Coronavirus: should the UK make vaccination mandatory?

By Robin McKie
A government advertisement encouraging the public to get booster vaccinations against Covid-19.
A government advertisement encouraging the public to get booster vaccinations against Covid-19. Photograph: Charlotte Tattersall/Getty Images

In Italy, it is now obligatory for people aged 50 or over to be vaccinated against Covid-19. Greece is pondering a similar move. In France, which has seen record numbers of positive cases, President Emmanuel Macron has also announced that he wants to “piss off” the unvaccinated, while Austria is contemplating a law to make the vaccine mandatory for all its citizens. By contrast, in the UK, Boris Johnson has confined himself to accusing anti-vaxxers of talking “mumbo-jumbo”.

But is that enough? Should the UK take a harder line on those who refuse to be vaccinated? After all, this is a virus that threatens to overwhelm the NHS. As doctors continue to point out, hospital beds are now filling up with more and more seriously ill Covid patients, many of whom are unvaccinated. So, should vaccines against Covid be made mandatory, not just in certain workplace settings but for all individuals?

What is the case for making Covid vaccines mandatory?

Most British scientists believe that increasing numbers of vaccinated people will give a major boost to efforts to limit hospitalisations from serious Covid complications. However, many question the wisdom of doing this by making vaccination mandatory. The issue is summed up by vaccine expert Peter English.

“Unvaccinated people are very much more likely to become ill and consume disproportionate healthcare resources. A single case of Covid-19 requiring admission to an ICU can block a bed that could be used for many critical operations,” he told the Observer. “However, the backlash that could occur as a result of compulsory vaccination – which is not part of our culture, unlike in Italy – might mean even fewer people coming forward for vaccination, so it is not something that I would recommend.”

What vaccines are mandatory in the UK?

The answer to this is straightforward, said child health expert, Professor Helen Bedford of University College London. “We don’t mandate any vaccine in the UK. We recommend that people have certain vaccines and advise parents to have their children vaccinated against particular diseases but we do not enforce that in law. In fact, the only vaccine we have ever mandated in Britain was smallpox and the legislation enforcing its use was repealed in the 1940s.

“Other countries have more of a tradition for mandatory vaccinations, however. For example, Italy now has a total of 10 vaccines that are mandatory.”

Unvaccinated people are more likely to become ill and consume disproportionate healthcare resources.
Unvaccinated people are more likely to become ill and consume disproportionate healthcare resources. Photograph: David Levene/the Guardian

What has been the impact of the Omicron variant, which is easier to catch but is thought to be less likely to cause serious illness?

This is a key question, said psychologist Marie Juanchich of Essex University. “I believe Omicron is changing things. People feel a bit safer with it. It may spread really rapidly but its severity is perceived to be lower. People are much more concerned about the severity of an illness and less concerned about the infectiousness of the virus that causes it.”

This point is backed by psychologist Simon Williams, at Swansea University. “There is now a widespread perception that Omicron is milder and I think a lot of people have taken that to mean they don’t have to worry about it and are not adjusting their behaviour.,” he said.

A particular problem was the take-up of the booster vaccine last month, which was helped by the public’s wish not to disrupt the festive season with the virus. The fact that this risk has passed might have removed some of the drive to take up the vaccine, Williams added. “One of the things we have come across is a factor we call ‘variant fatigue’, which translates as people saying: ‘Oh, here we go again, a new variant. This is what viruses do; we just need to get on with our lives.’ That’s not great from a public health perspective.”

So how should we improve Covid-19 vaccination rates?

An important issue is to differentiate between a diehard anti-vaxxer and someone who has nagging doubts about getting a vaccine, said Bedford. “If you lump them together, you will miss the chance to persuade those who have genuine concerns but who could change their minds and get vaccinated.

“We need to get to the people in this latter category although that takes time and resources. Some GPs have been ringing up all their unvaccinated patients to have a chat and that has proven to be effective. However, it is hard work. Nor does it have to be a doctor, it might be a religious leader or community leader.

“Certainly, from my own experience, I find that if you actually sit down with a doubter, listen to what their concern is, and respond appropriately, very often, you can encourage them to be vaccinated. Certainly, I don’t think we should be thinking about mandating or making a vaccine compulsory.”

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