Statement on mandatory vaccination for health and care workers

What we must learn above all is consent.

Many say yes, and yet there is no consent.

Many are not asked, and many

Consent to wrong things. Therefore:

What we must learn above all is consent.

[Bertolt Brecht, He Who Says Yes/He Who Says No,

cited in Rokem, 2015: 57]

On 6th October 2021 I found out that my medical career of 27 years is likely to be terminated abruptly in the next few weeks by the UK government if I do not concede to having the Covid-19 vaccine. I found this out while I was shopping in Tesco with my daughters, by catching sight of the front-page article in the i newspaper, headlined ‘Covid vaccine mandatory for frontline NHS workers in Javid plan’ (Waugh and Gallagher, 2021).

This wasn’t really a very happy moment. I was not aware of this consultation, perhaps as a result of being a single mother and a doctor and a student all at the same time, and having rather a lot of other things to think about. This article is my response to that article now, and to the UK government’s consultation more broadly.

I will argue that the proposed legislation represents a serious threat to human rights at precisely the time when the Human Rights Act itself is being held up for review (Vaughan, 2021). And I will argue that the phrasing of the current consultation is inherently biased and misleading, because the critical question that must be answered here is not whether or not healthcare workers should be vaccinated, but whether or not they should be forced to be vaccinated? And whether they should get the sack if they refuse.

The UK government is currently consulting on whether or not to make the COVID vaccination mandatory for all frontline NHS workers (GOV.UK, 2021, a). The formal consultation is due to end on October 22nd 2021, and according to the article in the i (Waugh and Gallagher, 2021) ‘vaccinations for frontline NHS staff are almost certain to be made compulsory’. They have already been made compulsory for staff in public sector care homes, and those who are not ‘double jabbed’ by 11th November 2021 (ibid.) will be legally barred from work. All the scientific and ethical questions I raise here in relation to NHS workers apply equally to staff in the care sector.

My name is Dr Ellen Storm and I currently work part-time as a Senior Clinical Fellow in Paediatrics. I qualified in medicine in 2000 from St George’s Hospital Medical School (SGHMS) in London. I have a BSc in biomedical sciences and an MSc in public health. I am a member of the Royal College of Paediatrics and Child Health (RCPCH), I have professional experience in general paediatrics, community paediatrics, and neonatology, and I have worked for one year in a public health department in London.

I also have an MA in creative writing that I undertook after I won first prize in the Hippocrates Prize for Poetry and Medicine, and after the Hippocrates Press published my first book of poetry. In 2019/2020 I taught political sociology and developmental and social psychology at [NAME WITHHELD] University, and I’m now a part-time PhD student at the University of [NAME WITHHELD] studying the learning plays of Bertolt Brecht and their potential relevance to theatre for health education work with children and young people.

I have not had the COVID vaccination, and I will not be having the COVID vaccination. My daughters will not be having it when they turn 12. If the Government implements its plans to make the COVID vaccination mandatory for all NHS staff, I will await my dismissal. If I am dismissed, and I am able to garner enough support to take my case to court for consideration under the Human Rights Act 1998, the presently somewhat unclear effects of Brexit on human rights legislation in the UK notwithstanding (House of Commons Library, 2019), then I will do so.

I will do so because I believe that to force a mentally competent adult to have a needle inserted into their body against their will, and to have a substance of any sort injected into their body against their will, is a fundamental contravention of that persons human rights. To threaten a person with the loss of their livelihood if they do not comply is a form of coercion tantamount to force that is absolutely unacceptable in a democratic nation.

This holds true irrespective of the nature of the substance in question, and its purported safety or risk. However, at no point since the introduction of the COVID vaccine have I been offered, or seen, the original research data on safety. I have been expected to accept the vaccine’s safety on trust. This is despite the fact that the government website does in fact outline a list of certain possible side effects. For the Pfizer/BioNTech vaccine for example, which ‘does not have marketing authorisation’, but which does have ‘temporary authorisation’ granting permission for its use ‘in individuals aged 12 years and over’, the following side effects are listed (GOV.UK, 2021, b):

Very common: may affect more than 1 in 10 people

· injection site: pain, swelling

· tiredness

· headache

· muscle pain

· chills

· joint pain

· diarrhoea

· fever

Common: may affect up to 1 in 10 people

· redness at injection site

· nausea

· vomiting

Uncommon: may affect up to 1 in 100 people

· enlarged lymph nodes

· feeling unwell

· arm pain

· insomnia

· injection site itching

· allergic reactions such as rash or itching

Rare: may affect up to 1 in 1,000 people

· temporary one sided facial drooping

· allergic reactions such as hives or swelling of the face

Not known (cannot be estimated from the available data)

· severe allergic reaction

· inflammation of the heart (myocarditis or pericarditis)

· extensive swelling of the vaccinated limb

· swelling of the face (swelling of the face may occur in patients who have had facial dermatological fillers)

The line ‘Not known (cannot be estimated from the available data)’ is the most concerning here. This category contains the most potentially severe (although rare) side effects. I have suffered from viral myocarditis in the past: I do not want to get it again. But quite apart from this, the point to be made here is that we simply do not have sufficient data, over a sufficient length of time, to be able to state conclusively what the risks are.

