transmissible that it is inevitable that we all have either already had Omicron, or we will do at some point, regardless of vaccination status. Vaccinated and unvaccinated alike should take care not to transmit disease of any kind of course, and should not go to work in NHS or social care settings if symptomatic of any illness.

Freedom of choice for medical treatment underpins our health system

The responses of the Royal Colleges and regulatory bodies have been disappointing to say the least. While the RCM, RCN and other Royal Colleges have spoken out against vaccine mandates, they have not taken any action – this compliance lets Government off the hook. Freedom of choice regarding medical treatment underpins our entire health system and undermining our freedom could have a further destabilising effect on a system that is already in crisis – to say nothing of the loss of essential staff. Midwives, nurses, doctors and others who are used to working to the most stringent ethical standards will feel undermined and ever more demoralised; mere tools to be used and ordered about, rather than autonomous human beings. Forcing, or witnessing the forcing, of medical treatment causes moral injury. Arguably, the most heinous moral damage is not to those who are vaccinated against their will in order to keep a job, but to those who follow orders, colluding in a system that overrides normal consent procedures.

The Covid-19 pandemic has caused an era of unprecedented confusion. It is understandable that our government and its advisors consider taking any steps necessary to get back to something like normality as quickly as possible. But politicians need to be aware of the long-term implications of vaccine mandates, not just for NHS staff and health and social care workers, but for all patients (which means everyone). Given that the legislation was drawn up prior to what we now know about Omicron, it would be justified to think again. Vaccine mandates are a slippery slope to medical authoritarianism, and I hope against hope that we prevent the slide before it is too late.
Bibliography

All photos courtesy of Erika Thompson
Midwives angry over compulsory jabs with Erika Thompson – Sky News

Nicky Grace

By Nicky Grace, RM, MA in Research Methods (Health)

Midwifery educator, independent midwifery consultant, writer and researcher (writing in personal capacity)

More Information

Links to sources of support for those facing vaccination or the loss of a job or place as a student health professional

Take Action! NHS100K
Workers of England union
Together Declaration (read/sign the declaration)

Petition

Prohibit employers from requiring staff to be vaccinated against Covid-19

Make it illegal for any employer to mandate vaccination for its employees. This should apply to all public sector (including the NHS, armed forces, care workers), third sector and all private sector.

Parliament debated this topic on 24 January 2022

Watch the debate or read the transcript

Sign this petition

*note: No Health Minister or Shadow Secretary was present; the only one present was the Under-Secretary of State for Business, Energy and Industrial Strategy ,Paul Scully

Legislation

By law, the Public Health (Control of Disease) Act 1984 (Section 45E) gives the Government the power to prevent and control an infection. However, the legislation specifically prevents a person from being required to undertake medical treatments such as vaccinations. Accordingly, further primary legislation would need to be introduced in order to legally mandate a COVID-19 vaccination. The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2022 did exactly that. The House of Lord’s Secondary Legislation Committee has stated that the Government’s case is too weak to justify a mandate.

‘For consent to immunisation to the valid, it must be given freely, voluntarily and without coercion by an appropriately informed person who has the mental capacity to consent to the administration of the vaccines in question. ‘ (The Public Health England Green Book: Immunisation Against Infectious Disease)

UNESCO declaration on bioethics and human rights states: all medical interventions are subject to prior, free and informed consent that may be withdrawn at any time and for any reason without disadvantage or prejudice.

The Nuremberg Code and the UN Int covenant on civil and political rights state: no one shall be subjected without his free consent to medical or scientific experimentation.

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