# Sajid Javid ‘leaning towards’ mandatory Covid jab for NHS staff (England)



## Northerner (Oct 25, 2021)

NHS staff have been warned they could face a mandatory requirement to be vaccinated against Covid, with the health secretary saying he is “leaning towards” making the jabs compulsory for staff in England.

Sajid Javid said he had not made a final decision, but the move would put NHS staff in England broadly in line with the requirement for care home workers.

It comes as the chancellor is expected to announce £5.9bn for NHS England as part of financial measures this week to clear the backlog of those waiting for tests and scans, which has been worsened by the pandemic, and also to buy equipment and improve IT.

Critics have said that as well as resources, the government must address the fact that there are not enough staff to support services.

“There are around 100,000 that are not [vaccinated in the NHS] at this point but what we saw with the care sector is that when we announced the policy … then we saw many more people come forward and do the right thing and get vaccinated, that’s what I hope, if we can do the same thing with the NHS, we will see,” Javid told Sky News.









						Sajid Javid ‘leaning towards’ mandatory Covid jab for NHS staff
					

Health secretary yet to make final decision on whether to bring NHS in line with care home sector in England




					www.theguardian.com
				




Personally, I think that if you work in a healthcare setting and there is no medical reason for you not to have it, I don't know why you wouldn't  There's surely enough evidence now that the vaccines work really well and are not dangerous.


----------



## trophywench (Oct 25, 2021)

I honestly thought it was compulsory, since last December our 16yo grandaughter, working part time as a cleaner at UHCW was the first of our family to have her first Covid jab!  She had her second jab not long after we had our first one.


----------



## Inka (Oct 25, 2021)

Many of those infected at the moment are children in my local area. Obviously the vast majority of them haven’t yet had any vaccine.

I agree that NHS staff should be vaccinated. It would be madness not to. It will also hopefully cut down on time off work and benefit the NHS that way.


----------



## Bruce Stephens (Oct 25, 2021)

Inka said:


> Many of those infected at the moment are children in my local area. Obviously the vast majority of them haven’t yet had any vaccine.


The ONS survey suggests prevalence is (or was, a week or two ago) 0.7%-1.5% in most age groups, with age 2 to 11 (so primary school) at 3.8% and secondary school 7.8%.

Let's hope it really is safer (or no less safe) for children to be infected than for them to be vaccinated.


----------



## Bruce Stephens (Oct 25, 2021)

Amity Island said:


> The other day the pm was quoted as saying this to reporters.


If I had to choose a source for accurate information (which'll often involve nuance) about this I wouldn't choose the PM. (Especially not filtered through a reporter who's likely a political reporter rather than a science or health reporter.)

A better summary would be something like being vaccinated does significantly reduce the chances of becoming infected and (if infected) becoming seriously ill. But there are signs of waning effectiveness, which means a booster probably makes sense. I'm not sure whether there's good evidence of waning of the protection against serious illness (it doesn't seem impossible to me that those of us who got Pfizer just have waning antibodies which would mean we'd be more likely to be infected, but we'd then have antibodies quickly produced to protect us against serious illness).

Real world evidence from ONS suggests protection against being infected is still pretty good but not great. Does suggest the waning is in people who got Pfizer, with Ox/AZ not waning much (in this respect). So giving the (Pfizer) booster to Ox/AZ recipients too is presumably an attempt at increasing the protection (since while Ox/AZ isn't waning much it's not great (compared to Pfizer) to begin with).


__ https://twitter.com/i/web/status/1452630900475314182


----------



## Bruce Stephens (Oct 25, 2021)

Amity Island said:


> Based on what the p.m said, I don't see how mandating vaccines which as the p.m states "doesn’t protect you against catching the disease, and it doesn’t protect you against passing it on" will help protect patients and visitors at hospitals and....how sacking or moving those from front line NHS duties (who chose not to be vaccinated) will help protect patients either.


I agree it's not at all clear what the effect of such mandates would be.