According to Forbes (Pratap, 2021), ‘Biotech giant Pfizer expects to generate $33.5 billion in Covid-19 vaccine sales in 2021, up from previous estimates of $26 billion’. Pfizer CEO Albert Bourla owns shares in the company worth over $8 million (Underwood, 2021). His CEO compensation package for 2020 was $21.03 million (ibid.).

Without a single exception that I have ever encountered in my years of medical practice, all pharmaceutical agents have side-effects, and carry risk-benefit profiles that have to be considered when making an informed decision as to whether or not a certain substance should be taken. Vaccines are no exception, as illustrated by the lists of side-effects for all vaccines currently in use as part of the UK routine vaccination schedule (GOV.UK, 2020), which are publicly available online (medicines.org, n.d.).

These lists should highlight the need for informed consent for vaccination. The debate has become very polarised, and this is unhelpful in a situation that is complex and without absolutes, but those who choose consciously not to vaccinate either themselves or their children should be respected for their decision. We may not always agree with other people’s decisions, and we may frequently wish we could bend them to our will, but a political situation in which a government is legitimated to impose laws at short notice that force citizens to accept certain conditions against their will and in violation of their individual rights and physiological integrity, is the beginning of a totalitarian dictatorship reminiscent of the Enabling Act passed in Germany in 1933.

Bertolt Brecht was a German playwright who wrote a collection of short, experimental pieces known as Lehrstücke, or learning plays, in the late 1920s and early 1930s, that dealt primarily with issues of justice and consent. That period of his writing life ended abruptly with the burning of the Reichstag (the German ‘Houses of Parliament’) on Monday 27thFebruary 1933. He left Germany shortly after this event, eventually settling in Denmark. His pair of plays known as He Who Said Yes/He Who Said No consider what consent means under conditions of duress: a boy who gets sick during a long journey over the mountains is expected to conform to custom and agree to be thrown into the valley, so as not to hold up the progress of the group.

What happened in Germany in 1933 was that a borderline majority government (52%) was formed by coalition on March 5th and on March 23rd an act was passed which allowed Hitler – then chancellor – to ‘pass and enforce unconstitutional laws without any objection’ and ‘to bypass the system of checks and balances in the government and these laws could explicitly violate individual rights prescribed in the Weimar Constitution’ (Wikipedia, n.d.). This followed the passing of the Reichstag fire decree on 28th February, which ‘abolished most civil liberties including the right to speak, assemble, protest, and due process’ (ibid.).

We should not think that the image presented on page 19 of the same edition of the i on the 6th October 2021 (Dunt, 2021), of protesters being dragged away by police, in relation to Ian Dunt’s article entitled ‘Patel is taking away the right to protest’, represents anything other than the same desire by those in power to exert the same kind of control over the people. We must learn from history. We are not better or worse than anybody else. As human beings we do battle over and over again with the same difficult aspects of our humanity. The coming together of the desire to impose mandatory vaccination, the desire to amend the Human Rights Act post-Brexit, and the desire to impose banning orders preventing public protest, represents a triad of threats to democratic society that we must recognise and critically interrogate now.

Between 2016 and 2018 I worked in a community paediatric department, assessing children for neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder (ADHD). During that period of time I met many parents who believed their children were damaged by vaccines.

One mother wanted to bring a legal case and asked for my assistance. I raised this with my supervisors and was advised not to get involved. To my shame, because I was about to leave the department anyway, I did not get involved. I can only extend my sincere apologies to that mother now for my cowardice. Every doctor knew that questioning vaccine safety was tantamount to career suicide. And yet we were seeing so many children with unexplained symptoms. Nobody knows why so many young children are experiencing isolated speech regression and social communication difficulties, but they are, and it is scientifically reasonable to ask the question ‘why?’ Speech regression means learning to speak and then stopping speaking. Children who lose their speech do not only lose their physical ability to form words. What the rather glib term ‘speech delay’ refers to is a failure of the development of complex thought: in a word, the thing that makes us human.

