Covid vaccination: a background briefing

This long blog is a response to members who have asked about the basis for CSP views and comments on Covid vaccination.  

by Rob Yeldham

Because Covid is a new disease, research and analysis of real world data are ongoing. Learning is therefore evolving. Even more than with other areas of medical science, there is therefore a need to make a judgement based on the best information available and to trust virologists, immunologists and public health clinicians when they give opinions.

This briefing brings together information from multiple sources to explain our policy perspective on Covid vaccination. It is not a scientific review of evidence but uses readily available information to evidence four key CSP statements.

Covid is a deadly and serious disease

There is good evidence that Covid is a far more serious disease than existing endemic illnesses such as influenza. Death rates vary by age, race, class, impairment and other factors. But Covid can be deadly for anyone who contracts it. Meta-analysis suggests 1% of people who contracted Covid in wealthy countries in the first wave died. This makes Covid at least 20 times more deadly than influenza.

Although older people are most at risk, younger people also die from Covid. For example, Covid killed 101 people under 45 in England or Wales between March and June 2021.

Some reports suggest over 50 different longer term impacts from CovidOne UK study found 13.7% of people who develop Covid reported ongoing symptoms. Long Covid can have serious impacts on people and is not directly related to the severity of their original infection. It is not yet known how long symptoms may last, but the CSP is aware of cases where previously healthy members have had to give up work due to ongoing post Covid illness.

Covid vaccination protects the vaccinated person

All the studies we have seen confirm that Covid vaccination significantly reduces the chances of serious illness or death at both an individual level and population level. The evidence comes from multiple countries and multiple sources and include independent peer reviewed work.

Analysis of real world data from Israel, which was an early adopter of mass vaccination, confirmed that vaccinations prevent infections, hospitalisations, severe disease and deaths.  Scottish research published in the New England Journal of Medicine found that vaccination was 90% effective in preventing death.

Analysis of the correlation between vaccination rates and Covid death rates globally indicates that the more of the population who are vaccinated the lower the death rate is from Covid.

Research in the UK suggests that vaccination may also help reduce the chance of getting Long Covid. 

Covid vaccination is safe 

The independent Joint Committee on Vaccination and Immunisation is that almost all people can safely be vaccinated. They have said that the higher risk of serious consequences from Covid for those for very many long term health conditions means they are a higher priority for vaccinations. 

We recognise that a small minority of members may not accept the JCVI are fully independent, although the CSP does believe that their advice is independent and scientifically based. 

Side effects

All vaccinations and medications have some potential side effects, but significant illness or death from vaccinations are incredibly rare. This is true of the current Covid vaccinations. Minor, temporary, side effects are common. UK research suggests over half of people have minor side effects. Studies amongst European healthcare workers have found that common side effects include; localised pain at the injection point, tiredness, headaches and muscle pain. This is in line with manufacturer advice on side effects. This is short term, although possible slightly longer lasting in some cases than estimated by manufacturers. (The relevant studies can be found here and here). 

Allergic reactions 

Covid vaccination is not advised for those who are allergic to the available vaccines or who have had an adverse reaction to the first dose (for example, myocarditis). UK screening process specifically ask people about their allergy status. The risk is one of the reasons vaccinations are supervised by clinicians and some patients have to wait after being vaccinated.

Long term conditions 

The impact of vaccines on existing health conditions is, we know, a concern for some people. Advice is available from a range of condition, patients or professional organisations, all of whom recommend vaccination:

Pregnancy and fertility

Pregnant women are more at risk from Covid, so vaccination is advised for pregnant women and women planning a pregnancy by midwives. 

Over 200,000 pregnant women in the UK and USA have been vaccinated with no adverse reactions for them or their babies according to the Royal College of Midwives. However, pregnant women can choose to opt for a medical exemption. 

There is no evidence of fertility being compromised by Covid vaccination.

Death post-vaccination 

In June 2021 there were reports of blood clots and unusual bleeding in 1 in 100,000 recipients of the AstraZeneca vaccination. Some of the people affected suffered life changing effects and some died. This seemed to have been more common in younger people. For this reason younger people are no longer offered this vaccine. Research is ongoing in this area. 

There have also been media reports of deaths amongst some older people who have recently been immunised. But dying soon after being vaccinated is not itself evidence that vaccines present a risk. Many such deaths relate to vulnerable people for whom there is a higher incidence of deaths. (The relevant research related to this can be found here and also here). 

The relative risk of dying from Covid is greater than the risk of dying from a side effect of vaccination.

Does Covid vaccination prevent transmission? 

There is some evidence that Covid vaccination may reduce transmission in a household context, although the evidence is not so clear for newer variants.  Newer variants seem to be more transmissible and a recent study of the Delta variant in UK families suggests little difference between infection rates where transmission was from vaccinated or unvaccinated index cases.  

We are not aware of any studies of transmission rates in UK health contexts. We have asked the authorities for any evidence they have so that we can consider any evidence. To date we have been offered none.  What is clear is that vaccination, even if it can reduce transmissibility for some variants and in some contexts, vaccination alone does not prevent a significant risk of transmission by vaccinated individuals.

We have therefore concluded that relying on vaccination to protect vulnerable patients and staff is not likely to be effective. The focus on staff being vaccinated could lead to a false sense of security.  The continued use of infection control measures including PPE, distancing, hygiene and regular testing are all needed. 

CSP policy 

The CSP supports Covid vaccination as an effective and safe public health intervention. We recommend vaccination to our members on the basis it is safe and effective and can protect them from death or debilitating illness due to Covid.

The CSP oppose compulsory vaccination as a matter of principle. Compulsion undermines trust in public health advice, breaches medical ethics and is frequently discriminatory. Given that vaccination alone can’t prevent transmission, and other methods are needed to protect the vulnerable, there is no basis to argue that the fundamental objections to compulsory vaccination should be set aside to protect those most at risk. 

Whilst the CSP and other health professional bodies and unions argued against mandatory vaccination for healthcare workers in England. However, Parliament voted to make vaccination a condition of working in most English NHS and social care contexts. There are limited exceptions and exclusions. There seems no realistic prospect of overturning this through lobbying or legal action in the near future.

Advice for members who do not want to be vaccinated

We are advising members in England who have concerns about vaccination to reconsider their position and seek advice on any specific concerns you may have. 

Unfortunately there are only limited options for members in England who choose not to be vaccinated once the new rules come into force.  Dismissal of some staff who decline vaccination and who are not exempt is a real possibility. In almost all cases there is no legal challenge possible as employers will be acting under a legal duty, rather than of their own volition.

Some people who can’t be vaccinated for medical reasons may be prioritised for redeployment by their employers. Redeployment will need to be to roles which do not involve face to face patient contact. Redeployment for people who do not have an exemption may be more difficult. 

The main options for anyone who decides not to be vaccinated are:

  • Seek NHS employment outside England. Scotland and Wales are not planning to require vaccinations. Northern Ireland is considering a requirement for new staff.
  • Seek employment in England in one of the areas of physiotherapy not covered by the new rules because they are not CQC regulated eg some occupational health services.
  • Become self-employed as stand-alone physio services are usually exempt from CQC registration.

The CSP's Covid-19 vaccine information can be found here

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