The Guardian view on Covid vaccines: persuading the public
D ominic Cummings launched a lurid attack this week on the “chronic dysfunction” and incompetence in the government’s pandemic handling, singling out the health secretary, Matt Hancock, for most criticism. While few would want to rely solely on an account from Boris Johnson’s controversial former aide, some of it quickly contested, there is plentiful evidence of the government’s failures.
There is no doubt its performance has improved. With Covid cases in the UK now doubling every 11 days, the vaccination push is intensifying; all over-18s can book for theirs from Friday. The speed of the rollout has helped to break the link between infections and deaths. The delay of a further relaxation of restrictions was a welcome and necessary decision. But the Delta variant’s rapid spread has meant that hospitalisations are up 15% week on week, and deaths 10%.
This is one of the reasons why the government plans to make vaccination mandatory for care home staff – with necessary medical exemptions – and to consult on extending the requirement to NHS workers. This is entirely sensible. In general, governments should not dictate the health decisions of citizens. But care home workers are by definition in close contact with people who are highly vulnerable to serious illness and death from the virus. They have a right to choose whether to have the vaccine, but not to put others at significant risk through their decision.
That principle is already established: for instance, medical staff can only carry out certain procedures if they have been protected against hepatitis B. If care staff are not willing to be immunised, they cannot work in frontline positions – though they must, of course, receive fair compensation if this means leaving their job.
Yet, if it is sometimes necessary to make doing the right thing mandatory, it is still advisable to make it desirable and simple. Staff should have paid time off for the immunisation (and, if necessary, to recover from any side effects). Engagement, persuasion and support are not always sufficient, but they are necessary and can go a long way. A mandate should not replace attempts to overcome practical and emotional barriers; it should go alongside them.
Sharply varying vaccination rates in different areas and ethnic groups reflect not only how easy people find it to access a vaccine, but also how much faith they place in authorities. There are often historical reasons why their overall trust is lower. Some are concerned about the Covid vaccines specifically, given the speed with which they were developed. Others are not committed anti-vaxxers, but are vaccine sceptical. Listening to their concerns, rather than dismissing them as foolish or conspiracist, is the best way to change their minds.
Throughout the pandemic the government has too often wagged its finger at individuals for not doing as they should, while failing to provide adequate support for those who need to self-isolate. According to leaked emails, the Treasury blocked guidance showing that a provision in the furlough scheme would cover self-isolation even as the second wave was surging. Senior civil servants recognised that people were not taking Covid tests because sick pay was too stingy: they could afford to risk losing income by self-isolating. A Unison study even found that a third of care staff were not receiving full sick pay for self-isolating – though a government fund was supposed to address this – and that several reported pressure from bosses to work when symptomatic.
Engagement and adequate financial support consumes both time and resources. But the longer-term costs of relying on diktat are greater. Ensuring that people buy in to health policy is essential in tackling this crisis, and preparing for those to come. Shaming and lecturing doesn’t keep us safe from Covid. Proper support does.