The UK government offers a one-off ‘Vaccine Damage Payment’ of £120,000 for those who have been severely disabled as a result of a vaccination. The UK government is well aware that vaccines sometimes cause severe damage, and a blanket strategy for vaccinating the whole population against every conceivable infectious disease will inevitably result in many more such cases than a more targeted approach. £120,000 is woefully inadequate in relation to the cost of caring for a severely disabled child for the rest of their life, and can in no way compensate for the loss of a person’s cognitive ability, which is a thing that, when it happens because of some external or environmental factor, would be better described as brain damage.

I am not here trying to make a case for the role of vaccines in neurodevelopmental disorders. I can only recount my personal clinical experience and how it has affected me, and point out that there is a great deal that we do not know: both about the safety of vaccines and about why all kinds of things are happening in our world.

We do not know why this particular thing is happening to so many children now. We do not know why so many children are suffering increasingly from other conditions like allergies either, and it is reasonable to ask the question why, and to remain skeptical in the face of those who would tell us there is no risk, because there is never no risk, and anyone who says there is no risk at all is lying.

The problem we have now with the COVID vaccine, in relation to obtaining clear, valid, reliable and unbiased information about risk, is that people have in general one of two reasons for wanting other people to believe there is no risk: fear, and profit.

I am not an anti-vaxxer: my decision in relation to the COVID vaccine is specific to this vaccine at this time. I have had all my routine vaccinations and so have my daughters. Before we travelled to South Africa in 2019 we all went to the travel clinic and had all the recommended travel vaccines. I believe the basic principle of vaccination is sound: that introducing a modified version of a pathogenic organism does stimulate an immune response that offers acquired immunity to the disease caused by that organism.

I also believe that we do not know what effect more and more vaccines are having and are going to have on our immune systems in the future in the medium to long term. We do have an immune system for a reason and for the most part healthy people are able to recover from respiratory viruses.

Bearing in mind the qualifying comment made by York University’s Centre for Applied Human Rights (2020) in relation to the need ‘to stress agency rather than vulnerability’, I do support targeted voluntary vaccination of the vulnerable. But for those with mental capacity, the person who must ultimately decide whether they are vulnerable or not is that person. Then, if the vaccine works, and the vulnerable are vaccinated, there is no need to vaccinate anyone else other than profit.

I am a high-raw vegan, and I do believe that pharmaceutical products that are tested on animals are not vegan, even if they do not contain any animal derivatives directly, although this is the least part of my argument. I will only note here that it is regrettable that none of the major vegan or animal rights organisations such as The Vegan Society (2021), Animal Aid (n.d.) or PETA (Sachkova, 2021) have come out in support of those vegans who do ethically object to vaccines on these legitimate grounds.

I generally consume more than ten to fifteen portions of fresh fruits and vegetables every day. I do not drink alcohol, or smoke, or take drugs. I exercise regularly. I do not take any regular medications or suffer from any chronic diseases. I judge my risk of dying from COVID-19 to be low, and I take the small but residual risk upon myself. I will not blame anyone else if I do die.

Life entails risk. We are all at risk of dying every day. We can and should take sensible measures to reduce our risk of dying tomorrow. But we cannot bring that risk down to zero, ever, and if we take ourselves into a situation in which our basic human rights are being compromised and our political commitment to freedom and democracy is being undermined in the pursuit of zero risk, we are taking ourselves into very dangerous territory indeed.

Human beings have lived in relationship with infectious diseases since time immemorial. We all want to live as long as possible (although few in our society actually live in a manner which makes healthy longevity likely), but when our pursuit of immortality begins to impact on the nature and quality of our lives in the present moment, and to impinge on the rights and freedoms of others, we have a serious problem. Because one of the things we can be absolutely sure of is that one day we are all going to die. Perhaps now would be a good time for all of us to reconsider our relationship to our own mortality.

We should beware of hypocrisy. In England and Wales in 2020 there were 73,766 deaths ‘due to’ COVID-19, and 81,795 deaths ‘involving’ COVID-19 (GOV.UK, 2021, c), out of a total of 607,922 deaths in total (GOV.UK, 2021, d), while, to take just one example, according to Cancer Research UK (2019) ‘Around 47,800 people are diagnosed with lung cancer in the UK each year’, and globally it is the second most common cause of cancer-related mortality (2.21 million cases in 2020 – World Health Organization, 2021), but most hospitals I work in still do not enforce non-smoking policies on their sites, and there is a particularly unpleasant taste to the experience of walking into a hospital wearing a fluid-repellant mask and having to hold my breath.

