Alizon S, Sofonea MT SARS-CoV-2 virulence evolution: avirulence theory, immunity and trade-offs. J Evol Biol. 2021; 34:(12)1867-1877

Beauchamp LT, Childress FJOxford: Oxford University Press; 2019

Biswas N, Mustapha T, Khubchandani J, Price JH The nature and extent of COVID-19 vaccination hesitancy in healthcare workers. J Community Health. 2021; 46:(6)1244-1251

Butler R, MacDonald NE Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015; 33:(34)4176-4179

Cox CL ‘Healthcare heroes’: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic. J Med Ethics. 2020; 46:(8)510-513

de Gier B, Andeweg S, Backer JA Vaccine effectiveness against SARS-CoV-2 transmission to household contacts during dominance of Delta variant (B.1.617.2), the Netherlands, August to September 2021. Eurosurveillance. 2021; 26:(44)

Dyer O COVID-19: New York’s health workers agree to vaccinate as mandate bites. BMJ. 2021; 374:(n2390) 10.1136/bmj.n2390

Emerson E, Totsika V, Aitken Z Vaccine hesitancy among working-age adults with/without disability in the UK. Public Health. 2021; 200:106-108

Gillon R Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. J Med Ethics. 2003; 29:(5)307-312

Iacobucci G COVID-19: how prepared is England’s NHS for mandatory vaccination?. BMJ. 2022; 376

MacDonald NE Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015; 33:(34)4161-4164

Boston (MA): James R Osgood and Co; 1871

Murray E Moral injury and paramedic practice. J Paramed Pract. 2019; 11:(10)

Cambridge: Cambridge Publishers; 2007 https//

O’Neill OCambridge: Cambridge University Press; 2002

Pacella-LaBarbara ML, Park YL COVID-19 vaccine uptake and intent among emergency healthcare workers: a cross-sectional survey. J Occup Environ Med. 2021; 63:(10)852-856

Pugh JOxford: Oxford University Press; 2020

Razai MS, Osama T, McKechnie DGJ, Majeed A Covid-19 vaccine hesitancy among ethnic minority groups. BMJ. 2021;

Stead M, Jessop C, Angus K National survey of attitudes towards and intentions to vaccinate against COVID-19: implications for communications. BMJ Open. 2021; 11:(10)

Stirrat GM, Gill R Autonomy in medical ethics after O’Neill. J Med Ethics. 2005; 31:(3)127-130

Tang S, Morgan K Key facts about the COVID-19 vaccination programme in the UK. J Paramed Pract. 2021; 13:(2)56-58

Veronese N, Saccaro C, Demurtas J Prevalence of unwillingness and uncertainty to vaccinate against COVID-19 in older people: a systematic review and meta-analysis. Ageing Res Rev. 2021; 72

Woolf K, McManus IC, Martin CA Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: results from the UK-REACH prospective nationwide cohort study. Lancet Reg Health Eur.. 2021; 9

Xin M, Luo S, She R, Chen X The impact of social media exposure and interpersonal discussion on intention of COVID-19 vaccination among nurses. Vaccines (Basel). 2021; 9:(10)

Yaya S, Yeboah H, Charles CH, Otu A, Labonte R Ethnic and racial disparities in COVID-19-related deaths: counting the trees, hiding the forest. BMJ Glob Health. 2020; 5:(6)

Mandatory vaccination for healthcare workers: an ethical dilemma?

02 March 2022
Volume 14 · Issue 3


Vaccines are advocated as the best defence against COVID-19. While most NHS staff, including ambulance clinicians, have been vaccinated, some remain hesitant. All health and social care staff, with some exemptions, were originally expected to be fully vaccinated by 1 April 2022. However, this is currently on hold due to the recent reconsideration by the Secretary of State.

There are ethical arguments against and in favour of mandatory vaccination. Arguments against include potential harm and loss of autonomy. Coercing staff may be interpreted by the public that health professionals do not trust vaccines. A mandate may also be seen as authoritarian, which may embolden the anti-vaccine movement. Compulsory vaccination is also opposed by Royal Colleges, professional bodies and trade unions. Arguments to support mandatory vaccination include that society has a legitimate interest in regulating behaviour that harms others, even if this limits individual choices and that people live in groups so their rights and powers are limited by the rights of others. Paramedics deal with a diverse population, and often encounter clinically vulnerable patients as well as those who are COVID-19 positive. It can be argued that patients’ right to be safe from unnecessary risk usurps that of a practitioner to refuse vaccination. Having all health and social care staff fully vaccinated will increase the health service’s resilience. Future decisions on any vaccine mandates must incorporate various ethical arguments and support with additional effort to address underlying issues related to vaccine hesitancy.

Since the discovery of the first SARS-CoV-2 infected case causing COVID-19 was reported in China in late 2019, there have been more than 360 million cases of COVID-19, linked to over 5.6 million deaths (World Health Organization (WHO), 2022a). As of 27 January 2022, there were 16.2 million cases of confirmed COVID-19 and 174 000 deaths with COVID-19 on the death certificate in the UK (HM Government, 2022).

Vaccines have been advocated as our best defence against COVID-19, with four approved by the Medicines and Healthcare products Regulatory Agency since early 2021 (UK Health Security Agency, 2021a). Frontline health and social workers who provide care to vulnerable people (including paramedics and ambulance clinicians) were among the highest priority groups for the COVID-19 vaccination since the UK COVID-19 vaccination programme was rolled out (Tang and Morgan, 2021).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed