Catholic Medical Quarterly Volume 72(2) May 2022

Correspondence

Dr Mark Coley the BMA Sessional Committee & GPC UK IT Policy Group Deputy Lead wrote to the General Medical Council about mandatory vaccination. Here is his letter and the GMC reply.

Letter to GMC

Dear Sir/Madam,

I've been following the debate in recent days with regard to the current Government policy on mandatory vaccinations for Covid- 19 for health care workers, due to come in in April 2022, particularly in regard to the stand off between Sajid Javid and Dr Steve James that was broadcast by Sky News. There are strong voices on either side of the debate. Having had Covid myself (and been hospitalised), I feel suitably qualified to comment.

One issue that has cropped up on social media has been Paragraph 29 of Good Medical Practice and how it should be interpreted: "You should be immunised against common serious communicable diseases (unless otherwise contraindicated)."

This really needs updating to reflect science and current practice within the NHS: "You should be immunised against (or be able to demonstrate immunity to) infection against common serious communicable diseases (unless otherwise contraindicated).

The existing phrase "(unless otherwise contraindicated)" attempts to allow flexibility but many contraindications are patient- specific. I had two Pfizer vaccines and was quite poorly after them, fevers for several days each time and quite bad headaches. I didn't want to have the vaccines as I had proven evidence of seroconversion a week after my hospital discharge, but vaccination was a necessary requirement to see family in Guernsey. I had written to their public health teams and their government but it was considered too much effort to enact a process whereby those who had recovered could be exempted from the need for a full vaccination course. France, and the EU, of note, allow prior recovery and a single vaccination to be considered as being fully vaccinated. It's plausible therefore, if following French guidance, a second dose in a previously recovered individual could be considered 'contraindicated'.

A further example. When I started work in the NHS as a Health Care Assistant in 2003 (after a PhD in physics and before applying to graduate-entry medicine), I was required to get the rubella jab as I would come in contact with pregnant women. This was available via the MMR or as a single dose rubella vaccine as there was still some stock left. I was concerned about having the MMR jab as I'd had mumps as a child and I wasn't sure what reaction might occur - MMR was not around in the 1970s. The NHS accepted evidence of recovery from mumps so a blood test was arranged which confirmed I had im-munoglobulins (IgGs) to mumps. A mumps vaccine was therefore not needed. It's not clear from these events whether I currently am working in accordance with Paragraph 29 of Good Medical Practice as I have not received a mumps vaccination. Yet I do not need one and medical science accepts that.

The same should be the case for Covid. There is an interesting article here from an immunologist at Cambridge, where I trained, where the author states "Importantly for humanity, past exposure still seems to protect against severe disease and death". See https://theconversation.com/omicron-may-not-bethe-final-variant-but-it-may-be-the-final-variant-of-concern-174094.

Could the GMC consider refining Paragraph 29 to include a statement on immunity? Or perhaps comment on whether a vaccination for an illness for which there is demonstrable immunity could be considered a 'contraindication'? If not able to comment specifically, could you offer an opinion on whether this is a decision that could be made between a patient and his or her General Practitioner?

I am a member of the British Medical Association's General Practice Committee and they are aware I am writing to you. I would be keen to share any response in due course.

Yours faithfully,
Dr Mark Coley GMC 7045856
BMA Sessional Committee & GPC UK IT Policy Group Deputy Lead.

The GMC replied as follows

Dear Dr Coley,

Thank you for writing to us. I understand you would like to know whether a patient who is a doctor can establish with their GP that prior im-munity to Covid-19 could be viewed as a con-traindication for Covid-19 vaccines. You also want to know whether we could amend paragraph 29 in our guidance on Good medical practice <https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice>(GMP), to include a statement on prior immunity. I have responded to each of your questions below.

I thought it would be helpful to set out how our guidance, including paragraph 29 of GMP, is designed to operate in practice. Our guidance is necessarily high- level, in order to apply to all doctors, at every stage of their training and in every specialty. We expect doctors to use their professional judgment to apply the provisions in the guidance to their specific circumstances and to be prepared to justify the decisions they have taken. This includes paragraph 29 in GMP.

We don’t provide clinical guidance and therefore can’t specify what vaccinations are required for individual doctors in their individual circumstances, and we also can’t specify whether prior immunity would constitute an acceptable ground for exemption for an individual doctor.

Where certain vaccinations may be required for occupational reasons, we understand this would generally be determined through discussions with occupational health colleagues, taking account of relevant clinical advice from public health bodies, national healthcare policies, as well as the doctor’s individual circumstances and nature of their practice.

For example, we are aware of public health requirements set out in the Green Book which indicate certain members of staff need to have a Hepatitis B vaccination in order to carry out particular procedures. In relation to Covid-19, the Government has taken the decision to introduce a legal requirement on employers that they only deploy vaccinated staff into patient facing roles in care homes and NHS settings in England. The GMC, as the statutory regulator for the medical profession in the UK, isn’t responsible for the design and implementation of Covid-19 or other national vaccination programmes.

It may be helpful to speak to someone in your organisation who is involved in planning and implementing the new regulations to understand what options may be available and their impact on your particular situation.

You have also asked whether we could amend paragraph 29 in GMP to include prior immunity. We are currently undertaking a review of Good Medical Practice and I will pass your feedback to the project team for consideration as part of the review. You may also find it helpful to sign up to our community of interest to be kept up to date with opportunities to participate in the review.

I hope this response is useful to you.