If they had the effect of persuading the unvaccinated healthcare staff to become vaccinated (apart from the small number who can't have a vaccine for medical reasons), that would help. The vaccines protect the individual against infection and protect everyone else (a vaccinated person is less likely to be infected, and when infected is less likely to infect someone else). (Regular testing as healthcare staff get also protects against infected staff continuing to work, of course.)

If we had more healthcare staff than we really needed, that would be persuasive, I think. After all, do we really want people working in healthcare who don't think they should be vaccinated? But we already have shortages, and there's a significant risk that some will quit and make that worse.

I don't know what the optimal strategy would be.


----------



## Bruce Stephens (Oct 25, 2021)

Amity Island said:


> They definitely need to get the facts straight between them (the p.m and health secretary).


I'm pretty sure that if questioned under oath by someone competent, they'd be giving the same information.

Which is that yes, it is possible for vaccinated people to become infected (and to get sick, and die), and to pass on the infection to others, but the vaccines make all those things significantly less likely.

So there is significant value in trying to get healthcare staff to get vaccinated. There are also costs to that (staff may refuse and leave, and in the UK we generally don't mandate vaccinations, believing that having them voluntary has value), and I'm not sure how the costs and benefits measure out.


----------



## Bruce Stephens (Oct 25, 2021)

Amity Island said:


> Why do you think the p.m keeps saying it's not the vaccines but the lockdowns that keep cases down?


When did he last say that? I presume he said it earlier in the year because that's what the modelling suggested: not that many people had received both doses. It would probably be true now if we were successfully keeping cases down, because while many more people have been vaccinated, the delta variant is much more infectious.

Having said that, all the predictions seem to be that cases will be falling shortly. A combination of vaccination and infection, I assume, with infection especially significant in children.


----------



## nonethewiser (Oct 26, 2021)

Should have been compulsory long before now, what's took so long?


----------



## Bruce Stephens (Oct 26, 2021)

Amity Island said:


> So I'd say again, if this _is_ the case and it's _not_ the vaccines cutting the spread of infections (only reducing early deaths from covid19), then how will mandating front line NHS staff with threats of dismissal help?


Nobody is claiming (well, I'm not) that the vaccines aren't reducing the spread of infections. It's just a question of numbers. The modelling suggested that earlier in the year (in April we were about 15% vaccinated) the numbers of vaccinated people just wasn't making a significant impact on the infections. They were having some effect, just an insignificant one compared with physical distancing.

In a population like healthcare staff you could reasonably hope to get very high vaccination rates (no children to worry about) so within healthcare settings that really could be significant.

(I'm not saying it would be bad to try and get the rest of the population vaccinated. Historically we've tried to do that with persuasion rather than broader mandates and felt that's better overall. No signs that's likely to change, though I think there are some employers who are at least considering requiring vaccination.)


----------



## Bruce Stephens (Oct 26, 2021)

Amity Island said:


> but the pm is


I think he (or a spokesdroid) would argue that he's technically not saying that. He's saying things like the bulk of the work to reduce cases is being done by restrictions, and that vaccines to not prevent transmission. Which is all true, but at other times I'm sure he wants to say that the vaccines are really effective and particularly that they are effective at reducing transmission. (So if only everyone was vaccinated, that really would help reduce infections.)

I think he (and his government) have locked themselves into a mindset that the public are liable to panic and won't follow advice unless it's conveyed in simple three word slogans.


Amity Island said:


> I think with the original story about mandates, given front line NHS staff have selflessly worked through a risky time dealing directly with patients, they are more than likely to have caught the virus at some point and for me, they are probably the least people of concern to anyone and I wouldn't want to see the NHS go down the pan (resignations, sacking and moving etc) for the wrong reasons.
> 
> As discussed in Dr John Campbells video "Natural versus vaccine immunity" based on his evidence it's established that natural infection / immunity (for those unlucky enough to have caught the virus e.g NHS staff)) will likely give them long lasting protection.