The list of diseases that are ‘behavioural’ in origin is long, and includes any disease that is caused by poor diet, lack of exercise, alcohol, drugs, and smoking: all things which also impair immune function and increase our risk of dying from infectious diseases. Selling anything that facilitates the conditions resulting in these diseases is an act that increases another person’s risk of dying. Most of these acts we tolerate and even frequently encourage. Statistically speaking, over the course of a lifetime, we should be much, much more frightened of dying from atherosclerotic cardiovascular disease than from COVID-19 (coronary artery disease caused 63,237 deaths in the UK in 2019 – British Heart Foundation 2021), but because infectious diseases are sudden and unpredictable, our fear response in relation to them is not proportional.

On the 7th September 2021 Julie Ponesse, Professor of Ethics at the University of Western Ontario in Canada, was fired for refusing to take the COVID-vaccine (Walia, 2021). At the time I watched her video explaining her ethical position, and expressing her grief, with a sense of gratitude for the fact that I lived in a country with more sense. I believed it to be the case. My employers had assured me that the vaccine would not be made mandatory, but they cannot override the law.

In fact, I’m not sure I entirely agree with Julie Ponesse. If private organisations wish to make vaccination a condition of employment then they arguably have a right to do so: they are not physically holding anyone down. But coercion of existing employees is a real concern, particularly when it occurs in relation to significant power differentials. It is those employees who are most socially and financially vulnerable – which is likely to be those with certain protected characteristics – who will be least likely to be able to walk away.

But in relation to healthcare in the UK we have a particular situation. The NHS is a public organisation and it’s also effectively a government monopoly: as close to communism as we get in this country. At its best its staff profile should represent the diversity that exists in the UK. That means different gender identities, ethnicities, sexualities and faiths, but also people who see the world in different ways. At its worst we begin to see echoes of Animal Farm (Orwell, 1945).

If only those who accept the vaccine are allowed to work as doctors in the UK, then those who may wish to be treated by doctors sympathetic to their own decision not to be vaccinated have nowhere to go, because I cannot offer my services elsewhere: I simply cannot practice medicine any more.

What we risk creating in this situation is a two-tier society, where our healthcare system serves only those who adhere to a particular world-view, while all those of different persuasions try to avoid it like the plague.

But what is much more frightening to me is the way that my dismissal will cause me to be silenced. What we will create, overnight, is a healthcare system in which there is no space for questioning or dissent: in which those who raise valid scientific or ethical concerns are not answered with intelligent debate, but are summarily crushed. And that is an extremely dangerous situation about which I would urge you to be very, very concerned indeed.

The Medical Royal Colleges may be unanimous in their agreement that vaccination should not be made mandatory (Waugh and Gallagher, 2021), but the view that the remaining 111,000 unvaccinated workers (ibid.) are simply ‘hesitant’, and will be persuaded, at this point in time, is naïve. If those unvaccinated workers have received as many invitations to attend for vaccination as I have, which they have simply ignored or deleted, then there is a reason for that. Those workers do not want to be vaccinated. If compulsory vaccination is made law, some of them will leave and some of them – those whose social or financial vulnerability leaves them no choice – will concede.

As a paediatrician, like all my colleagues, I have worked all the way through lockdown to care for my patients to the best of my ability under difficult circumstances. I have on multiple occasions worked with inadequate Personal Protective Equipment (PPE) because I failed two fit tests for the masks in general use for aerosol-generating procedures, and was not for some time supplied with an alternative. Currently a regular surgical mask is deemed sufficient to protect me from known COVID positive patients who are coughing on the ward (coughing, apparently, is not an aerosol-generating procedure). Perhaps this is because by now my employers assume I am ‘double-jabbed’. I have not been asked. I have continued to care for my patients as normal because from the beginning of the pandemic I took the view that eventually I would get COVID, that I might be a bit ill as a result of it, but that I would likely get over it, and then I would get on with the rest of my life. I have not been paid extra for assuming this risk. All the rhetoric about NHS heroes rather stings in the throat when I was not given a choice but to assume this risk: the only alternative on offer being to give up the career I have invested 27 years in the pursuit of, and with it probably also my and my children’s home.

I wrote the bulk of this article on 7th October 2021. I started to feel unwell while I was writing it, and on 8th October I tested positive for COVID-19. I do not know whether natural immunity from wild-type disease will exempt me from immunisation if the proposed legislation comes into force. It should, but the immunisation programme does not currently include first testing people for COVID antibodies.

