Good news. Edward Jenner’s rustic thatched hut in his Gloucestershire garden where he conducted his first smallpox vaccination in 1796 has just been saved by English Heritage. Here Jenner gave free vaccinations every week to local people. Here he became the single human being to save more lives than any other person who has ever lived.
This triumph of the age of enlightenment, at a time when a third of children died before adulthood, is too easily forgotten. But enlightenment itself has been in retreat, with Robert F Kennedy Jr, Donald Trump’s health secretary, leading the vanguard of unreason, dismantling vaccination programmes and stirring vaccine conspiracy and paranoia around the world. His infectious messaging has contributed to falling vaccination rates in rich as well as poor countries. Here’s hoping this week is the end of that Trumpian rolling back of reason.
What would Jenner think now as the winter flu season approaches? Last year fewer than half of frontline NHS staff in England were vaccinated, with only one in 10 trusts reaching the (very low) NHS target of 60% protected against flu. Healthcare workers have a high risk of catching flu, spreading it to vulnerable people and to their own families, and taking sick days when they are most needed. These people are trained in science, steeped in evidence of the extraordinary value of vaccines, and yet many are reluctant. Doctors were the staff group that scored the highest, but still only half of them got vaccinated – half! – instead of influencing the public towards protection.
Overall, healthcare workers in GP practices were the most likely to take up the vaccine, with 53.5% covered: they have most access, and are likely to be prodded by colleagues. But even so, that’s disgracefully low for people with signs on their noticeboards urging patients to get the jab (free for NHS and care staff, under-16s, over-65s and vulnerable people). Official figures show an astonishing difference between the best and worst NHS trusts, from the highest at 77.2% to the lowest at 0.6%.
Why so few? The reasons, finds the National Institute for Health and Care Research, are complex. The easiest to solve are practical obstacles – for example, badly timed clinics not matching work on the wards, instead of anytime drop-in sessions. But deeper reasons suggest staff lack the motivation or are suspicious of employers, with some “feeling like the organisation does not care”, finds the NIHC.
Some don’t think flu is serious, others that vaccines don’t work, or that protective equipment and hand gels will do. Some don’t trust vaccine safety information, while others fear secret side-effects and distrust pharmaceutical companies.
Ethnic minority staff are more likely to be vaccine hesitant out of general mistrust of institutions they feel are not on their side. But, as compilers of the latest NHS guidance stress to me, the variation in rates of vaccination is miles wider than the smaller disparities in ethnic makeup or social differences in staff: that can’t account for that yawning 77.2% to 0.6% gap.
Something happened during the pandemic that stopped NHS staff getting vaccinated. Despite the heroic risks they took then, Covid has left a strong residue of mistrust, alongside a poisonous stream of anti-vaccine misinformation on social media. Meanwhile, the anti-science right keeps stirring suspicion of anything the state recommends. Before Covid, 74% of NHS staff took the flu vaccine, but now the official target has fallen to just 60%, though the NHS constitution commits to a 100% offer of the jab to eligible groups.
The mystery is why NHS staff, most of whom are dedicated to their patients, don’t do the right thing of their own accord. As a matter of patient safety, vaccination should be a compulsory condition of NHS service (excluding those who cannot be vaccinated for medical reasons). Anyone working with children needs a DBS check, drivers need licences, doctors and nurses need qualifications. Compulsion was ordered in late 2021 as some staff refused the Covid vaccine mid-pandemic, but it was rescinded almost immediately when surveys suggested 80,000 people might lose their roles. No one dared test if that would really happen, when losing so many staff would do more damage to patients than the risk of infection.
What would work? The NHS coordinator I spoke to said that trusts with high staff vaccinations encourage close colleagues to act as persuaders and explainers, convincing all but a few adamants. You wonder about the working culture of hospitals with very low rates and disaffected staff.
The NHS has 1.55 million staff, reaching deep into every community. They should be vaccine advocates at a time when fewer children under five are getting their full routine jabs – down again this year, failing the World Health Organization’s 95% threshold for herd immunity.
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The next flu pandemic is a matter of “when, not if”, says the WHO. For national herd immunity, we need compulsory vaccination as a civic duty, along with compulsory voting and paying your taxes. Flu vaccines last winter prevented about 100,000 hospitalisations, but in a bad flu wave an average of 2,660 patients a week will occupy a hospital bed. But fearful politicians think that this is a price worth paying rather than face down libertarian anti-vaxxers.
What would Jenner think of today’s NHS staff? This smallpox saviour faced fierce opposition but his work was later championed by the pro-science Prince Albert, who erected a statue in his memory in Trafalgar Square, amid demonstrations by anti-vaxxers and the military who regarded those plinths as theirs. Within a year of Albert’s death in 1861, they shunted Jenner off to a remote spot in Kensington Gardens and erected on his plinth Maj Gen Sir Henry Havelock, who died of dysentery at the siege of Lucknow while putting down an Indian rebellion.
Time, I think, for a national vaccination day, in keeping with our current life-sciences success. Jenner should be brought back from exile in a triumphal carriage to his plinth and Sir Henry – well, anyone who wants him can have him.
