Catholic Medical Quarterly Volume 72(1) February 2022


Mandatory Vaccination for Health Care Workers

Dr Adrian Treloar


Adrian TreloarAll Health Care Workers (HCWs) have the human right to consent or to refuse vaccination. Whilst both the vaccinated and unvaccinated can transmit covid to the vulnerable the risk of death or serious disease is substantially greater for the unvaccinated. If mandatory vaccination is enforced for HCW, it will be for them to make their decision in the knowledge that they might well forfeit their prospect of employment.

Grounds of conscience remain critically important. For those who truly believe that they cannot, on grounds of conscience, accept a vaccine made using cell lines from an aborted foetus, conscientious objection remains a key duty.

The Coronavirus pandemic has disrupted the whole world and profoundly changed economies and much more. Many have died.

Vaccination has been a hotly disputed topic, with passionate anti-vaxxers refusing to get vaccinated and also passionately believing that vaccines don’t work, or harmful, are untested experimental rugs and much more. In the Church the clear guidance from three successive Popes has been that using a vaccine which has either been developed using embryonic foetal cells (Pfizer and Moderna vaccines) or for which each dose is manufactured inside a foetal cell line (Astra-Zeneca) is not illicit. It is unpleasant, distasteful or grotesque depending upon your preferred adjective. But the vaccines are not morally illicit according to the Church [1].

A minority view, headed by Bishop Schnieder (an auxiliary Bishops of Kazakhstan) proclaimed that any linkage to foetal cells makes accepting the vaccine a proximate cooperation with evil (and therefore morally illicit). I believe that he is profoundly wrong on that matter.

For many reasons therefore, both within the Church and outside of it there are many people who bitterly and clearly oppose the vaccines. Recent demonstrations across a cold and wintry Europe attest that reality. Some, simply cannot bear to accept the vaccines for reasons of logic, risk, science etc. Others, will not touch them as a result of the fetal cell link.

Is mandatory vaccination wise?

Here is not the place to discuss the extensive science of the vaccines. But a summary of the evidence and debates is this.

  • We know now that vaccination appears to work well  to modify the illness reducing severity and reducing hospitalisation, ventilation and death.
  • The people most at risk of the virus are elderly, frail and those with complex and known conditions. The vast majority of deaths are among frail older people and people with dementia etc.
  • But the vaccines do not stop people getting Covid and that it also do not stop vaccinated people infected with Covid from passing Covid on to others.
  • Therefore the people who need to be primarily protected are the at risk groups.
  • And it follows that  vaccinating the young and healthy will not primarily help the people you vaccinate:- although it will help vulnerable people if as a result of vaccinating them, there is an effective reduced infection rate among vulnerable groups.

A little more specifically,

  • Vaccination does not stop you getting Covid a second time.
  • Nor does vaccination stop you passing Covid on.
  • The latest (Omicron) variant of the virus is less sensitive to the vaccines (leading to concern at the possibility of at least some vaccine escape.
  • So the primary aim must be to do focus upon protecting elderly and vulnerable people by encouraging them to have the vaccine.
  • Which all then means, (given that vaccination does not stop people getting Covid and does not stop them passing it on) that vaccinating young people may not really protect the old.
  • Others point out that the vaccines have still not completed Phase 3 drug trials and that long term data on fertility etc is absent etc.
  • All currently available Covid 19 vaccinations have been produced and /or tested on cell lines obtained from unborn children who were aborted. the vaccines

The list of worries and queries could be far longer. And (unusually for this author) the above statements are not referenced. They may be true, they may be false, and data often points in both directions. But they are all believed, sometimes very deeply, by conscientious and diligent people who have spent time looking at the science.

In arguing for the vaccines, the Governments of the world and the associated health departments often appear to use whatever piece of data they have today and make sure it gets to the same conclusion . You need to get a third (or fourth jab). In the end, people stop believing such data and conclusions, however right thy may be.

No-one should be surprised therefore that some (not a few) people refuse the vaccine. Governments around the world are responding by making vaccination mandatory for whole populations. In the UK, mandatory vaccination for healthcare workers is to be introduced in April 2022. In the care home industry, such mandating since November 2021 has already led to staff shortages and care home closures. That in turn has blocked hospital beds and will cause more deaths of vulnerable people. Mandatory vaccination therefore appears risky.

International Law, consent and conscientious objection?

The declaration of Helsinki and the Nuremberg code set out very clearly that informed consent is the free and prior expression of agreement made by a capable individual to carry out a medical procedure or disclose protected information. It has autonomy as a central part of its underlying principles. Consent also specifically requires voluntariness (which mean s the ability to exercise autonomy free of external influence).

Informed consent is both an ethical and a legal obligation of medical care. It represents collaborative decision-making between the clinician and the individual regarding the steps to be followed in the individual’s care.