As far as I understand it, immunity is really complex and varied. Nobody (that I've seen) suggests that vaccines don't also generate memory B cells, for example.

The strongest immunity (that's known about so far) is seen from people who were infected in the first wave and have now been vaccinated. https://www.nature.com/articles/d41586-021-02795-x

Should we count prior infection for something? As I understand it that can happen in France, where infection followed by a single dose of vaccine is counted as full vaccination. Doesn't seem a crazy idea.

I think the worry about treating people who've recovered from infection the same as those who've been vaccinated is that the level of immune response can vary quite a bit. Even if you can be sure that the person actually was infected. It's a lot easier just to require vaccination, which is a great idea even if you were infected earlier.


----------



## Bruce Stephens (Oct 28, 2021)

Amity Island said:


> See on page 17 Figure 2a.
> 
> It shows a bar graph showing covid cases for those "vaccinated" against those "unvaccinated" in all age groups. This is the only thing I can find that indicates why the comment was made. What do you make if it? Seems to be indicating that there are double the number of covid cases in those vaccinated (per 100,000 people) either that, or it's completley wrong or an error?


People think it's an error. See the footnotes on Table 2 (Page 13). The problem is nobody knows what our population is. They know exactly how many people they plan to vaccinate (it's just the number of people registered) and of course how many have been vaccinated, but there's some unknown number who aren't registered.


----------



## Bruce Stephens (Oct 28, 2021)

Bruce Stephens said:


> People think it's an error.


For example, 

__ https://twitter.com/i/web/status/1451565485150068736


----------



## Bruce Stephens (Oct 28, 2021)

Amity Island said:


> where is his bar graph showing the real data?


Unfortunately there isn't really "real data" because the problem is we don't know the populations. Some of the replies to that tweet offer some replacement charts using ONS estimates rather than NIMS data, for example.


----------



## Bruce Stephens (Oct 28, 2021)

Amity Island said:


> So this basically leaves us where? In terms of official statements and data? pm saying about the vaccines "it doesn’t protect you against catching the disease, and it doesn’t protect you against passing it on"


The consensus view is that the vaccines do offer significant protection against both catching and passing on the infection. But not perfect protection.


----------



## SueEK (Oct 28, 2021)

Irrespective of the differences of opinions above, as an NHS worker I believe we should all be fully vaccinated if we are able to be, some people cannot have the vaccine. Mixing with people who are poorly or vulnerable we should all do what we can to ensure we do not spread the virus. I am not a clinician but nevertheless come into contact with patients and it is our duty to do what we can to keep each other safe. This is just my personal opinion.


----------



## Eddy Edson (Oct 29, 2021)

Bruce Stephens said:


> Unfortunately there isn't really "real data" because the problem is we don't know the populations. Some of the replies to that tweet offer some replacement charts using ONS estimates rather than NIMS data, for example.


And the FT piece from a couple of weeks ago: https://www.ft.com/content/125fbaf8-175a-4e2e-852a-9995ca5176b2


----------



## trophywench (Oct 29, 2021)

Lies, damned lies and statistics ....


----------



## mikeyB (Oct 29, 2021)

To attempt to get this thread back on track, let's get away from the anti-vaxxer arguments and look at at this topic dispassionately.

It is undoubtedly true that vaccinated folk who get Covid, even if it not seriously, can pass on the disease. Many NHS and careworker staff have died from Covid, but the infection rate has dropped as most health workers have been vaccinated. A vaccinated person picking up the disease or coming into close contact with the disease still has to self isolate, but where did the disease arise? Probably, like Kier Starmer, from a child.

With regard to NHS workers, they come into regular close close contact with diseased folk, but use protective clothing and masks. If they are vaccinated, they are extremely unlikely to get ill, and can carry on working. To me it seems that as the NHS is on its knees due to cuts since 2010, we would expect all NHS staff to be vaccinated to be able to carry on working.  There are no spare doctors, nurses, porters, cleaners to pick up the slack. Notwithstanding Amity Islands contentions, the vaccines do work at protecting individuals, and society. As do face masks and social distancing, a fact tacitly acknowledged by Boris wearing a face mask in Parliament.