I must also note here that some of the questions being asked of respondents to the government consultation are entirely the wrong questions. They invite a particular response because they give no option for the correct answer. This makes the consultation inherently biased and misleading.

For example, care providers are asked to choose from six options in relation to whether they feel that care providers should be vaccinated against COVID-19:

· I feel strongly that we should be vaccinated against COVID-19

· I would prefer that we are vaccinated against COVID-19

· I don’t mind either way

· I would prefer that we are not vaccinated against COVID-19

· I feel strongly that we should not be vaccinated against COVID-19

· I don’t know

Who is the ‘we’ in this question? Care providers are not one single, homogenous group, and the phrasing of this question pre-assumes a political standpoint that favours communal responsibility over individual self-determination.

Few people faced with this list will choose options four or five, because they are unlikely to feel that we should be actively not vaccinated. Most people presented with this list will feel they should take a position. The only other position being offered here is that we should be vaccinated. ‘I don’t mind’ suggests apathy and ‘I don’t know’ suggests ignorance.

There is no option here for the more complex, more nuanced truth.

Those who want to be vaccinated should be vaccinated. Those who do not want to should not be. Everybody should be provided with full information on risks and benefits with which to make their own decision. Since there are both risks and benefits to vaccination, and people will take different positions in relation to this depending on their own personal circumstances and beliefs, as a result of this process a certain proportion will be vaccinated, and this will have the effect on disease rates that it has. In the absence of coercion, one might expect that this proportion will reflect the level of certainty in existence in relation to potential benefit versus potential risk.

The problem with this line of questioning is that the majority of respondents will almost certainly say that they feel strongly or that they would prefer healthcare workers to be vaccinated. But we must separate the question of whether we personally believe that healthcare workers should be vaccinated – based on our personal analysis of safety and efficacy – from the question of who gets to decide.

Do I as an intelligent thinking individual get to say that I have not yet been provided with sufficient information to reassure me of the vaccine’s safety? Do I get to say that I believe that a policy of blanket-vaccination is wrong? And what kind of society is being created if those who raise difficult questions are simply thrown out, rather than met at the debating table? Anyone who belongs to a minority group of any kind has reason to be concerned about the answer to this question. Just because 99 out of 100 people believe that healthcare workers should be vaccinated, that does not give them the right to abuse the human rights of the one who disagrees.

In the field of medical ethics much is made of informed consent. Patients undergoing medical procedures are required to sign consent forms after a conversation with a person qualified to carry out that procedure about the potential risks and benefits, and they often give their consent even when one of the risks is death. They do this because they judge the risk of death to be low and the potential benefit high.

In relation to the administration of pharmaceutical agents with similarly significant side-effects we are not so diligent, and I have seen patients suffer severe side-effects from medications that were administered without any such consent. These kinds of experiences leave scars, and make one much more cautious. I am now being threatened with the loss of my career, livelihood and home if I do not accept a pharmaceutical agent that offers little benefit to me as an individual, but that I judge to carry a currently unspecified level of both short and long-term risk.

I do not give my consent. I may give my consent if I am at some stage presented with convincing risk-benefit data produced under conditions likely to minimise bias. Unfortunately, until all those, at all levels, involved in the manufacture and sale of vaccines receive an NHS equivalent salary and cannot profit any more from the activity, I will not judge this to be the case.

If this law is passed and I am unable to find equivalently paid work in the next few weeks, my daughters will undoubtedly lose the home they have lived in since they were born. I can only say this to them: girls, I am very sorry for what may be about to happen, but if I teach you just one single thing in life, let it be this: never, ever, allow yourself to be frightened into agreeing to do something you fundamentally believe to be wrong. To do so is to subscribe to a form of aberrant logic that leads directly to the death camps. Since the days of Sophocles’ Antigone (Rokem, 2015: 59) (Antigone must decide whether to bury her dead brother Polynices, despite having been threatened with death if she does) and before, human beings have been grappling with this one dilemma, which is fundamental to all questions of justice.

Overly emotive analogies with Nazis are unhelpful (BBC NEWS, 2021), but a dictatorship is a dictatorship, whether it’s a fascist or a communist one, and these things don’t generally happen overnight. They happen by degrees, and then one day good people wake up and realise they’ve lost control. Any situation in which either physical force or psychological threat or coercion is applied to intelligent, thinking citizens to make them conform to the will of those in power is somewhere on that slippery slope. Most of those who supported the Enabling Act almost certainly thought it was the right thing too: they simply did not see where they were going.

Disclaimer:

The opinions expressed in this piece are entirely my own and do not in any way represent the views, opinions or policies of any organisation with which I may be associated.

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