In the Nuremberg Code, consent is set out as a mandatory requirement for research on human beings to protect dignity and freedom. In the Helsinki Declaration: A physician must seek the subject’s freely given informed consent.

And informed consent requires disclosure to the individual of adequate, relevant, and complete medical information needed regarding the condition, the name and purpose of treatment or intervention, consequences of refusing treatment, potential risks and benefits, and alternatives.

In 1948, the issue of the right to "conscience" was dealt with by the United Nations General Assembly in Article 18 of the Universal Declaration of Human Rights. It reads: “Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance. The proclamation was ratified during the General Assembly on 10 December.

Consent is to be freely given. And capacity of the individual to make medical decisions is determined by the attending physician. In children, parental consent must also be informed and freely given.

Therefore, except in very exceptional circumstances, treatment must not be imposed upon mental capacitated persons without their explicit consent. In the absence of very exceptional circumstances forced or mandatory vaccination is unethical.

In what circumstances have mandatory vaccination been justified before?

Health workers are already expected to show immunity to Rubella and also Hepatitis B to be allowed to work in at risk settings. Especially with Rubella, the purpose of vaccination is to prevent other people:- namely the yet to be conceived in utero (unborn) children who suffer so badly from Congenital Rubella.

Smallpox was a far more lethal disease to those who got it. The Vaccination Act of 1853 introduced mandatory smallpox vaccination in England and Wales for infants up to three months old. The Act was met with opposition from people who demanded the right to control their bodies and those of their children [2]

The Anti Vaccination League and the Anti-Compulsory Vaccination League formed in response to the mandatory laws, and numerous anti-vaccination journals sprang up. After a visit to New York, in 1879, by prominent British anti-vaccinationist William Tebb, The Anti-Vaccination Society of America was founded. Despite the opposition to vaccination by some, smallpox was completely eradicated from the world 100 years after the Anti-Vaccination League was set up[3]. Not everyone was persuaded by the Anti-vaxxers. 100 years later, small po had been eliminated from the entire world by a truly effective vaccine.

But the key points here is that with all three vaccines there is good evidence of safety and they are also effective at stopping the individual from getting the disease.

An important point about Hepatitis B vaccination is this:- There is an exemption for people who show evidence of immunity  to  Hep B. "The [Hepatitis B] vaccine... is not necessary for individuals known to have markers of current (HBsAg) or past (anti-HBc) infection."[4]  and  "Where there is evidence that a HCW, who is known to have had previous [Hepatitis B virus] infection which has cleared, now has natural immunity, immunisation is not necessary."  [5]

How does the evidence look for Covid Vaccines?

With regard to Covid, the vaccines are known not to prevent you from catching covid or from passing it on. Very many of us know family members or others who have caught the virus since being vaccinated. And although the vaccines seem to reduce transmission, relying upon them to stop transmission will fail. As Singanayagam et al wrote:-

“Vaccination reduces the risk of delta variant infection and accelerates viral clearance. Nonetheless, fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts. Host–virus interactions early in infection may shape the entire viral trajectory”[6].

The vaccines do not stop us passing it on either. Some evidence suggest that transmission is reduced- other evidence included the opposite. But vaccination does appear to reduce levels of harm caused by the virus including death . In December 2021, at a time when 59% of the UK population have had a booster injection, 23% of all admissions to hospital this week are of people who have been double vaccinated and boosted (three doses) [7]. As England’s Chief Medical Officer, Professor Sir Chris Whitty, said in  a government press briefing on 4th  January  2022, “It's absolutely heartbreaking that as many as 90% of those in intensive care with Covid have not had their booster, and over 60% of those in intensive care who have Covid have not had any vaccination at all. 'People are dying needlessly because they haven't had their jabs, they haven't had that booster.'. We should clearly conclude that with only 10% of the UK population unvaccinated,  vaccines really does  protect vulnerable people from  serious illness. Although  we cannot conclude that  vaccination stops people getting Covid or passing it on to  other (vulnerable) people.   

Natural  Immunity?

Many Health Care Workers do not want to get vaccinated because they know that they have had COVID and the evidence is that natural immunity is comparable to that from vaccination [e.g. 8]. Therefore, to get vaccinated on top of this would bring only medical risks, without significant private or public health benefits. Therefore,  some Health Care Workers argue that  there should be an exemption for HCWs with a documented history of infection and/or antibodies.

Consent is required

But the fundamental principle of consent is that an autonomous and capacitous individual may refuse treatment for any reason or no reason. We are legally entitled to make unwise decisions. I do not believe that the covid vaccines should be mandated. People need to be persuaded to accept a vaccine and that has been accepted by 90% of British People.