If only 5% of MHS staff aren't vaccinated, you can't depend on herd immunity, because each member of staff may deal with infected people, particularly in reception areas. So making vaccination compulsory seems seems sensible.

With regard to the veracity of Boris Johnson he has long been been known to be a liar,and indeed has been sacked from previous jobs for doing just that. It's a habit. Like he told kids recently that recycling was a waste of time. 

And with regard to his performance during the early period of the pandemic, let's compare The UK with Brazil. President Bolsanoro, A Trump-like idiot, left the country wide open - no lockdowns, no social distancing, no masks. The death rate per 100,000 of the population is 286.51. A congressional inquiry into his mishandling of the crisis has concluded he should be charged with crimes against humanity. What is the equivalent death rate in the UK? 208.82 per 100,000. Higher than any country in Europe. I wonder why Boris wants an inquiry next year...

France is still compelling mask wearing in all public places and gatherings, as is social distancing. Has done for months, the people don't object. And their infection rate is far, far lower than in the UK. (I was the only person wearing a mask at the football last week, though only in the refreshment room. There was nobody within 3m of me outside.)

And finally, on the general subject of compulsory vaccination, you cannot enter many tropical countries without a Yellow Fever vaccination certificate. If you haven't got one, you get put on the plane back. People do that without question. For sure, you won't get in by arguing about efficacy. What is the difference? In the NHS, Surgeons are vaccinated against Hepatitis, because they operate on anybody who needs it. And protecting subsequent patients. 

It's all about safety, protecting patients and the general public. And the continuing work of NHS England.


----------



## nonethewiser (Oct 29, 2021)

SueEK said:


> Irrespective of the differences of opinions above, as an NHS worker I believe we should all be fully vaccinated if we are able to be, some people cannot have the vaccine. Mixing with people who are poorly or vulnerable we should all do what we can to ensure we do not spread the virus. I am not a clinician but nevertheless come into contact with patients and it is our duty to do what we can to keep each other safe. This is just my personal opinion.



Good personal opinion to have.


----------



## Bruce Stephens (Oct 29, 2021)

Amity Island said:


> As discussed in Dr John Campbells video "Natural versus vaccine immunity" based on his evidence it's established that natural infection / immunity (for those unlucky enough to have caught the virus e.g NHS staff)) will likely give them long lasting protection.


There's some doubt (and likely variation between people). 



__ https://twitter.com/i/web/status/1454159035092045840


Amity Island said:


> On a positive note in the latest antibody survey, we are over 90% in England so effectively means we are already within herd immunity?


Immunity is complex. I don't think anyone's felt confident about herd immunity for a while now: the fear is that the Delta variant replicates so fast that even someone with high immunity might catch it for a few days so nobody can be considered to have perfect immunity which means you'd need an even higher proportion of the population vaccinated or previously infected.
The Flawed Science of Antibody Testing for SARS-CoV-2 Immunity


----------



## Eddy Edson (Oct 29, 2021)

Bruce Stephens said:


> There's some doubt (and likely variation between people).
> 
> 
> 
> ...


Anyway, 10's of thousands of daily cases and hundreds of deaths would seem to rule out "herd immunity" right now.


----------



## Bruce Stephens (Oct 29, 2021)

Eddy Edson said:


> Anyway, 10's of thousands of daily cases and hundreds of deaths would seem to rule out "herd immunity" right now.


True, we've been at ~90% for a while now.


----------



## mikeyB (Oct 30, 2021)

I doubt that this particular virus will be lasting only two years. It is much more likely to be around forever, mingling with the other coronaviruses that cause 20% of our common colds. That is the usual trajectory.

And I also doubt that the NHS England will be around for everyone, forever, as long as the fans of private health insurance are running the country. Already, in England, GP practices are being bought up by American healthcare companies.

None of this is happening in NHS Scotland, where there are no private companies supplying services to the NHS, and never will be.


----------



## Docb (Oct 30, 2021)

Liked your analysis in your previous post @mikeyB - straightforward common sense.  

The thing I find difficult to get a real handle on are the relative risks of the various approaches.  I can cope with the extremes.  Snogging somebody dripping with the virus is will give you covid with a probability of 0.9999999.  Locking yourself away in a sterile room will keep you free of it with a probability of .0000001.   What about the other things?

So, what is the probability of becoming infected on a visit to a supermarket.  How does that compare with a visit to a nightclub or a school or being a medic or a wander round town or walk in the countryside.  How are each of those risks affected by being vaccinated, keeping a social distance or wearing a mask?  

When it comes to being infected, what is the probability of the effects being at a level which require home medical attention or a stay in hospital or the services of a funeral director.  How do those probabilities vary with vaccination, your state of health or where you happen to live.

My gut instinct is that being vaccinated makes a significant change in risks irrespective of anything else but that wearing a mask will only be a significant benefit in a narrow band of circumstances.   It's a gut instinct only because I don't have the data to work out the probabilities for myself and if somebody else is doing it, I have not seen their conclusions.

Can't help but think that a bit of numerical analysis would go a long way to focussing debates like mask wearing or vaccination which generally finish up with an "I'm right you're wrong argument".  

Good job the nuclear industry was not run this way.  Safety decisions were always made on consensus derived from a numerical assessment of risk.  If things did not work out as assessed then at least you could go back and work out where you went wrong and improve things for the future.  This was generally done without rancour because it focussed on numerical analysis and not opinionated argument.


----------



## Docb (Oct 31, 2021)

Looked at the reference hoping to find some answers to the points I made in my post above.  I will have to keep on looking!


----------



## Eddy Edson (Oct 31, 2021)

CDC has recently updated its science brief on vaccine-induced vs infection-induced immunity: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html


----------



## Docb (Oct 31, 2021)

Amity Island said:


> Hi @Docb
> 
> I think it would probably help as a starter if we knew where the virus came from. Is it a natural virus? or has it been played with in some lab to try and make it more dangerous (a.k.a. gain of function)? If this was known, a lot of the questions you raised could probably be answered, because if it was designed/made more dangerous, then they would also likely know the answer to some of your questions.
> 
> ...



Not sure about that Amity.  Where it came from does not affect the risks that I was curious about.

And Eddy, if the quote you give is right, then that removes one factor in my quest to numerically assess risks.  It would be a right pain if the risks associated with resistance from infection were different to those from vaccination.


----------



## Docb (Oct 31, 2021)

My thought was that there ought to be enough data around from the pandemic itself to make an attempt at numerically assessing the risks and the effect of the various attempts to minimise its effects.


----------



## Bruce Stephens (Oct 31, 2021)

Docb said:


> My thought was that there ought to be enough data around from the pandemic itself to make an attempt at numerically assessing the risks and the effect of the various attempts to minimise its effects.


I think (especially with the delta variant, which is so much easier to spread) it's just hard to get good figures. The ONS infection survey chart I showed earlier makes an attempt for just the effects of vaccinations and prior infections, but even there you can see the large error bars. We have some on face masks but not a whole lot.

I think we're stuck with what you said earlier: some things are easy (it's airborne so outdoors is safer than indoors, outdoors on a windy day is better than on a quiet day, indoors with really good ventilation is better than with poor ventilation), but quantifying it all is much harder.


----------



## Bruce Stephens (Nov 26, 2021)

Amity Island said:


> This came out today, worth a look? what do you make of it?


From that well known neutral body the HART group? Probably deliberate nonsense, though I'm not sure quite what they've got wrong.

The general denominator problem has been well discussed and probably doesn't have a great solution. The ONS publication series you mention has lead to a letter from the Office for Statistics Regulation because of the risk of misinterpretation, https://osr.statisticsauthority.gov...g-covid-19-by-vaccination-status-publication/


----------