What about objection on conscientious grounds?

All currently available Covid 19 vaccinations have been produced and /or tested on cell lines obtained from unborn children who were aborted. These individuals had their life terminated and then their cells were used without consent (which  they  could not give) for medical experimentation. While the Church  has taught that  use of such  vaccines may  not be illicit [1,2]  these facts inform many people to make a sincere judgement in conscience that they cannot be complicit with any therapy that results from such a patently unjust act.

Others, whilst recognising the primary injustice (and mindful  of what  the Church has said [1,2]) feel that the degree of cooperation with this act is so remote that the proportionate amount of good that can be achieved by accepting the therapy allows the acceptance of a vaccine.

But that does all  mean that, for Catholics, objection on religious grounds is not really possible. The Church does not prohibit the use of those vaccines. However,  that  does not remove the possibility of conscientious objection. If,  after serious consideration,  a healthcare worker feels that  he/she cannot take a vaccine manufactured using a foetal  cell  line then that  should be an adequate reason for any  refusal  to  be respected. 

What can those who refuse vaccination do?

As set out above there is arrange of reasons why people may refuse vaccination. One is the ethics of using cell lines derived from aborted foetuses. Others are based within the science and the available safety data etc. But there is a very important point here. Consent and refusal is to be freely given after discussion and analysis of the benefits and risks of a procedure. And the patient does not have to say why they are refusing care. Confidentiality means that the reason for refusal is not automatically public. It does not appear, in this circumstance,  to be a requirement for an objection in conscience to be explicitly stated as such. It is enough to  object  for “any  or no reason”

Therefore, a carefully thought through refusal on whatever grounds ought to enable a medical exemption for that individual. But especially in the area of conscience, where rights and duties were so clearly protected in the Universal Declaration on Human Rights, there is a compelling need to respect the duties of conscience.

There is also  the need to  be willing to consider ways of mitigating risks of transmitting Covid to patients, including perhaps, daily lateral  flow tests, mask wearing,  preparedness to rapidly consider any future prophylactic therapies where there are no moral questions in terms of preparation or testing, as well  as any other reasonable intervention that the state/employer asks from those who object.


We have already seen staff losing their jobs in care homes as a result of mandatory vaccination. That has caused closure of homes and unnecessary deaths. I believe that mandatory vaccination is wrong headed and unjustified. The evidence does not support its efficacy.

All health workers have the human right to consent or not to consent to vaccination. As well  as being allowed to  refuse treatments for any or  reason, healthcare workers must  also  retain  the right to  refuse treatments on grounds of conscience. 

 Whilst both the vaccinated and unvaccinated can transmit covid to the vulnerable the risk of death or serious disease is substantially greater for the unvaccinated. If mandatory vaccination is enforced for healthcare workers, it will be for them to make their decision in the knowledge that they might well forfeit their prospect of employment.

Medical exemptions may help, but I doubt they will solve the challenges posed by a policy of mandatory vaccination. If mandatory vaccination is imposed in the wider NHS, then good staff will lose their jobs. Tragically, patients will then also die as a result.

Dr Adrian Treloar MB, BS, BSc, FRCP, MRCPsych, MRCGP  is a Consultant Old Age Psychiatrist.

Declaration of  interests He has had three doses of the Pfizer vaccine.  He was never offered the Astra-Zeneca vaccines although  (in line with US episcopal  advice [8]),  he had clear preference for  the Pfizer vaccine.


  1. Treloar A, 2021) So which vaccine should I take? Catholic Medical Quarterly Volume February 2021 71(1) p5-6.
  2. Treloar A, (2019) Measles Mumps and Rubella (MMR) Vaccines: The ethics and the need for an alternative vaccine Catholic Medical Quarterly Volume 69(3) August 2019
  3. Science Museum (April 2019) . Smallpox and the story of vaccination.
  4. UK HSA Immunisation against infectious disease (aka “The Green Book”)
  5. UK HSA Integrated guidance on health clearance of healthcare  workers and the management of healthcare workers living with bloodborne viruses (hepatitis B, hepatitis C and HIV.
  6. Singanayagam A et al (2021) Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study. Lancet Infectious Diseases Published: October 29, 2021DOI:
  7. Andrews Luke, Daily Mail 31 December 2021 Four-fifths of patients hospitalised with Omicron have NOT had a booster, data shows as health chiefs say third jab cuts risk of hospitalisation by 88% (and even TWO doses slash odds by over 70%)
  8. Kojima N, Klausner J (2021)Protective immunity after recovery from SARS-CoV-2 infection Lancet Infect Dis Published Online November 8, 2021  
  9. Catholic News Agency, December 14th  2021. Catholic US bishops approve use of COVID-19 vaccines with 'remote connection' to abortion.